Neoadjuvant nimotuzumab plus chemoradiotherapy compared to neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy for locally advanced esophageal squamous cell carcinoma

Abstract

Neoadjuvant therapy improves long-term locoregional control and overall survival after surgical resection for esophageal cancer, and neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT) are commonly used in clinical practice. Nimotuzumab is a humanized monoclonal antibody against epidermal growth factor receptor (EGFR), the efficacy of nimotuzumab added to nCRT for esophageal cancer is uncertain. We conducted this retrospective study in which combining neoadjuvant treatment of nimotuzumab with chemoradiotherapy (NimonCRT) is compared with nCRT and nCT for patients with potentially resectable locally advanced esophageal squamous cell carcinoma. One hundred ninety-five patients received neoadjuvant therapy and 172 (88.2%) underwent esophagectomy. Surgical resection was performed in 94.4% after Nimo-nCRT, versus 92.5% after nCRT and 83.5% after nCT (P = 0.026). The R0 resection rate was 100% after Nimo-nCRT, 95.9% after nCRT and 92.6% after nCT (P = 0.030). Pathological complete response (pCR) was achieved in 41.2% after Nimo-nCRT, versus 32.4% after nCRT and 14.8% after nCT (P = 0.0001). Lymph-node metastases were observed in 29.4% in the Nimo-nCRT group, versus 21.6% in the nCRT group and 35.8% in the nCT group (P = 0.093). More patients in the Nimo-nCRT and nCRT group developed grade 3 esophagitis compared to those in the nCT group, P = 0.008. There was no difference in surgical complications between the treatment groups. nCRT results in improved R0 resection, higher pCR rate, and a lower frequency of lymph node metastases compared to nCT, adding nimotuzumab to nCRT is safe and appears to facilitate complete resection and increase the pCR rate.

Neoadjuvant therapy for non-small cell lung cancer and esophageal cancer

“…However, several studies on the combination of neoadjuvant radiotherapy/chemotherapy with cetuximab have shown disappointing results, with no significant improvement in pCR rate, increased toxicity, and no clear survival benefit compared to neoadjuvant radiotherapy alone [69,70]. In contrast, the results of studies on the combination of neoadjuvant radio-chemotherapy with nimotuzumab seem more promising, and the use of nimotuzumab in combination with radio-chemotherapy improved R0 resection rate, pCR rate, and disease control rate (DCR), without significant increase in toxicity [71,72]. In addition, some studies have shown that for some esophageal adenocarcinoma patients with positive HER-2 expression, the use of trastuzumab, a HER-2 targeted therapy drug, in combination with radio-chemotherapy improved the pCR rate and R0 resection rate [73,74].…”

Recent Progress in the Neoadjuvant Treatment Strategy for Locally Advanced Esophageal Cancer

“…The results showed that the addition of monoclonal antibodies was safe, the R0 resection rate reached 100%, and the pCR rate reached 41.2%. Compared with nCRT and nCT alone, the R0 resection and pCR rate, respectively, increased by 4.1% and 7.4%, and 8.8% and 26.4% [91]. In another phase I study, Qi et al [92] concluded that nimo combined with nCT (paclitaxel/carboplatin + 41.4Gy RT) had a favorable anti-cancer effect in locally resectable advanced EC with tolerable toxicities.…”

PD-1 Inhibitor Plus Chemotherapy Versus Chemotherapy as First-line Treatment for Advanced Esophageal Cancer: A Systematic Review and Meta-Analysis

“…6 A large number of studies are being conducted to explore new treatment modalities to improve the survival of patients with EC. 7,8 In recent years, immunotherapy has continuously made new breakthroughs in the treatment of various tumor types. 9,10 Immune checkpoint inhibitors have been used in a large number of clinical studies on EC and have achieved certain results.…”

“… 6 A large number of studies are being conducted to explore new treatment modalities to improve the survival of patients with EC. 7 , 8 …”

“…Although the application of surgery, radiotherapy, chemotherapy, and targeted therapy in the comprehensive treatment of cancer is constantly updated, the 5-year survival rate of EC is still low worldwide, at ~30%–40% 6. A large number of studies are being conducted to explore new treatment modalities to improve the survival of patients with EC 7,8…”