Does Induction Immunotherapy Benefit Patients With Advanced Esophageal Cancer?

The current standard nonoperative treatment for locally advanced esophageal cancer is concurrent chemoradiotherapy.

A phase 2 trial conducted by Kuaile Zhao, MD, and colleagues sought to determine if a treatment regimen of PD-1 inhibitors and chemoradiotherapy has the potential to benefit esophageal tumor vascular normalization, alleviate hypoxia, enhance radiosensitivity, and improve local control.

The study was published in eClinicalMedicine.

Dr. Zhao and colleagues observed that local recurrence in patients with esophageal cancer is the primary reason for more than half of treatment failures and that the sensitivity of radiotherapy is lacking.

The multicenter, single-arm trial included 75 patients with locally advanced esophageal cancer who received 2 cycles of sintilimab, paclitaxel, and carboplatin once every 21 days. While in the concurrent phase, patients received 5 cycles of carboplatin and paclitaxel once per week with radiotherapy of 50.4 Gy delivered in 28 fractions.

Researchers evaluated hypoxia and vessel normalization using immunofluorescence and perfusion computed tomography (CT) prior to and following the induction phase. The study’s primary end point was the 2-year local control rate.

Of the 75 patients who received treatment between October 2019 and April 2021, the median follow-up of surviving patients was 33.6 months. The 2-year local control rate was 81.7% (95% CI, 72.7-90.7), which was a significant increase from previous studies investigating concurrent chemoradiation (71.3%).

Investigators noted that vascular normalization and hypoxia alleviation were both found in biopsy specimens and perfusion CT.

Dr. Zhao and colleagues observed that induction immunotherapy plus concurrent chemoradiotherapy may be a viable option for improving radiosensitivity as a nonsurgical treatment option for patients with locally advanced esophageal cancer. They also remarked that the therapy combination increased the local control rate by improving vascular normalization and alleviating hypoxia.

“Our findings suggest that induction immunotherapy followed by concurrent chemoradiotherapy could be a potential option in future treatment,” researchers stated.