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Yang X, Wang X, Xiao Q, Ge X, Yu N, Li J, Feng G, Zheng Z, Jiang Y, Lu L, Xia X, Deng L, Zhang T, Wang W, Liu W, Wang J, Xiao Z, Zhou Z, Bi N, Wang H, Chen C, Wang X. Definitive chemoradiotherapy combined with anti-PD-1 immunotherapy for inoperable esophageal squamous cell carcinoma: a multicenter real-world study. Cancer Biol Ther 2025; 26:2504726. [PMID: 40367097 PMCID: PMC12080274 DOI: 10.1080/15384047.2025.2504726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 04/18/2025] [Accepted: 04/28/2025] [Indexed: 05/16/2025] Open
Abstract
TRIAL REGISTRATION Trial no. NCT04821778 registered in ClinicalTrials.gov.
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Affiliation(s)
- Xiongtao Yang
- Department of Oncology, Beijing Changping Hospital, Beijing, China
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaomin Wang
- Department 1st of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Qin Xiao
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Xiaolin Ge
- Department of Radiation Oncology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Nuo Yu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiao Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guojie Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziyu Zheng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingying Jiang
- Department of Oncology, Province Geriatric Hospital, Nanjing, Jiangsu, China
| | - Lin Lu
- Department of Radiotherapy, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaojie Xia
- Department of Radiation Oncology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenqing Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Wang
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Cheng Chen
- Department of Radiotherapy, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lee CK, Park S, Lee Y, Yun C, Hong M, Nam CM, Chung HC, Rha SY. Efficacy of the first-line immune checkpoint inhibitor plus chemotherapy for gastroesophageal cancer: A meta-analysis of phase III trials including unreported PD-L1 subgroups. Cancer Lett 2025; 623:217718. [PMID: 40239914 DOI: 10.1016/j.canlet.2025.217718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 03/03/2025] [Accepted: 04/12/2025] [Indexed: 04/18/2025]
Abstract
The treatment paradigm for gastroesophageal cancers is evolving with immune checkpoint inhibitors (ICIs) as first-line therapy, making it crucial to understand their efficacy across patient subgroups, especially concerning PD-L1 expression. We performed a meta-analysis of Phase III randomized controlled trials targeting the effectiveness of ICIs with or without chemotherapy for advanced/metastatic HER2-negative gastroesophageal adenocarcinoma (GEA) or esophageal squamous cell carcinoma (ESCC). Kaplan-Meier (KM) curves of all-comer populations and subgroups according to reported PD-L1 cut-offs were extracted from published reports. Using KMSubtraction algorithm, unreported PD-L1 subgroup survival data were reconstructed by utilizing published KM survival curves. Thirteen first-line phase III RCTs involving 11,795 patients with GEA or ESCC were included. For GEA, ICI with or without chemotherapy showed longer OS in patients with PD-L1 combined positive score ≥1 (HR 0.77, 95 % confidence intervals [CI] 0.71-0.83 for ICI plus chemotherapy; HR 0.86, 95 %CI 0.75-1.01 for ICI alone) compared to chemotherapy alone, showing less benefits in low PD-L1 subgroups. ICI, with or without chemotherapy displayed survival benefits among PD-L1 tumor proportion score ≥1 % for ESCC (HR 0.62, 95 %CI 0.52-0.74 for ICI plus chemotherapy; HR 0.67, 95 %CI 0.54-0.84 for ICI alone) compared to chemotherapy alone. ICI combinations were similarly beneficial for Asian and global patients with GEA or ESCC. In conclusion, this meta-analysis, which includes unreported PD-L1 subgroups show benefit of ICIs with or without chemotherapy as a first-line treatment for advanced gastroesophageal cancers, particularly among patients with high PD-L1 expression.
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Affiliation(s)
- Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Song-dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Sejung Park
- Song-dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Yaeji Lee
- Department of Biostatistics and Computing, Yonsei University College of Medicine, Seoul, South Korea
| | - Choa Yun
- Department of Biostatistics and Computing, Yonsei University College of Medicine, Seoul, South Korea
| | - Moonki Hong
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Chung Mo Nam
- Department of Biostatistics and Computing, Yonsei University College of Medicine, Seoul, South Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Cheol Chung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Song-dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Song-dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea.
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Massaro G, Paulet A, Lavacchi D, Brugia M, Rossini D, Giommoni E, Catalano M, Pillozzi S, Antonuzzo L, Roviello G. Immune checkpoint inhibitors in the first-line treatment of esophageal squamous cell carcinoma: Minireview for a big shift. World J Gastrointest Oncol 2025; 17:106707. [DOI: 10.4251/wjgo.v17.i6.106707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2025] [Revised: 04/09/2025] [Accepted: 04/23/2025] [Indexed: 06/13/2025] Open
Abstract
Esophageal cancer is an aggressive malignancy often diagnosed at advanced stages, with esophageal squamous cell carcinoma being the predominant subtype worldwide. Standard first-line chemotherapy provides limited survival benefits, with a median overall survival of less than 1 year. Recent advancements in immunotherapy, particularly immune checkpoint inhibitors (ICIs), have transformed the treatment landscape, improving overall survival and progression-free survival. However, response rates remain variable, with programmed death ligand 1 (PD-L1) expression being the primary predictive biomarker. The variability in PD-L1 testing methods and immune microenvironment alterations after prior treatments complicate patient selection for ICIs. Several phase 3 trials, including KEYNOTE-590 and CheckMate 648, have demonstrated the efficacy of ICIs combined with chemotherapy, particularly in patients positive for PD-L1. Despite these advances, long-term survival remains low, emphasizing the need for better biomarkers and novel therapeutic strategies. This review explored current first-line treatment options for esophageal squamous cell carcinoma, challenges in biomarker-based patient selection, and emerging therapeutic approaches.
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Affiliation(s)
- Giulia Massaro
- School of Human Health Sciences, University of Florence, Florence 50134, Tuscany, Italy
| | - Alexandra Paulet
- School of Human Health Sciences, University of Florence, Florence 50134, Tuscany, Italy
| | - Daniele Lavacchi
- Oncology Unit, Careggi University Hospital, Florence 50134, Tuscany, Italy
| | - Marco Brugia
- Oncology Unit, Azienda Universitaria Ospedaliera Careggi, Florence 50134, Tuscany, Italy
| | - Daniele Rossini
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Tuscany, Italy
| | - Elisa Giommoni
- Oncology Unit, Azienda Universitaria Ospedaliera Careggi, Florence 50134, Tuscany, Italy
| | - Martina Catalano
- Department of Health Sciences, University of Florence, Florence 50134, Tuscany, Italy
| | - Serena Pillozzi
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Tuscany, Italy
| | - Lorenzo Antonuzzo
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Tuscany, Italy
| | - Giandomenico Roviello
- Department of Health Sciences, University of Florence, Florence 50134, Tuscany, Italy
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Yu B, Qi C, Liu Z, Ma N, Tian C, Wang Y, Li C, Li Z. Spatial heterogeneity of PD-L1 expression influence its assessment in esophageal squamous cell carcinoma. Transl Oncol 2025; 59:102442. [PMID: 40513524 DOI: 10.1016/j.tranon.2025.102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2025] [Revised: 05/20/2025] [Accepted: 06/05/2025] [Indexed: 06/16/2025] Open
Abstract
Immune checkpoint inhibitors are a promising treatment for esophageal squamous cell carcinoma (ESCC). However, the predictive value of programmed death-ligand 1 (PD-L1) expression, the most common biomarker for immunotherapy, remains controversial, particularly in the neoadjuvant setting. We hypothesized that the spatial heterogeneous of PD-L1 expression within tumors might render limited biopsy samples unrepresentative of the bulk tumor. In this study, we assessed the spatial heterogeneity in PD-L1 expression within ESCC by sampling four distinct regions using endoscopic biopsy forceps and the largest longitudinal sections on complete resected tumor from treatment-naïve patients. Our findings demonstrated the insufficiency of using limited biopsy tumor tissue to accurately determine the combined positive score (CPS) within the tumor. Notably, spatial heterogeneity was reduced when tumor's CPS was sufficiently high. Multi-region sampling assessment revealed that the maximum CPS derived from three regions provided a more accurate approximation of the bulk tumor's PD-L1 status. Additionally, the densities of CD8+/CD4+T cells were positively correlated with CPS. These findings emphasize the clinical need for standardized and modified biopsy assessment strategies to improve the accuracy of PD-L1 evaluation, thereby guiding therapeutic decision-making in ESCC.
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Affiliation(s)
- Boyao Yu
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Cong Qi
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Ning Ma
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Chenyang Tian
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yikang Wang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Chunguang Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
| | - Zhigang Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
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Saeed SH, Sinnamon AJ, Fontaine JP, Mehta RJ, Baldonado JJ, Pena LR, Pereira AAL, Hoffe SE, Frakes JM, Pimiento JM. Survival after Esophagectomy for Metastatic Esophageal Cancer: Should the Role of Surgery be Reconsidered? J Gastrointest Surg 2025:102118. [PMID: 40513811 DOI: 10.1016/j.gassur.2025.102118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 04/14/2025] [Accepted: 06/07/2025] [Indexed: 06/16/2025]
Abstract
INTRODUCTION Standard treatment for stage IV esophageal cancer (EC) is systemic therapy, with surgery to the primary tumor considered contraindicated. This study seeks to assess the impact of surgical resection on outcomes for metastatic esophageal cancer patients. METHODS We reviewed our institution's IRB-approved database of 1408 esophagectomies (1994-2024), identifying 19 patients with distant disease (stage IV) based on AJCC 8 found before or at time of surgical resection. Demographics, clinical characteristics, and survival for metastatic versus non-metastatic patients were compared using Fisher Exact, Wilcoxon rank-sum, and Kaplan-Meier. Metastatic disease sub-analysis was also performed. RESULTS Patients with stage IV were younger (57 vs 64 years old; p=0.003) and non-Caucasian (15.8% vs 5.7%; p<0.001). However, most patients in both groups were male (p=0.46) and had adenocarcinoma (p=0.16). Postoperative complication rates were similar between cohorts (57.9% vs 63.8%; p=0.60). In the stage IV sub-analysis, patients receiving surgery >1 year after stage IV diagnosis had better survival than those diagnosed <1 year before or during surgery (p=0.04). For stage IV patients diagnosed >1 year before surgery, shorter OS was observed in those with PD-L1 positivity (18.7 months vs mOS not reached; p=0.94) while neither HER2neu positive nor negative groups reached mOS (p=0.24). CONCLUSIONS Esophagectomy for highly selected stage IV patients demonstrates similar postoperative complication rates to surgery for locally advanced EC. For stage IV patients, diagnosis-to-surgery intervals >12m demonstrate better outcomes. Surgery's role in treating stage IV esophageal cancer, preferably >1 year after stage IV diagnosis, warrants further study.
