Camrelizumab may be safe and effective in the management of locally advanced esophageal squamous cell carcinoma

1. Neoadjuvant immunoradiotherapy with camrelizumab and radiotherapy demonstrated favourable pathologic tumour regression and safety in the management of resectable locally advanced esophageal squamous cell carcinoma (ESCC).

Evidence Rating Level: 2 (Good)

Standard treatment for locally advanced ESCC involves neoadjuvant chemoradiotherapy followed by surgery. However, distant metastasis remains common, and chemotherapy can result in substantial toxicity. Camrelizumab, a humanized anti-programmed cell death protein 1 (PD-1) monoclonal antibody, in combination with chemotherapy, has been studied in ESCC management. This improved pathological complete response rates but led to high-grade toxicities. It has been shown that immunotherapy combined with radiotherapy leads to synergistic effects. This approach has been studied in other cancers, but evidence in ESCC remains limited. This single-arm, phase II trial included patients aged 18-75 years with histologically confirmed ESCC. 25 patients (mean [SD] age, 62.2 [6.9] years; 20% female) received nIRT with camrelizumab and radiotherapy. Camrelizumab 200 mg was administered intravenously on day 1 of each of two 21-day cycles. Neoadjuvant radiotherapy was delivered 5 days per week using intensity-modulated radiotherapy (IMRT). Patients who showed no disease progression or new metastases underwent esophagectomy 4-8 weeks following nIRT. Three patients did not undergo surgery (one radiographic complete response with refusal of surgery, one disease progression, and one withdrawal). Major pathologic response and pathologic complete response occurred in 12 of 22 patients (54.5%) and 8 of 22 patients (36.4%), respectively. No grade 3 or higher treatment-related adverse events were observed. The most common side effects were radiation esophagitis (36% patients) and transient leukopenia (28% patients). At a median follow-up of 36 months, 5 patients experienced recurrence. Overall, camrelizumab demonstrated good tolerance, low toxicity, and favourable pathologic tumour regression.

Click here to read the study in BMC Medicine

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