Comparison of efficacy and safety between pembrolizumab combined with chemotherapy and simple chemotherapy in neoadjuvant therapy for esophageal squamous cell carcinoma

Huang, Bingjiang; Shi, Haiyan; Gong, Xiaomeng; Yu, Jing; Chen, Xiao; Zhou, Bin; Liang, Zhongxing; Li, Xiaojian

doi:10.21037/jgo-21-610

Cited by 30 publications

(37 citation statements)

References 39 publications

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“…Of the 21 studies included, there were 20 single-arm open-label cohort studies ( 15 , 19 – 37 ) and there was one two-arm open-label randomized controlled trial (RCT) ( 38 ). Of the 21 studies included, three are still ongoing ( 26 , 29 , 30 ) and 18 ( 15 , 19 – 25 , 27 , 28 , 31 – 38 ) have been completed. The main neoadjuvant immunotherapy drugs include pembrolizumab, sintilimab, and camrelizumab, amongst others.…”

Section: Resultsmentioning

confidence: 99%

“…In the 21 qualifying experiments, the average PCR amounted to 28.3%. Individual ORs in each eligible study supported neoadjuvant immunotherapy in combination with chemotherapy (individual OR < 1.0) ( 15 , 19 – 38 ). The combined OR was 0.29 (95% CI, 0.25–0.32), a statistically significant difference ( p < 0.001) that overall favored neoadjuvant immunotherapy in combination with chemotherapy.…”

Section: Resultsmentioning

confidence: 99%

“…To understand the possible correlation between the type of ICI and the outcome of neoadjuvant immunotherapy in combination with chemotherapy, we performed subgroup analysis. The 21 selected studies included two studies in which patients were treated with pembrolizumab ( 36 , 38 ), four studies in which patients were treated with sintilimab ( 27 , 32 , 33 , 37 ), four studies in which patients were treated with toripalimab ( 20 , 25 , 26 , 34 ), and nine studies in which patients were treated with Carlizumab ( 19 , 21 – 23 , 28 – 31 , 35 ).The potential correlation between ICI type and the efficacy and safety of neoadjuvant immunotherapy in combination with chemotherapy has not seen significant findings, implying that ICI type does not currently predominate in neoadjuvant immunotherapy ( Figure 12 ).…”

Section: Resultsmentioning

confidence: 99%

“…In the end, 21 studies, which included 759 patients, were used for the analysis. Of the 21 studies included, there were 20 single-arm open-label cohort studies (15,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) and there was one two-arm open-label randomized controlled trial (RCT) (38). Of the 21 studies included, three are still ongoing (26,29,30) and 18 (15, 19-25, 27, 28, 31-38) have been completed.…”

Section: Results Of Searchmentioning

confidence: 99%

“…A total of 759 patients were enrolled in the study, 38 (24) of whom received one cycle of neoadjuvant immunotherapy combined with chemotherapy, the remaining patients received two to four cycles of neoadjuvant immunotherapy combined with chemotherapy, 677 patients underwent follow-up surgery, and 18 (26,29,30) patients awaited surgery. R0 resection was achieved by 664 (15,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) patients. Further details of the patient characteristics are summarized in Supplementary Table The definition of MPR is less than 10% of the remaining viable tumor cells in the resected primary tumor.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Efficacy and safety of neoadjuvant immunotherapy combined with chemotherapy in locally advanced esophageal cancer: A meta-analysis

et al. 2022

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ObjectiveThe progress of neoadjuvant therapy for resectable locally advanced esophageal cancer has been stagnant. There has been much progress in immunotherapy for advanced esophageal cancer, but the efficacy and safety of neoadjuvant immunotherapy for resectable locally advanced esophageal cancer have not yet been definitively demonstrated.MethodsOriginal articles describing the safety and efficacy of neoadjuvant immunotherapy in resectable locally advanced esophagus published until July 2022 were retrieved from PubMed, Embase, and the Cochrane Library. The ratio (OR) and 95% confidence interval (CI) were calculated to conduct heterogeneity and subgroup analysis.ResultsIn total, 759 patients from 21 studies were enrolled. The effectiveness of neoadjuvant immunotherapy in combination with chemotherapy was evaluated using the major pathologic response (MPR) and pathologic complete response (PCR). In the enrolled patients, 677 were treated surgically and 664 achieved R0 resection. Major pathological remission was achieved in 52.0% (95% CI: 0.44–0.57) of patients on neoadjuvant immunotherapy combined with chemotherapy and complete pathological remission in 29.5% (95% CI: 0.25–0.32) of patients. The safety was primarily assessed by the incidence of treatment-related adverse events (TRAEs) and surgical resection rates. The incidence of TRAEs and the surgical resection rate combined ORs were 0.15 (95% CI: 0.09–0.22) and 0.86 (95% CI: 0.83–0.89), respectively.ConclusionNeoadjuvant immunotherapy combined with chemotherapy in locally advanced resectable esophageal cancer is effective and safe.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Results Of Searchmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