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Affiliation(s)
- Samir H Saeed
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, 33612, Tampa, FL, USA
| | - Andrew J Sinnamon
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, 33612, Tampa, FL, USA
| | - Jacques P Fontaine
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, 33612, Tampa, FL, USA
| | - Rutika J Mehta
- Department of Gastrointestinal Oncology, Weill Cornell Medical College, 1305 York Avenue, 10021, New York, NY, USA
| | - Jobelle Jr Baldonado
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, 33612, Tampa, FL, USA
| | - Luis R Pena
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, 33612, Tampa, FL, USA
| | - Allan A Lima Pereira
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, 33612, Tampa, FL, USA
| | - Sarah E Hoffe
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, 33612, Tampa, FL, USA
| | - Jessica M Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, 33612, Tampa, FL, USA
| | - Jose M Pimiento
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, 33612, Tampa, FL, USA.
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Miao Y, Wang X, He F, Zhang F, Huang Y, Lai Y, Wang Y, Zhang L, Yin H, Meng X, Liu H, Li W, Yang S. Targeting CALR reduces energy metabolism of esophageal cancer cells and inhibits tumor‑associated fibroblast infiltration. Int J Oncol 2025; 66:49. [PMID: 40417915 PMCID: PMC12118950 DOI: 10.3892/ijo.2025.5755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 03/13/2025] [Indexed: 05/27/2025] Open
Abstract
Calreticulin (CALR) supports the induction of dendritic cell maturation, which makes it a key target for effective esophageal squamous cell carcinoma (ESCC) immunotherapy. The mechanism of CALR in the immunotherapy of ESCC is not fully studied. The aim of the present study was to explore the contributing role of CALR in ESCC progression. The association of CALR expression with calnexin (CANX) and protein disulfide isomerase A3 (PDIA3) expression in ESCC was analyzed. The functions of CALR in ESCC cells were examined by detection of cell migration, endoplasmic reticulum (ER) stress, mitochondrial function, cytoskeletal remodeling, cell proliferation and apoptosis. The effects of CALR on tumor growth and tumor‑associated fibroblast infiltration were examined by subcutaneous xenograft assay. The expression of CALR, CANX and PDIA3 in ESCC tissue significantly increased and the expression of PDIA3 was positively associated with CANX. Overexpression of CALR resulted in enhanced cell proliferation, migration, ER stress, mitochondrial function and cytoskeletal remodeling; knockdown of CALR expression had the opposite effect. In the subcutaneous xenograft assay, knockdown CALR significantly inhibited the growth of esophageal cancer tumors, suppressed the invasion of tumor‑associated fibroblasts and decreased the expression of α‑smooth muscle actin (α‑SMA), fibroblast activation protein (FAP), fibroblast specific protein‑1 (FSP1), platelet‑derived growth factor and transforming growth factor beta (TGF‑β) in tumor tissue. These findings suggested that CALR promotes the progression of ESCC by regulating ER stress and mitochondrial function to mediate ATP production, cytoskeletal remodeling, cell proliferation and apoptosis through CANX and PDIA3. Knockdown CALR significantly inhibited tumor‑associated fibroblast infiltration and is a potential drug target for ESCC.
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Affiliation(s)
- Yu Miao
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
| | - Xiaofei Wang
- Department of Pathology, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei 063000, P.R. China
| | - Fang He
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
| | - Feixiong Zhang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
| | - Ying Huang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
| | - Yafang Lai
- Department of Gastroenterology, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Yuanzhen Wang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
| | - Lina Zhang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
| | - Hua Yin
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
| | - Xiangkun Meng
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
| | - Hao Liu
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
| | - Weiqiang Li
- College of Traditional Chinese Medicine, Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
- Key Laboratory of Ningxia Ethnomedicine Modernization, Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
| | - Shaoqi Yang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui 750004, P.R. China
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Lu Z, Du W, Jiao X, Wang Y, Shi J, Shi Y, Shu Y, Niu Z, Hara H, Wu J, Hsu CH, Van Cutsem E, Brock MV, Zhang Z, Ding N, Zhang Y, Shen Z, Shen L. NOTCH1 Mutation and Survival Analysis of Tislelizumab in Advanced or Metastatic Esophageal Squamous Cell Carcinoma: A Biomarker Analysis From the Randomized, Phase III, RATIONALE-302 Trial. J Clin Oncol 2025; 43:1898-1909. [PMID: 40179324 PMCID: PMC12118624 DOI: 10.1200/jco-24-01818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 01/07/2025] [Accepted: 02/04/2025] [Indexed: 04/05/2025] Open
Abstract
PURPOSE Although multiple agents targeting PD-1 have been approved as second-line treatment for esophageal squamous cell carcinoma (ESCC), only a fraction of patients derive long-term survival. Hence, reliable predictive biomarkers are urgently needed. METHODS Comprehensive tumor genomic profiling and transcriptome sequencing were performed on samples from the RATIONALE-302 study. We also conducted single-cell RNA sequencing analysis on Notch1 knockdown ESCC murine models to further explore the potential molecular mechanisms underlying anti-PD-1 benefit. RESULTS We identified NOTCH1 mutation as a potential predictive biomarker for longer overall survival (OS) with tislelizumab versus chemotherapy (18.4 months v 5.3 months; hazard ratio, 0.35 [95% CI, 0.17 to 0.71]). At the transcriptional level, type I IFN (IFN-I)/toll-like receptor expression signatures were positively associated with OS benefit of tislelizumab, whereas B-cell and neutrophil signatures predicted unfavorable OS. Exploratory analyses showed that the presence of NOTCH1 mutation correlated with enrichment of IFN-I signatures and reduced infiltration of B cells and neutrophils. In murine models, comparative single-cell transcriptome analyses further revealed that Notch1 deficiency facilitated a more immunologically activated tumor microenvironment which potentiated anti-PD-1 treatment. CONCLUSION Our data provide novel insights for anti-PD-1 treatment selection using NOTCH1 mutations and may provide a rationale for combination therapy in ESCC.
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Affiliation(s)
- Zhihao Lu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Wenting Du
- Clinical Biomarker, BeiGene (Shanghai) Co, Ltd, Shanghai, China
| | - Xi Jiao
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yanni Wang
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Jingwen Shi
- Clinical Biomarker, BeiGene (Beijing) Co, Ltd, Beijing, China
| | - Yang Shi
- Clinical Biomarker, BeiGene (Beijing) Co, Ltd, Beijing, China
| | - Yongqian Shu
- The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital)—Cancer Center, Nanjing, China
| | - Zuoxing Niu
- Shandong Cancer Hospital—Oncology, Jinan, China
| | - Hiroki Hara
- Saitama Cancer Center—Gastroenterology, Kitaadachi-gun, Japan
| | - Jun Wu
- The First People's Hospital of Changzhou—Oncology, Changzhou, China
| | - Chih-Hung Hsu
- National Taiwan University Hospital, Taipei, Republic of China
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg/Leuven & KU Leuven, Leuven, Belgium
| | - Malcolm V. Brock
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zhang Zhang
- Statistics, BeiGene (Beijing) Co, Ltd, Beijing, China
| | - Ningning Ding
- Clinical Development, BeiGene (Beijing) Co, Ltd, Beijing, China
| | - Yun Zhang
- Clinical Biomarker, BeiGene (Beijing) Co, Ltd, Beijing, China
| | - Zhirong Shen
- Clinical Biomarker, BeiGene (Beijing) Co, Ltd, Beijing, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
- Department of Gastrointestinal Oncology, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, China
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8
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Shi Y, Han G, Zhou J, Shi X, Jia W, Cheng Y, Jin Y, Hua X, Wen T, Wu J, Gu S, Bai Y, Wang X, Zhang T, Chen Z, Zhang B, Huang M, Liu H, Mao Y, Zhou L, Wang R, Shan Y, Zhang W, Song T, Guo Y, Zhou F, Shao B, Zhang M, Liang B, Zheng J, Zhang G, Shen J, Su W, Zhang F, He Y, Hu S, Liu R, Zhang C, Shen S, Zeng H, Wang TE, Guo W, Shen Y, Chen Y, Li Y, Samol J, Hu H, Zhang W, Du C, Li E, Liu C, Pin CS, Li X, Xu H, Huang JF, Hao C, Lv J, Wang W, Xu Q, Bai A, Zhang X, Liu B, Jin C, Fan J. Toripalimab plus bevacizumab versus sorafenib as first-line treatment for advanced hepatocellular carcinoma (HEPATORCH): a randomised, open-label, phase 3 trial. Lancet Gastroenterol Hepatol 2025:S2468-1253(25)00059-7. [PMID: 40409323 DOI: 10.1016/s2468-1253(25)00059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 02/14/2025] [Accepted: 02/14/2025] [Indexed: 05/25/2025]
Abstract
BACKGROUND Although several PD-1 or PD-L1 inhibitors combined with antiangiogenic agents have been approved as first-line treatment of advanced hepatocellular carcinoma, treatment needs remain unmet given the high incidence and mortality of hepatocellular carcinoma and due to factors such as regional approval status, medical insurance restrictions, and cost considerations. In this phase 3 HEPATORCH study, we aimed to compare the efficacy and safety of toripalimab plus bevacizumab versus sorafenib in patients with previously untreated advanced hepatocellular carcinoma. METHODS We did a randomised, open-label, phase 3 study in 57 hospitals across mainland China, Taiwan, and Singapore. Using a central interactive web response system, eligible patients aged 18-75 years with unresectable or metastatic hepatocellular carcinoma were randomly assigned (1:1) through a stratified block randomisation method to receive 240 mg toripalimab (intravenously, once every 3 weeks) plus 15 mg/kg bevacizumab (intravenously, once every 3 weeks) or 400 mg sorafenib (oral, twice daily). Randomisation was stratified by macrovascular invasion or extrahepatic spread (presence vs absence), ECOG performance status score (0 vs 1), and history of locoregional therapy (yes vs no). The co-primary endpoints were progression-free survival (assessed by the Independent Review Committee per Response Evaluation Criteria in Solid Tumors, version 1.1) and overall survival. Efficacy analysis was performed in the intention-to-treat population (ie, all patients randomly assigned to a treatment group). Safety was assessed in all patients who received at least one dose of study treatment. The study is registered with ClinicalTrials.gov, NCT04723004, and is completed. FINDINGS Between Nov 23, 2020, and Jan 21, 2022, 545 patients were screened for study inclusion, of whom 219 did not meet the screening criteria. 326 patients were randomly assigned to receive an intervention: 162 patients were assigned to the toripalimab plus bevacizumab group and 164 were assigned to the sorafenib group, with median age 58·0 years (IQR 50·0-66·0) and 56·0 years (49·0-61·0) years, respectively. All 326 patients were included in the intention-to-treat population and the safety population. 282 (87%) patients were male and 44 (14%) were female. At the primary analysis of progression-free survival (data cutoff Aug 10, 2022), median follow-up was 9·4 months (IQR 7·0-12·0). Toripalimab plus bevacizumab significantly prolonged progression-free survival compared with sorafenib (median 5·8 months [95% CI 4·6-7·2] vs 4·0 months [2·8-4·2]; hazard ratio [HR] 0·69 [95% CI 0·53-0·91; p=0·0086). At the final analysis of overall survival (May 31, 2024), median follow-up was 16·4 months (IQR 7·1-29·5). Toripalimab plus bevacizumab significantly improved overall survival compared with sorafenib (median 20·0 months [95% CI 15·3-23·4] vs 14·5 months [11·4-18·8]; HR 0·76 [95% CI 0·58-0·99; p=0·039). Grade 3 or higher adverse events occurred in 102 (63%) patients in the toripalimab plus bevacizumab group compared with 100 (61%) in the sorafenib group, and led to discontinuation of treatment in 21 (13·0%) participants in the toripalimab plus bevacizumab group and 20 (12%) participants in the sorafenib group. The incidence of treatment-related fatal adverse events (two [1%] vs one [1%]) was similar between the toripalimab plus bevacizumab and sorafenib groups. The most common (incidence ≥5% in the toripalimab plus bevacizumab group) grade 3-4 adverse events were hypertension (26 [16%] in the toripalimab plus bevacizumab group vs 19 [12%] in the sorafenib group), thrombocytopenia (16 [10%] vs four [2%]), upper gastrointestinal haemorrhage (ten [6%] vs one [1%]), anaemia (nine [6%] vs seven [4%]), and abnormal hepatic function (nine [6%] vs five [3%]). The most common (incidence ≥2% in the toripalimab plus bevacizumab group) serious adverse events were upper gastrointestinal haemorrhage (12 [7%] vs one [1%]), abnormal hepatic function (eight [5%] vs five [3%]), ascites (six [4%] vs three [2%]), and gastrointestinal haemorrhage (four [2%] vs three [2%]). INTERPRETATION Among patients with previously untreated advanced hepatocellular carcinoma, toripalimab plus bevacizumab resulted in significantly longer progression-free survival and overall survival than did sorafenib, with an acceptable safety profile. Based on these results, the regimen has been approved for use in China by the National Medical Products Administration. FUNDING Shanghai Junshi Biosciences. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yinghong Shi
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guohong Han
- Xi'an International Medical Center Hospital of Digestive Diseases, Xi'an, China
| | - Jian Zhou
- Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | | | | | | - Xiangdong Hua
- Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Tianfu Wen
- West China Hospital, Sichuan University, Chengdu, China
| | - Jianbing Wu
- The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | | | - Yuxian Bai
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Xiangcai Wang
- First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Tao Zhang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiyu Chen
- The Southwest Hospital of Army Medical University, Chongqing, China
| | - Bixiang Zhang
- Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | | | - Hongming Liu
- Daping Hospital, Army Medical University, Chongqing, China
| | - Yilei Mao
- Peking Union Medical College Hospital, Beijing, China
| | - Ledu Zhou
- Xiangya Hospital Central South University, Changsha, China
| | - Rui Wang
- The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Yunfeng Shan
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wu Zhang
- Shulan (Hangzhou) Hospital, Hangzhou, China
| | - Tianqiang Song
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Yabing Guo
- Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Fuxiang Zhou
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | | | - Mingjun Zhang
- The Second Hospital of Anhui Medical University, Hefei, China
| | - Bo Liang
- Jilin Guowen Hospital, Changchun, China
| | | | | | - Jie Shen
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Weiwen Su
- Changhua Christian Hospital, Changhua, China
| | | | - Yifu He
- Anhui Provincial Cancer Hospital, Hefei, China
| | - Sheng Hu
- Hubei Cancer Hospital, Wuhan, China
| | - Rong Liu
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chengwu Zhang
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Shunli Shen
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Zeng
- Zhejiang Cancer Hospital, Hangzhou, China
| | | | - Wenzhi Guo
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Shen
- The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yajin Chen
- Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Yong Li
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - J Samol
- Tan Tock Seng Hospital, Singapore
| | | | | | - Chengyou Du
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Enxiao Li
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chao Liu
- Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Choo Su Pin
- National Cancer Center and Curie Oncology, Singapore
| | - Xun Li
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Hao Xu
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jee-Fu Huang
- Kaohsiung Medical University Chung Ho Memorial Hospital, Taiwan, China
| | | | - Jing Lv
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Wang
- The First People's Hospital of Foshan, Foshan, China
| | - Qian Xu
- Shanghai Junshi Biosciences, Shanghai, China
| | - Aobing Bai
- Shanghai Junshi Biosciences, Shanghai, China
| | - Xiao Zhang
- Shanghai Junshi Biosciences, Shanghai, China
| | - Bifeng Liu
- Shanghai Junshi Biosciences, Shanghai, China
| | - Chunlei Jin
- Shanghai Junshi Biosciences, Shanghai, China
| | - Jia Fan
- Zhongshan Hospital, Fudan University, Shanghai, China.
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9
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Han X, Xu J, Cui M, Yun Z, Zhao H, Tian S, Mi S, Hou L. Haematological toxicities with immune checkpoint inhibitors in digestive system tumors: a systematic review and network meta-analysis of randomized controlled trials. Clin Exp Med 2025; 25:157. [PMID: 40360867 PMCID: PMC12075026 DOI: 10.1007/s10238-025-01688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Accepted: 04/13/2025] [Indexed: 05/15/2025]
Abstract
This study aims to comprehensively evaluate the hematologic toxicity profiles, toxicity spectrum, and safety rankings of immune checkpoint inhibitors (ICIs) used for digestive system tumors. The PubMed, Cochrane Library, Web of Science, and Embase databases were systematically searched from inception to August 2024 to identify randomized controlled trials (RCTs). The primary outcome was anemia, while secondary outcomes included neutropenia, neutrophil count decreased, thrombocytopenia, platelet count decreased, leukopenia, white blood cell (WBC) count decreased, lymphocyte count decreased, and febrile neutropenia (FN). Subgroup analyses were performed based on tumor type, country category, study phase, ICI regimen, control group, chemotherapy regimen, ICI plus different chemotherapy regimens. Two reviewers independently selected the studies, extracted data according to pre-specified criteria, and assessed the risk of bias using the Cochrane Collaboration risk of bias tool. RevMan 5.4 software was utilized to visualize the risk of bias assessments. Stata 16.0 was used to conduct network meta-analysis, sensitivity analysis and meta-regression. 25 phase II and III RCTs (n = 15216) were included. The general safety of ICIs ranked from high to low for grade 1-5 anemia were as follows: avelumab, nivolumab, pembrolizumab, sintilimab, camrelizumab, and tislelizumab. For grade 3-5 anemia, the general safety profile of the ICIs were as follows, from highest to lowest: avelumab, nivolumab, pembrolizumab, sintilimab, and camrelizumab. Compared to chemotherapy, treatment-related hematologic toxicities with ICIs occurred primarily in grade 1-5 anemia, neutropenia, thrombocytopenia, leukopenia, and WBC count decreased. Taking ICI monotherapy, nivolumab plus ipilimumab were generally safer than taking chemotherapy, one ICI drug with chemotherapy, or two ICI drugs with chemotherapy. In terms of grade 1-5 hematologic toxicities, tislelizumab had the highest risk of neutropenia and leukopenia; the primary treatment-adverse events (AEs) for sintilimab was neutrophil count decreased and WBC count decreased; the primary treatment-related AE associated with nivolumab was platelet count decreased; camrelizumab posed the highest risk for lymphocyte count decreased. In terms of grade 3-5 hematologic toxicities, pembrolizumab was predominantly linked to neutropenia; sintilimab showed the greatest risk for neutrophil count decreased, platelet count decreased, and lymphocyte count decreased; avelumab was most associated with WBC count decreased. FN primarily manifested as grade 3-5, with camrelizumab having the highest risk. Among agents used in gastric or gastroesophageal junction cancer, avelumab demonstrated the most favorable safety profile for anemia. Each treatment regimen has its unique safety profile. Early identification and management of ICI-related hematologic toxicities are essential in clinical practice.Systematic Review Registration: PROSPERO CRD42024571508.