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Efficacy and safety of neoadjuvant immunotherapy combined with chemotherapy in locally advanced esophageal cancer: A meta-analysis

et al. 2022

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Evaluation of Clinical and Safety Outcomes of Neoadjuvant Immunotherapy Combined With Chemotherapy for Patients With Resectable Esophageal Cancer

Huo

et al. 2022

JAMA Netw Open

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ImportanceA considerable number of clinical trials of neoadjuvant immunotherapy for patients with resectable esophageal cancer are emerging. However, systematic evaluations of these studies are lacking.ObjectiveTo provide state-of-the-art evidence and normative theoretical support for neoadjuvant immunotherapy for locally advanced resectable esophageal cancer.Data SourcesPubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for relevant original articles and conference proceedings that were published in English through April 1, 2022.Study SelectionPublished phase 2 or 3 clinical trials that included patients with resectable stage I to IV esophageal cancer who received immune checkpoint inhibitors (ICIs) before surgery as monotherapy or in combination with other therapies.Data Extraction and SynthesisThe Preferred Reporting Items for Systematic Reviews and Meta-analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines for meta-analysis were followed to extract data. A random-effects model was adopted if the heterogeneity was significant (I2 statistic &gt;50%); otherwise, the common-effects model was used. Data analyses were conducted from April 2 to 8, 2022.Main Outcomes and MeasuresPathological complete response (pCR) rate and major pathological response (MPR) rate were considered to be the primary outcomes calculated for the clinical outcomes of neoadjuvant immunotherapy. Incidence of treatment-related severe adverse events was set as the major measure for the safety outcome. The rate of R0 surgical resection was summarized. Subgroup analyses were conducted according to histologic subtype and ICI types.ResultsA total of 27 clinical trials with 815 patients were included. Pooled rates were 31.4% (95% CI, 27.6%-35.3%) for pCR and 48.9% (95% CI, 42.0-55.9%) for MCR in patients with esophageal cancer. In terms of safety, the pooled incidence of treatment-related severe adverse events was 26.9% (95% CI, 16.7%-38.3%). Most patients achieved R0 surgical resection (98.6%; 95% CI, 97.1%-99.6%). Regarding histologic subtypes, the pooled pCR rates were 32.4% (95% CI, 28.2%-36.8%) in esophageal squamous cell carcinoma and 25.2% (95% CI, 16.3%-35.1%) in esophageal adenocarcinoma. The pooled MPR rate was 49.4% (95% CI, 42.1%-56.7%) in esophageal squamous cell carcinoma.Conclusions and RelevanceThis study found that neoadjuvant immunotherapy with chemotherapy had promising clinical and safety outcomes for patients with resectable esophageal cancer. Randomized clinical trials with long-term follow-up are warranted to validate the findings and benefits of ICIs.

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Multi-omics analysis uncovers tumor ecosystem dynamics during neoadjuvant toripalimab plus nab-paclitaxel and S-1 for esophageal squamous cell carcinoma: a single-center, open-label, single-arm phase 2 trial

Zhang¹,

Yuan²,

Pan³

et al. 2023

eBioMedicine

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Comparison of efficacy and safety between pembrolizumab combined with chemotherapy and simple chemotherapy in neoadjuvant therapy for esophageal squamous cell carcinoma

Cited by 30 publications

References 39 publications

Efficacy and safety of neoadjuvant immunotherapy combined with chemotherapy in locally advanced esophageal cancer: A meta-analysis

Efficacy and safety of neoadjuvant immunotherapy combined with chemotherapy in locally advanced esophageal cancer: A meta-analysis

Evaluation of Clinical and Safety Outcomes of Neoadjuvant Immunotherapy Combined With Chemotherapy for Patients With Resectable Esophageal Cancer

Multi-omics analysis uncovers tumor ecosystem dynamics during neoadjuvant toripalimab plus nab-paclitaxel and S-1 for esophageal squamous cell carcinoma: a single-center, open-label, single-arm phase 2 trial

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