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Affiliation(s)
- Xinpu Han
- Department of Oncology and Hematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Jing Xu
- Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei, China
| | - Meichen Cui
- Department of Oncology and Hematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Zhangjun Yun
- Department of Oncology and Hematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Hongbin Zhao
- Department of Oncology and Hematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Shaodan Tian
- Department of Oncology and Hematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Suicai Mi
- Xiamen Hospital, Dongzhimen Hospital, Beijing University of Chinese Medicine, Xiamen, China.
| | - Li Hou
- Department of Oncology and Hematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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10
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Emiloju O, Miao R, Alese O. The Evolving Role of Immunotherapy for Gastroesophageal Malignancies. Ann Surg Oncol 2025:10.1245/s10434-025-17386-7. [PMID: 40332652 DOI: 10.1245/s10434-025-17386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Accepted: 04/13/2025] [Indexed: 05/08/2025]
Abstract
The incorporation of immunotherapy has transformed the treatment landscape for advanced, unresectable, or metastatic gastroesophageal cancers (GECs), with improved survival outcomes. These improvements in outcomes for advanced GECs have led to clinical trials evaluating the role of immunotherapy in patients with resectable early-stage GECs. However, there remains a high burden of morbidity and mortality, and ongoing trials utilizing novel immunotherapy agents and combinations are underway. This review summarizes the findings of previous and ongoing clinical trials related to immunotherapy for patients with early- and late-stage GECs.
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Affiliation(s)
| | - Ruoyu Miao
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Olatunji Alese
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
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11
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Sugase T, Kanemura T, Matsuura N, Sugimura K, Takeoka T, Ushimaru Y, Masuike Y, Yanagimoto Y, Mori R, Kitakaze M, Kubo M, Mukai Y, Komatsu H, Sueda T, Kagawa Y, Nishimura J, Wada H, Yasui M, Miyata H. Clinical outcomes of pembrolizumab plus chemotherapy for postoperative recurrent esophageal squamous cell carcinoma. Dis Esophagus 2025; 38:doaf029. [PMID: 40448400 DOI: 10.1093/dote/doaf029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 04/03/2025] [Indexed: 06/02/2025]
Abstract
BACKGROUND Immunotherapy combined with chemotherapy has been the first-line treatment for metastatic or unresectable locally advanced esophageal cancer. However, postoperative recurrences have not been sufficiently investigated. We investigated the clinical outcomes of pembrolizumab plus cisplatin plus 5-fluorouracil (CF) therapy for postoperative recurrent esophageal squamous cell carcinoma. METHODS We retrospectively analyzed 100 consecutive patients with postoperative recurrence and compared their treatment response and survival outcomes in response to pembrolizumab plus CF therapy and conventional CF therapy. RESULTS Pembrolizumab plus CF therapy had higher response and objective response rates (41% vs. 27%, 77% vs. 57%, respectively) and prolonged progression-free survival (median 6.5 vs. 4.9 months, P = 0.011) and overall survival (not reached [NR] vs. 14.0 months, P = 0.087) compared to CF therapy. Early tumor shrinkage (ETS) ≧20% had a longer duration of response with pembrolizumab plus CF therapy compared with conventional CF therapy (NR vs. 10.2 months, P = 0.007). Conversely, the additional benefit of pembrolizumab in CF therapy was limited when ETS was <20% (4.0 vs. 3.4 months, P = 0.814). CF therapy was associated with worse survival outcomes for recurrences within 6 months post-surgery compared to those after 6 months. Pembrolizumab plus CF therapy provided comparable survival outcomes regardless of the timing of recurrence; however, it was less effective in combined positive score < 10 within the first 6 months. CONCLUSION First-line pembrolizumab plus chemotherapy for postoperative recurrent esophageal cancer improved clinical outcomes compared to conventional CF therapy and can be expected to be one of the treatment options even in early postoperative recurrence.
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Affiliation(s)
- Takahito Sugase
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Takashi Kanemura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Norihiro Matsuura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Keijiro Sugimura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Tomohira Takeoka
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Yuki Ushimaru
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Yasunori Masuike
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Yoshitomo Yanagimoto
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Ryota Mori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Masatoshi Kitakaze
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Masahiko Kubo
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Yosuke Mukai
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Hisateru Komatsu
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Toshinori Sueda
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Yoshinori Kagawa
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
| | - Hiroshi Miyata
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuou-ku, Osaka, 541-8567, Japan
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12
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Shiraishi K, Yamamoto S, Kato K. Tislelizumab for the treatment of advanced esophageal squamous cell carcinoma. Future Oncol 2025; 21:1473-1481. [PMID: 40257370 PMCID: PMC12077467 DOI: 10.1080/14796694.2025.2495542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Accepted: 04/16/2025] [Indexed: 04/22/2025] Open
Abstract
Advanced esophageal squamous cell carcinoma (ESCC) patients had poor prognosis and few effective drugs based on the randomized controlled trials (RCTs). In such a circumstance, recent RCTs have shown the clinical efficacy of immune checkpoint inhibitors (ICIs) as first- or second-line treatment for advanced ESCC patients. Tislelizumab is one of the anti-Programmed-Death-1 (PD-1) antibodies; at first, tislelizumab monotherapy showed clinical efficacy as a second-line treatment for advanced ESCC patients based on the results of the RATIONALE-302 trial. Since then, tislelizumab plus doublet chemotherapy has shown superiority in overall survival compared to doublet chemotherapy for untreated advanced ESCC patients in the RATIONALE-306 trial. In this review, we share the overview of the development of tislelizumab and discuss the future perspectives on ICIs for advanced ESCC patients. In our opinion, tislelizumab plus doublet chemotherapy is one of the first-line standard treatments for advanced ESCC patients regardless of Programmed cell Death ligand 1 expression. Some other ICI-containing treatments showed clinical efficacy for untreated ESCC patients; we need further investigation to select these treatments appropriately.
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Affiliation(s)
- Kazuhiro Shiraishi
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shun Yamamoto
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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13
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Li C, Liu S, He Y, Yao H, Yuan Z, Yang J, Cao D, Cheng N, Yang J, Peng P, Xiang Y. Toripalimab combined with bevacizumab plus chemotherapy as first-line treatment for refractory recurrent or metastatic cervical cancer: a single-arm, open-label, phase II study (JS001-ISS-CO214). J Gynecol Oncol 2025; 36:e44. [PMID: 39482930 PMCID: PMC12099045 DOI: 10.3802/jgo.2025.36.e44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 09/25/2024] [Accepted: 10/03/2024] [Indexed: 11/03/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of adding toripalimab to bevacizumab and platinum-based chemotherapy as first-line treatment for refractory recurrent or metastatic (R/M) cervical cancer (CC). METHODS Patients were administered toripalimab (240 mg) + bevacizumab (7.5 mg/kg) combined with platinum-based chemotherapy once every three weeks for six cycles, followed by the maintenance therapy involving toripalimab + bevacizumab once every 3 weeks for 12 months or when disease progression or intolerable toxicity occurred. The primary endpoint was the objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1. The secondary endpoints were safety profiles, disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). RESULTS Twenty-four patients were enrolled in this study and in the final analysis. The median follow-up duration was 18.6 (range, 3.3-28.5) months. The ORR was 83.3% (95% confidence interval [CI]=62.6-95.3) and the DCR was 95.8% (95% CI=78.9-99.9); 9 (37.5%) patients achieved complete response, 11 (45.8%) achieved partial response, and 3 (12.5%) had stable disease. The median PFS was 22.6 (95% CI=10.4-34.7) months and the median OS was not reached. The most common grade 3 treatment-related adverse events (AEs) were neutropenia (41.7%) and leukopenia (16.7%). The most common immune-related AEs (irAEs) were thyroid dysfunction (37.5%) and increased adrenocorticotropic hormone (37.5%) and serum cortisol levels (33.3%). No grade ≥3 irAEs were observed. CONCLUSION Toripalimab combined with bevacizumab and platinum-based chemotherapy show promising clinical efficacy and favorable safety profile, providing an alternative first-line treatment option for patients with R/M CC. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04973904.
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Affiliation(s)
- Chen Li
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shikai Liu
- Department of Gynecology, Cangzhou Central Hospital, Cangzhou, China
| | - Yonglan He
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hairong Yao
- Department of Gynecology, Cangzhou Central Hospital, Cangzhou, China
| | - Zhilin Yuan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ninghai Cheng
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junjun Yang
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peng Peng
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Xiang
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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14
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Xu J, Kato K, Hubner R, Park SR, Kojima T, Ishihara R, Wyrwicz L, Van Cutsem E, Jimenez-Fonseca P, Wu H, Wang L, Yan S, Shi J, Kadva A, Yoon HH. First-Line Tislelizumab Plus Chemotherapy for Esophageal Squamous Cell Carcinoma with Programmed Death-Ligand 1 Expression ≥ 1%: A Retrospective Analysis of RATIONALE-306. Adv Ther 2025; 42:2269-2284. [PMID: 40075024 PMCID: PMC12006250 DOI: 10.1007/s12325-025-03115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 01/15/2025] [Indexed: 03/14/2025]
Abstract
INTRODUCTION The United States Food and Drug Administration Oncologic Drugs Advisory Committee voted (September 2024) against the use of programmed cell death protein-1 inhibitors for first-line treatment of advanced or metastatic unresectable esophageal squamous cell carcinoma (ESCC) with a programmed death-ligand 1 (PD-L1) expression Tumor Area Positivity (TAP) score < 1% or combined positive score < 1 due to an unfavorable benefit-risk profile observed across the phase 3 CheckMate 648, KEYNOTE-590, and RATIONALE-306 trials. Therefore, we conducted a retrospective analysis of RATIONALE-306 to evaluate the efficacy and safety of tislelizumab plus investigator-chosen chemotherapy (ICC) versus placebo plus ICC in patients with advanced or metastatic unresectable ESCC and a PD-L1 TAP score ≥ 1%. METHODS Adult patients with advanced or metastatic unresectable ESCC enrolled in the global, randomized, phase 3 RATIONALE-306 trial randomly received tislelizumab 200 mg every 3 weeks plus ICC or matched placebo plus ICC. Efficacy and safety outcomes were evaluated among patients who were retrospectively assessed for PD-L1 expression defined by a TAP score ≥ 1%. RESULTS At primary analysis data cutoff (February 28, 2022), a clinically meaningful improvement in median overall survival was observed among 230 patients in the tislelizumab plus ICC arm {16.8 [95% confidence interval (CI) 15.3-20.8] months} versus 248 patients in the placebo plus ICC arm [9.6 (95% CI 8.9-11.8) months] [stratified hazard ratio 0.64 (95% CI 0.51-0.80)]; this was maintained at a 3-year follow-up data cutoff (November 24, 2023). Similar findings at primary analysis were observed for progression-free survival, objective response rate, disease control rate, and duration of response. Tislelizumab plus ICC was tolerable and no new safety signals were observed. CONCLUSIONS Tislelizumab plus ICC is an effective and well tolerated first-line treatment option for patients with advanced or metastatic unresectable ESCC and a tumor PD-L1 TAP score ≥ 1%. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03783442.
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Affiliation(s)
- Jianming Xu
- Department of Gastrointestinal Oncology, Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ken Kato
- Department of Head and Neck, National Cancer Center Hospital, Tokyo, Japan
| | - Richard Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Sook Ryun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Takashi Kojima
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Lucjan Wyrwicz
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie National Cancer Research Institute, Warsaw, Poland
| | - Eric Van Cutsem
- Department of Digestive Oncology, University Hospitals Gasthuisberg, Leuven, and KU Leuven, Leuven, Belgium
| | - Paula Jimenez-Fonseca
- Department of Medical Oncology, Central University Hospital of Asturias, ISPA, Oviedo, Spain
| | - Hongqian Wu
- Biostatistics, BeiGene USA, Inc., Ridgefield Park, NJ, USA
| | - Lei Wang
- Clinical Development, BeiGene (Beijing) Co., Ltd., Beijing, China
| | - Sebastian Yan
- Clinical Development, BeiGene (Beijing) Co., Ltd., Beijing, China
| | - Jingwen Shi
- Clinical Biomarker, BeiGene (Beijing) Co., Ltd., Beijing, China
| | - Alysha Kadva
- Clinical Development, BeiGene USA, Inc., San Mateo, CA, USA
| | - Harry H Yoon
- Department of Oncology, Mayo Clinic Comprehensive Cancer Center, 200 First Street SW, Rochester, MN, 55905, USA.
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Huang X, You R, Liu F, Jian Z, Zhou G, Yin H, Wu M, Sun T, Duan Z, Xu W, Zhang S, Yang X, Jiao H, Yang S, Wang Q, Yin J, Tang H, Lin M, Tan L. Identification and validation of poor prognosis immunoevasive subtype of esophageal cancer with tumor-infiltrating SAMD3 + NK cell abundance. Cancer Immunol Immunother 2025; 74:177. [PMID: 40252130 PMCID: PMC12009252 DOI: 10.1007/s00262-025-04028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 03/19/2025] [Indexed: 04/21/2025]
Abstract
INTRODUCTION Esophageal cancer (EC) remains highly lethal due to tumor microenvironment (TME)-mediated immune evasion. While natural killer (NK) cells are central to antitumor immunity, their functional states in EC are poorly characterized. METHODS We integrated bulk RNA-seq (TCGA/GEO) and single-cell data to construct an NK cell-derived prognostic signature (NK score) via LASSO-Cox regression. Immunofluorescence was applied to assess the clinical relevance of SAMD3 + NK cells in EC. Using both xenograft mouse models and in vitro co-culture procedures, the impact of SAMD3 on NK cell function was confirmed. RESULTS In EC patients, the prognostic NK score-which is generated from important NK cell markers including SAMD3-was substantially correlated with a worse chance of survival. NK cells within the TME had significant levels of SAMD3 expression, as seen by immunofluorescence labeling. Moreover, NK cells with SAMD3 knockdown exhibited enhanced antitumor activity, leading to decreased tumor development in the xenograft model. DISCUSSION Our results demonstrate the predictive significance of NK cell markers in EC and pinpoint SAMD3 as a critical modulator of NK cell activity. We pioneer SAMD3 + NK cells as architects of TME immunosuppression in EC. Our findings nominate SAMD3 inhibition as a combinatorial strategy to overcome immune checkpoint blockade resistance.
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Affiliation(s)
- Xu Huang
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Runze You
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Fangyi Liu
- The School of Basic Medical Sciences, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Zitao Jian
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Guanyou Zhou
- The School of Basic Medical Sciences, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Hao Yin
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Mengyuan Wu
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Tiantao Sun
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Zhiyun Duan
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Wenyi Xu
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Shaoyuan Zhang
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Xinyu Yang
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Heng Jiao
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Shuyi Yang
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Qingle Wang
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Jun Yin
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Han Tang
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Miao Lin
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
- The School of Basic Medical Sciences, Fudan University, Shanghai, China.
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China.
| | - Lijie Tan
- Departments of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
- The School of Basic Medical Sciences, Fudan University, Shanghai, China.
- Departments of Thoracic, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China.
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Lemay F, Sandhu AS, Stein BD, Goodwin R. A Canadian algorithm for upper gastrointestinal cancer management. Front Oncol 2025; 15:1548637. [PMID: 40297809 PMCID: PMC12034531 DOI: 10.3389/fonc.2025.1548637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 03/24/2025] [Indexed: 04/30/2025] Open
Abstract
Recent advances in immunotherapy have changed the treatment landscape for cancers of the upper gastrointestinal (GI) system. Immune checkpoint inhibitors can lead to better survival and improved quality of life for affected individuals. Adopting new treatment strategies in real-world practice can be challenging, and algorithms that are easy to implement in Canadian oncology practices would benefit clinicians and patients. In this study, we present expert opinion on best practices for upper GI cancer management, including a new algorithm that integrates the latest evidence for screening, workup, diagnosis, treatment, and survivorship. The algorithm is based on a novel approach comprising a case-based, accredited educational program with asynchronous discussion among clinicians practicing across Canada, with the input of expert medical oncologists and gastroenterologists. A needs assessment was employed to determine current areas of educational need in the field of upper GI cancers, and a patient representative provided insights into patient concerns and priorities. The best practices described here include seeking patient input throughout treatment, integrating immune checkpoint inhibitors into systemic therapy for both localized and advanced disease, and providing comprehensive supportive care throughout the treatment and survivorship journey.
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Affiliation(s)
- Frédéric Lemay
- Division of Gastroenterology, Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Amindeep S. Sandhu
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Rachel Goodwin
- Division of Medical Oncology, Department of Medicine, University of Ottawa, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
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Huang J, Zhang H, Lin X, Wu X, Chen X, Chen W, Liang S, Chen Y, Luo Q, Xu C, Liu S, Liu X, Zhang S. Regulatory T Cell Infiltration-Driven Single-Cell Transcriptomic Analysis Identifies SAP18 as a Prognostic Marker for Esophageal Squamous Cell Carcinoma. J Gastrointest Cancer 2025; 56:97. [PMID: 40208395 DOI: 10.1007/s12029-025-01174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2025] [Indexed: 04/11/2025]
Abstract
BACKGROUND Advanced esophageal squamous cell carcinoma (ESCC) is characterized by molecular heterogeneity and distinct patterns of immune cell infiltration. Regulatory T cells (Tregs), in particular, play a critical role in shaping an immunosuppressive tumor microenvironment (TME), which is associated with poor clinical outcomes. METHODS We developed a prognostic model by integrating GEO-derived bulk RNA sequencing data and single-cell transcriptome. Model predictions were confirmed through RT-qPCR, Western blot, and immunohistochemistry on clinical specimens, while in vitro assays (CCK8, transwell invasion, scratch, colony formation, and immunofluorescence) validated the function of SAP18 in cell proliferation, invasion, and ECM remodeling. RESULTS Expression patterns of the 5 Tregs-associated genes in clinical specimens aligned with model predictions, underscoring the model's robustness. The high-risk subgroup was associated with upregulated extracellular matrix (ECM) remodeling, an abundance of immune-suppressive cells, higher TP53 mutation rate, and limited benefit from immunotherapy. In contrast, the low-risk subgroup exhibited anti-tumor immunity. Cell-cell communication analysis also implicated the collagen pathway in Tregs-mediated immune evasion in ESCC. Functional assays indicated that SAP18 in the prognostic model significantly promotes proliferation, invasion, and ECM reconstruction, further highlighting its potential as a therapeutic target. CONCLUSION Our findings elucidate the role of Tregs in the TME, underscoring significant potential of SAP18, which is essential for assessing patient prognosis and may facilitate the development of personalized therapies for ESCC.
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Affiliation(s)
- Jianxiang Huang
- Department of Pharmacy, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, 510220, PR China
- College of Pharmacy, Jinan University, Guangzhou, 510220, PR China
| | - Hanshuo Zhang
- Gastrointestinal Anorectal Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, 510220, PR China
| | - Xinyue Lin
- Department of Pharmacology, Medical College of Shantou University, Shantou, 515063, PR China
| | - Xiaolong Wu
- Department of Pharmacy, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, 510220, PR China
- College of Pharmacy, Jinan University, Guangzhou, 510220, PR China
| | - Xiaoshan Chen
- Department of Pharmacy, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, 510220, PR China
| | - Wang Chen
- Department of Pharmacy, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, 510220, PR China
| | - Shanshan Liang
- Department of Pharmacy, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, 510220, PR China
| | - Yun Chen
- Department of Pharmacy, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, 510220, PR China
| | - Qianhua Luo
- Department of Pharmacy, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, 510317, PR China
| | - Chengcheng Xu
- College of Pharmacy, Jinan University, Guangzhou, 510220, PR China
| | - Shaojie Liu
- Gastrointestinal Anorectal Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, 510220, PR China
| | - Xingmei Liu
- Department of Pharmacy, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, 510220, PR China.
- Department of Nursing, Guangzhou Red Cross Hospital of Jinan University, Haizhu District, No. 396, Tongfuzhong Road, Guangzhou, 510220, PR China.
| | - Shuyao Zhang
- Department of Pharmacy, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, 510220, PR China.
- College of Pharmacy, Jinan University, Guangzhou, 510220, PR China.
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Peng L, Gao Z, Liang Y, Guo X, Zhang Q, Cui D. Nanoparticle-based drug delivery systems: opportunities and challenges in the treatment of esophageal squamous cell carcinoma (ESCC). NANOSCALE 2025; 17:8270-8288. [PMID: 40052671 DOI: 10.1039/d4nr05114a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2025]
Abstract
Esophageal squamous cell carcinoma (ESCC) is an aggressive malignancy characterized by limited treatment options and poor prognosis. Nanoparticle-based drug delivery systems have emerged as a promising strategy to enhance cancer therapy efficacy by improving drug targeting, reducing toxicity, and enabling multifunctional applications. This review highlights some key types of nanoparticles, including liposomes, polymeric nanoparticles, metallic nanoparticles, dendrimers, and quantum dots, which could effectively improve the delivery of various drugs used in chemotherapy, radiotherapy, and immunotherapy, offering more precise and effective treatment options. With the ability to improve drug stability and overcome biological barriers, nanoparticle-based systems represent a transformative strategy for ESCC treatment. Despite some challenges, such as biocompatibility and scalability, the future of nanoparticle-based drug delivery holds great promise, particularly in the development of personalized nanomedicine and novel therapeutic approaches targeting the tumor microenvironment. With ongoing advancements, nanoparticle-based drug delivery systems hold immense potential to revolutionize ESCC treatment and improve patient outcomes.
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Affiliation(s)
- Linjia Peng
- The First Afffliated Hospital of Henan University, N. Jinming Ave, Kaifeng, 475004, China
| | - Zixuan Gao
- The First Afffliated Hospital of Henan University, N. Jinming Ave, Kaifeng, 475004, China
| | - Yanfeng Liang
- The First Afffliated Hospital of Henan University, N. Jinming Ave, Kaifeng, 475004, China
| | - Xiaonan Guo
- The First Afffliated Hospital of Henan University, N. Jinming Ave, Kaifeng, 475004, China
| | - Qiuli Zhang
- The First Afffliated Hospital of Henan University, N. Jinming Ave, Kaifeng, 475004, China
| | - Daxiang Cui
- The First Afffliated Hospital of Henan University, N. Jinming Ave, Kaifeng, 475004, China
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Wang LH, Jiang Y, Sun CH, Chen PT, Ding YN. Advancements in the application of ablative therapy and its combination with immunotherapy in anti-cancer therapy. Biochim Biophys Acta Rev Cancer 2025; 1880:189285. [PMID: 39938664 DOI: 10.1016/j.bbcan.2025.189285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 02/02/2025] [Accepted: 02/04/2025] [Indexed: 02/14/2025]
Abstract
Cancer is a significant health issue impacting humans. Currently, systemic therapies such as chemotherapy have significantly increased the life expectancy of cancer patients. However, some patients are unable to endure systemic treatment due to its significant adverse effects, leading to an increased focus on local therapies including radiation and ablation therapy. Ablation therapy is a precise, low-toxicity, and minimally invasive localized therapy that is increasingly acknowledged by clinicians and cancer patients. Many cancer patients have benefited from it, with some achieving full recovery. Currently, numerous studies have shown that ablation therapy is effective due to its ability to kill cancer cells efficiently and activate the body's anti-cancer immunity. It can also convert "cold cancers" into "hot cancers" and enhance the effectiveness of immunotherapy when used in combination. In this article, we categorize ablation therapy into thermal ablation, cryoablation, photodynamic therapy (PDT), irreversible electroporation (IRE), etc. Thermal ablation is further divided into Radiofrequency ablation (RFA), microwave ablation (WMA), high-frequency focused ultrasound (HIFU), photothermal therapy (PTT), magnetic heat therapy (MHT), etc. We systematically review the most recent advancements in these ablation therapies that are either currently used in clinic or are anticipated to be used in clinic. Then, we also review the latest development of various ablative therapies combined with immunotherapy, and its future development. CLINICAL RELEVANCE STATEMENT: Ablation therapy, an invasive localized treatment, offers an alternative to systemic therapies for cancer patients who cannot tolerate their adverse effects. Its ability to kill cancer cells efficiently and activate anti-cancer immunity. This article reviews recent advancements in ablation therapies, including thermal, cryoablation, PDT, and IRE, and their potential clinical applications, both standalone and in combination with immunotherapy.
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Affiliation(s)
- Lu-Hong Wang
- Department of Interventional Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Center of Interventional Radiology & Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, China; State Key Laboratory of Digital Medical Engineering, National Innovation Platform for Integration of Medical Engineering Education (NMEE) (Southeast University), Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Yi Jiang
- Department of Interventional Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Zhejiang Key Laboratory of Imaging and Interventional Medicine, Hangzhou, Zhejiang 310022, China; Zhejiang Provincial Research Center for Innovative Technology and Equipment in Interventional Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Chen-Hang Sun
- Department of Interventional Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Zhejiang Key Laboratory of Imaging and Interventional Medicine, Hangzhou, Zhejiang 310022, China; Zhejiang Provincial Research Center for Innovative Technology and Equipment in Interventional Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Peng-Tao Chen
- Department of Interventional Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Zhejiang Key Laboratory of Imaging and Interventional Medicine, Hangzhou, Zhejiang 310022, China; Zhejiang Provincial Research Center for Innovative Technology and Equipment in Interventional Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Yi-Nan Ding
- Department of Interventional Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Zhejiang Key Laboratory of Imaging and Interventional Medicine, Hangzhou, Zhejiang 310022, China; Zhejiang Provincial Research Center for Innovative Technology and Equipment in Interventional Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
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Zhou X, Wu Z, Qiu Z, Lin M, Tao Y, Su Y. Efficacy and Failure Patterns Following Target Volume and Dose Reduction After Neoadjuvant Therapy in Locoregionally Advanced Head and Neck Squamous Cell Carcinoma. Head Neck 2025; 47:1247-1255. [PMID: 39697038 DOI: 10.1002/hed.28037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Revised: 12/03/2024] [Accepted: 12/04/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND In this study, we aimed to analyze the efficacy and failure patterns of contouring target volume based on the residual tumor and decreasing the dose to the area of tumor regression after neoadjuvant therapy in locoregionally advanced head and neck squamous cell carcinoma (HNSCC). METHODS We retrospectively analyzed the patients with locoregionally advanced HNSCC treated by our group from May 2011 to June 2023. All patients received neoadjuvant therapy followed by intensity-modulated radiation therapy. Gross tumor volumes for the primary tumor and metastatic lymph nodes were delineated according to postneoadjuvant extension. The tumor shrinkage after neoadjuvant therapy was included in the high-risk clinical target volume (CTV1) and prescribed a dose of 60 Gy. Kaplan-Meier analysis was employed to calculate local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), overall survival (OS), and distant metastasis-free survival (DMFS). Failure patterns were analyzed by mapping the location and extent of locoregional recurrence onto pretreatment planning CT. RESULTS This study included a total of 114 patients, with a median follow-up of 34 months. The 5-year LRFS, RRFS, OS, and DMFS rates were 70.2%, 70.7%, 74.8%, and 73.8%, respectively. Among the 14 patients with recurrences, there were 5 local failures, 6 regional recurrences, and 3 both local and regional recurrences. All local recurrences occurred within the 95% isodose line, classified as in-field failures. Only one regional recurrence was marginal failure. No out-of-field failure was observed. CONCLUSION Reduction of target volume after neoadjuvant therapy and distribution of 60 Gy of dose to the tumor regression area may be feasible.
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Affiliation(s)
- Xiong Zhou
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Zheng Wu
- Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Zichen Qiu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Minchuan Lin
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yalan Tao
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yong Su
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
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Lian D, Yang Y, Gan Y, Xiao D, Xiang Y, Jiang S, Gu Y, Chen Y. Cost-effectiveness of toripalimab plus chemotherapy versus chemotherapy as first-line treatment for advanced non-small cell lung cancer in China: a societal perspective. Expert Rev Pharmacoecon Outcomes Res 2025; 25:587-596. [PMID: 39778974 DOI: 10.1080/14737167.2025.2451748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 12/01/2024] [Accepted: 12/03/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND To investigate the cost-effectiveness of toripalimab plus chemotherapy versus chemotherapy alone for advanced non-small cell lung cancer (NSCLC) patients from a societal perspective. METHODS A partitioned-survival model estimated the costs and cost-effectiveness of toripalimab plus chemotherapy versus standard chemotherapy for advanced NSCLC over 20 years. Clinical data were derived from the CHOICE-01 trial, and cost and utility inputs were gathered from Yaozh.com, expert interviews, and a nationwide hospital-based survey. Costs were reported in 2022 US dollars, and outcomes included quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), with a 5% discount rate was applied. Sensitivity, subgroup, and scenario analyses verified the robustness of results. RESULTS Toripalimab plus chemotherapy resulted in 3.048 QALYs and a total cost of $60,813, with an ICER of $19,066 per QALY gained, below China's 3 times GDP per capita threshold ($38,223). Robustness is confirmed through sensitivity, subgroup and scenario analyses. CONCLUSIONS Toripalimab plus chemotherapy is a cost-effective option for treatment-naive advanced NSCLC compared to chemotherapy alone, providing valuable evidence for clinical and reimbursement decision-making.
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Affiliation(s)
- Dai Lian
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yi Yang
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yuling Gan
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Dunming Xiao
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yuliang Xiang
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Shan Jiang
- Macquarie Business School, Australian Institute of Health Innovation, Macquarie University Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Yuanyuan Gu
- Macquarie Business School, Australian Institute of Health Innovation, Macquarie University Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
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22
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Chuang CH, Guo JC, Kato K, Hsu CH. Exploring novel immunotherapy in advanced esophageal squamous cell carcinoma: Is targeting TIGIT an answer? Esophagus 2025; 22:139-147. [PMID: 39847233 PMCID: PMC11929690 DOI: 10.1007/s10388-024-01105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 12/26/2024] [Indexed: 01/24/2025]
Abstract
Esophageal squamous cell carcinoma (ESCC) is a prevalent and highly lethal malignancy in Asia. Recent advancements in immune checkpoint inhibitors (ICIs) have markedly transformed the systemic therapy landscape for ESCC. Anti-PD-1-based combination with chemotherapy or with ipilimumab, an anti-CTLA-4 antibody, have been established as the new standard first-line treatments for patients with advanced ESCC. Moreover, anti-PD-1 monotherapy has demonstrated improved efficacy and survival compared with second-line chemotherapy in previously treated patients with ESCC. Novel ICIs targeting other immune checkpoints also show potential for enhancing anticancer therapy in advanced ESCC.The TIGIT/PVR pathway represents a new immune checkpoint. Preclinical studies have indicated that the dual blockade of TIGIT and PD-1 can enhance antitumor immune responses. Clinical trials have reported that combining anti-TIGIT with anti-PD-1/PD-L1 antibodies elicited clinical responses in patients with advanced ESCC. In the first-line systemic therapy setting, combinations of dual ICIs targeting TIGIT and PD-1/PD-L1 plus platinum-based chemotherapy have demonstrated acceptable toxicity profiles and promising antitumor activity in several phase II trials and one phase III study. However, the role of adding an anti-TIGIT antibody to the current standard of anti-PD-1/PD-L1 plus platinum-based chemotherapy in first-line therapy for advanced ESCC remains to be fully determined, necessitating further clinical trials. Ongoing studies are also investigating the role of anti-TIGIT, with or without anti-PD-1/PD-L1, in locoregional ESCC. Additional research is essential to optimize the potential of anti-TIGIT therapy in ESCC and other malignancies by identifying predictive biomarkers, determining optimal antibody types, and gaining key mechanistic insights.
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Affiliation(s)
- Chien-Huai Chuang
- Department of Medical Oncology, National Taiwan University Cancer Center, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jhe-Cyuan Guo
- Department of Medical Oncology, National Taiwan University Cancer Center, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
| | - Chih-Hung Hsu
- Department of Medical Oncology, National Taiwan University Cancer Center, 7 Chung-Shan South Road, Taipei, 10002, Taiwan.
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
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23
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Wang J, Li B, Zhang Y, Luo X, Zhang Y, Li H, Pan Y, Shao L, Zheng S, Yuan C, Li Y, Zheng Q, Sun S, Zhao W, Sun Y. Tislelizumab combined with nab-paclitaxel and cisplatin as the more effective chemoimmunotherapy strategy in the neoadjuvant treatment of locally advanced thoracic esophageal squamous cell carcinoma: A prospective, two-cohort, phase 2 trial. Int J Cancer 2025; 156:1429-1438. [PMID: 39686540 DOI: 10.1002/ijc.35261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 09/04/2024] [Accepted: 09/17/2024] [Indexed: 12/18/2024]
Abstract
This prospective, two-cohort phase 2 trial with random allocation was conducted to evaluate the safety and efficacy of neoadjuvant tislelizumab combined with nab-paclitaxel/paclitaxel and cisplatin (TP) in patients with esophageal squamous cell carcinoma (ESCC). Patients were enrolled and randomly assigned to the nab-paclitaxel or paclitaxel cohorts at a 1:1 ratio, and received intravenous tislelizumab (200 mg, day 1) combined with cisplatin (25 mg/m2, days 1-3) and either nab-paclitaxel (125 mg/m2, days 1 and 8) or paclitaxel (150 mg/m2, day 1) in a 21-day cycle for two cycles before surgery. The primary endpoint was the major pathological response (MPR) rate. From March 01, 2022 to April 10, 2023, 46 patients were enrolled (n = 23 in each cohort), with 42 patients receiving the full two-cycle treatments and undergoing surgery (n = 22 in the nab-paclitaxel cohort, n = 20 in the paclitaxel cohort). The MPR rate and the pCR rate in the total cohort were 44.2% (19/42) and 19.0% (8/42), respectively, with 59.1% (13/22) and 31.8% (7/22) in the nab-paclitaxel cohort and 30.0% (6/20) and 5.0% (1/20) in paclitaxel cohorts. The most common treatment-related adverse events (TRAEs) were anemia (89.1%) and alopecia (71.7%), and no significant difference in TRAEs was observed between the two cohorts. Up until March 28, 2024, the median follow-up time was 15.5 months (range of 6.0-24.3 months), and the survival analysis revealed that the patients in the nab-paclitaxel cohort had a higher event-free survival (p = .002). In conclusion, neoadjuvant tislelizumab combined with cisplatin and nab-paclitaxel, rather than cisplatin and paclitaxel, is a more effective neoadjuvant strategy for locally advanced thoracic ESCC.
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Affiliation(s)
- Jie Wang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bin Li
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yawei Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoyang Luo
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiliang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hang Li
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yunjian Pan
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Longlong Shao
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shanbo Zheng
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chongze Yuan
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qiang Zheng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Si Sun
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Weixin Zhao
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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24
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Okui J, Nagashima K, Matsuda S, Sato Y, Kawakubo H, Takeuchi M, Hirata K, Yamamoto S, Nomura M, Tsushima T, Takeuchi H, Kato K, Kitagawa Y. Investigating the synergistic effects of immunochemotherapy in esophageal squamous cell carcinoma. Esophagus 2025; 22:188-197. [PMID: 39966261 DOI: 10.1007/s10388-025-01113-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 02/07/2025] [Indexed: 02/20/2025]
Abstract
BACKGROUND Although combinations of immune-checkpoint inhibitors (ICI) with chemotherapy have been approved for esophageal squamous cell carcinoma (ESCC), it remains unclear whether immunochemotherapy (ICT) offers advantages over the simple addition of individual monotherapies. This study aimed to investigate whether ICT exhibits a synergistic effect in patients with advanced ESCC. METHODS Reconstructed individual patient data of 3330 patients were electronically extracted from the Kaplan-Meier (KM) curves of eight randomized-controlled trials (ATTRACTION-3, CheckMate648, KEYNOTE-181, KEYNOTE-590, RATIONALE-302, RATIONALE-306, ESCORT, and ESCORT-1st). The observed progression-free survival (PFS) curve of each constituent monotherapies was used to estimate simulated PFS curves expected under a model of independent drug action. If the observed curve demonstrated significantly better PFS than the simulated curve, the combination of ICI and chemotherapy may have a synergistic effect, implying a superior outcome compared to simply adding the component monotherapy. RESULTS The 1-year, 2-year, and median PFS of the observed and simulated KM curves were 26.3% vs. 24.8%, 14.6% vs. 12.0%, and 6.9 vs. 6.4 months, respectively. The one-sample log-rank test showed no significant differences between the observed and simulated KM curves (p = 0.073). CONCLUSIONS The observed PFS with ICT was comparable to the simulated PFS estimated from the data for each monotherapy. Although it is unclear whether potential synergies exist for ICT, these findings suggest that the benefits of ICI and chemotherapy do not interfere with each other, thereby providing theoretical support for the efficacy of ICT.
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Affiliation(s)
- Jun Okui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Biostatistics, Keio University School of Medicine, Tokyo, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Yasunori Sato
- Department of Biostatistics, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shun Yamamoto
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Motoo Nomura
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Takahiro Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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25
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Ren W, Zhang H, Li Y, Sun W, Peng H, Guo H, Hou T, Wang M, Hu Z, Wu T, Liu B. Efficacy and safety of PD-1/PD-L1 inhibitors as first-line treatment for esophageal squamous cell carcinoma: a systematic review and meta-analysis. Front Immunol 2025; 16:1563300. [PMID: 40207226 PMCID: PMC11979238 DOI: 10.3389/fimmu.2025.1563300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 03/07/2025] [Indexed: 04/11/2025] Open
Abstract
Purpose This study aims to investigate the efficacy and safety of PD-1/PD-L1 inhibitors in the first-line treatment of esophageal squamous cell carcinoma (ESCC) and identify factors influencing efficacy through a meta-analysis of multiple phase 3 randomized controlled trials (RCTs). Methods A systematic literature search was conducted in Cochrane, PubMed, and Embase databases. Two researchers independently extracted trial data, including efficacy-related outcomes such as overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and duration of response (DoR), along with their subgroup data and safety-related indicators. The overall hazard ratio (HR) and 95% confidence interval (CI) were calculated for OS and PFS, while the overall odds ratio (OR) and 95% CI were computed for ORR to compare the classification and predictive abilities of combined positive score (CPS) and tumor proportion score (TPS) for PD-L1 status. Additionally, survival outcomes across different subgroups were evaluated to explore the potential influencing factors for the efficacy of PD-1/PD-L1 inhibitors in ESCC. Results This meta-analysis included eight phase 3 RCTs encompassing 4,479 participants. PD-1/PD-L1 inhibitors combined with chemotherapy significantly improved OS (HR: 0.68, 95% CI: 0.63-0.74) and PFS (HR: 0.62, 95% CI: 0.58-0.67) in ESCC patients compared to non-combination therapy. Patients with higher PD-L1 expression (CPS>1 or TPS>1) demonstrated superior responses to PD-1/PD-L1 inhibitions, with CPS identified as a stronger predictor of therapeutic benefit, particularly at a threshold of CPS =10. Subgroup analysis revealed that male, Asian, smoking, and liver metastasis patients exhibited a greater trend toward improved disease control with PD-1/PD-L1 inhibitors. However, there was no significant difference in treatment efficacy between immune therapy combined with TP (taxol [paclitaxel] + cisplatin) and FP (5-fluorouracil [5-FU] + cisplatin) regimens (POS =0.51, PPFS =0.11). Finally, PD-1/PD-L1 inhibition was associated with a higher incidence of grade ≥3 adverse events compared to chemotherapy alone (HR: 1.21, 95% CI: 1.07-1.37). Conclusions This study confirms that the combination of PD-1/PD-L1 inhibitors and chemotherapy provides significant clinical benefits in ESCC. CPS =10 serves as a key threshold for predicting treatment response. There is a trend suggesting that male, Asian, smoking, and liver metastasis patients may experience better survival benefits, while no significant difference was observed between TP- and FP-based regimens. Systematic Review Registration https://www.crd.york.ac.uk/prospero, identifier CRD42024536221.
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Affiliation(s)
- Wei Ren
- The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Hanyu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yixin Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wu Sun
- The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Hexiang Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Huangda Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Tianjiao Hou
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Mengying Wang
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Zhendong Hu
- Department of Esophageal Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Baorui Liu
- The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, China
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26
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Wei ZJ, Wang L, Wang RQ, Wang Y, Chen H, Ma HL, Xu YJ. Safety and effectiveness of induction chemoimmunotherapy followed by definitive radiotherapy or concurrent chemoradiotherapy in esophageal squamous cell carcinoma. World J Clin Oncol 2025; 16:101251. [PMID: 40130057 PMCID: PMC11866093 DOI: 10.5306/wjco.v16.i3.101251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 12/01/2024] [Accepted: 12/25/2024] [Indexed: 01/21/2025] Open
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) is a common malignancy in China, often diagnosed at an advanced stage, with poor prognosis. Standard treatments such as definitive chemoradiotherapy offer limited survival benefits. Recent advances in immune checkpoint inhibitors combined with chemotherapy have shown promise, but their effectiveness and safety in conjunction with radiotherapy for unresectable ESCC require further exploration. AIM To assess the safety and effectiveness of induction chemoimmunotherapy followed by definitive radiotherapy or concurrent chemoradiotherapy (CCRT) in locally advanced unresectable ESCC. METHODS This retrospective study included 80 patients with locally advanced unresectable ESCC who underwent induction chemoimmunotherapy followed by definitive radiotherapy, recruited from Zhejiang Cancer Hospital. All patients received 2-4 cycles of chemotherapy plus programmed cell death 1/programmed cell death ligand 1 inhibitor, were re-evaluated to be inoperable, then received definitive radiotherapy or CCRT. Primary endpoint was treatment safety and tolerance. SPSS 26.0 software was used for data analysis. Th Kaplan-Meier method was used for survival analysis. RESULTS Thirty-seven (46.3%) patients received CCRT and 43 (53.7%) received radiotherapy alone. The most common treatment-related adverse events included radiation esophagitis (32/80, 40.0%) and anemia (49/80, 61.3%), with 22 (27.5%) experiencing grade ≥ 3 adverse events. No treatment-related deaths occurred. After median follow-up of 16.5 months, the median progression-free survival (PFS) was 14.2 months, and median overall survival (OS) was 19.9 months. The 1-year and 2-year PFS and OS were 55.8% and 31.6%, and 67.5% and 44.1%, respectively. Patients with partial response had better outcomes than those with stable disease: 1-year PFS 69.4% vs 43.9% (P = 0.011) and OS 83.2% vs 48.8% (P = 0.007). Induction therapy effectiveness and immunotherapy maintenance were independent prognostic factors for OS. CONCLUSION Chemotherapy combined with programmed cell death 1/programmed cell death ligand 1 inhibitor followed by definitive radiotherapy or CCRT in patients with locally advanced ESCC was safe and effective.
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Affiliation(s)
- Zhuo-Jun Wei
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
- School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang Province, China
| | - Lin Wang
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Rui-Qi Wang
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Yu Wang
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Huan Chen
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Hong-Lian Ma
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Yu-Jin Xu
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
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Chen H, Yan J, Liu Z, Ge X, Sun X, Xia X. Real-World Clinical Outcomes of Trilaciclib for the Prevention of Myelosuppression in Patients with Esophageal Cancer Undergoing Chemotherapy. Curr Oncol 2025; 32:189. [PMID: 40277746 PMCID: PMC12025781 DOI: 10.3390/curroncol32040189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Revised: 03/12/2025] [Accepted: 03/19/2025] [Indexed: 04/26/2025] Open
Abstract
This study aims to evaluate the clinical effectiveness of trilaciclib in preventing myelosuppression in patients with esophageal cancer undergoing chemotherapy. Based on the use of trilaciclib, 81 patients were divided into a primary prevention group (PP group, n = 49) and a secondary prevention group (SP group, n = 32). The incidence of myelosuppression, antibiotic usage rate, survival outcomes, and other treatment-related toxicities were analyzed using chi-square tests and Kaplan-Meier survival curves. The incidence of chemotherapy-induced myelosuppression in the SP group was significantly higher than that in the PP group (96.9% vs. 79.6%), with a significantly higher proportion of grade III and above events (37.6% vs. 8.2%, p < 0.05). For chemotherapy-induced neutropenia, the incidence of grade III/IV events in the SP group was significantly higher than in the PP group (28.1% vs. 8.2%, p = 0.017). Additionally, the SP group experienced higher rates and severity of chemotherapy-induced anemia and thrombocytopenia. The PP group provided better protection against grade III/IV leukopenia and neutropenia (p < 0.05). Non-hematological toxicities and efficacy outcomes were similar between groups (p > 0.05). The study is the first to demonstrate that trilaciclib is a safe and effective option for the prevention of myelosuppression in esophageal cancer patients.
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Affiliation(s)
- Hui Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (H.C.); (J.Y.); (X.G.)
| | - Jingze Yan
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (H.C.); (J.Y.); (X.G.)
| | - Zeyuan Liu
- Department of Radiation Oncology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211199, China;
- Department of Oncology, Kangda College of Nanjing Medical University, Nanjing 210029, China
| | - Xiaolin Ge
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (H.C.); (J.Y.); (X.G.)
| | - Xinchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (H.C.); (J.Y.); (X.G.)
| | - Xiaojie Xia
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (H.C.); (J.Y.); (X.G.)
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28
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Hong Y, Liu J, Lu P, Chang Z, Zhang G, Ma X, Liang W, Tian Y, Xia J, Cao H, Huang J. Feasibility and tolerability of anlotinib plus PD-1 blockades as rechallenge immunotherapy in previously treated advanced ESCC: a retrospective study. Oncologist 2025; 30:oyae245. [PMID: 39303674 PMCID: PMC11954505 DOI: 10.1093/oncolo/oyae245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/01/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Rechallenge with immune checkpoint inhibitor (ICI) seemed favorable in several tumors, but clinical experience on esophageal squamous cell carcinoma (ESCC) was scanty. This real-world study aimed to assess the feasibility and safety of anlotinib plus ICI for patients with previously ICI-treated advanced ESCC. MATERIALS AND METHODS We retrospectively identified advanced ESCC patients who received anlotinib plus ICI in the rechallenge setting for evaluation of clinical outcomes and safety. Totally 110 ICI-pretreated patients, of which 89 (80.9%) received prior first- or second-line treatment, were included from September 9, 2019, to November 30, 2022. Most patients (63.6%) discontinued initial ICI due to disease progression. RESULTS After rechallenge, median overall survival (OS) and progression-free survival (PFS) were 11.1 (95% CI, 8.6-13.7) and 5.6 (95% CI, 4.4-6.8) months, respectively; estimated OS and PFS rates at 12 months were 47.6% (95% CI, 36.8%-57.7%) and 21.4% (95% CI, 10.9%-34.2%), respectively. No complete response was reported and 21 (19.1%) patients attained partial response; the objective response rate was 19.1%. Fifty-five (50.0%) had stable disease for a disease control rate of 69.1%. Of the 21 responders, median duration of response was 6.4 months. Tendencies for longer OS were observed in patients with Eastern Cooperative Oncology Group Performance of 0 (P = .056). The incidence of grade 3 or higher treatment-related adverse events was 10.0%. CONCLUSION Anlotinib plus ICI in the rechallenge setting was promising and resulted in encouraging benefits for patients with previously ICI-treated advanced ESCC. Our findings provided preliminary but unique evidence to help select ESCC patients benefiting from this strategy. TRIAL REGISTRATION chictr.org.cn; number ChiCTR2300070777.
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Affiliation(s)
- Yonggui Hong
- Gastroenterology, Anyang Tumor Hospital, Anyang 455000, People’s Republic of China
| | - Jun Liu
- Radiation Oncology Department, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200025, People’s Republic of China
| | - Ping Lu
- Medical Oncology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, People’s Republic of China
| | - Zhiwei Chang
- Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People’s Republic of China
| | - Guifang Zhang
- Medical Oncology, Xinxiang Central Hospital, Xinxiang 453700, People’s Republic of China
| | - Xiumei Ma
- Radiation Oncology, Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200127, People’s Republic of China
| | - Wei Liang
- Radiation Oncology, Huixian People’s Hospital, Xinxiang 453000, People’s Republic of China
| | - Yongjing Tian
- Thoracic surgery, Nanyang Central Hospital, Nanyang 473000, People’s Republic of China
| | - Jin Xia
- Department of Oncology and Palliative Care, Anyang Tumor Hospital, Anyang 455000, People’s Republic of China
| | - Heng Cao
- Gastroenterology, Anyang Tumor Hospital, Anyang 455000, People’s Republic of China
| | - Jing Huang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People’s Republic of China
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Lu Z, Sun G, Li J, Zhao J, Wang Z, Qian D, Yang Z, Li N, Wang J, Yuan S, Wang Y, Li S, Yang Z, Ran F, Ji Y, Zhu S, Zhang Y, Wang C, Wan L, Zheng R, Deng W, Cheng F, Shen L. Effectiveness, safety, and patterns of use of camrelizumab in advanced esophageal cancer: an individual patient data pooled analysis of 987 patients from three prospective cohort studies. Cancer Immunol Immunother 2025; 74:138. [PMID: 40056201 PMCID: PMC11890476 DOI: 10.1007/s00262-025-03970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 02/06/2025] [Indexed: 03/10/2025]
Abstract
BACKGROUND AND AIMS This individual patient data pooled analysis aimed to evaluate the effectiveness, safety, and patterns of use of camrelizumab in a large cohort of advanced esophageal cancer (AEC) patients. APPROACH AND RESULTS Adult patients (≥ 18 years) who had received camrelizumab as part of AEC treatment were pooled from three independent, prospective observational cohort studies (NCT04616040, ChiCTR1900027275, and ChiCTR2000039499). The main outcomes were patterns of camrelizumab use, progression-free survival (PFS), overall survival (OS), and safety in the overall population and specific subgroups of underrepresented patients. Among 987 patients, 450 (45.6%) received camrelizumab in the first line, 398 (40.3%) in the second line, and 139 (14.1%) in the third line or later. Most (69.7%) patients received camrelizumab plus chemotherapy regardless of treatment lines. The median PFS was 9.9 (95% CI 7.4, 14.4), 6.6 (95% CI 5.1, 8.8), and 5.7 (95% CI 3.1, 9.6) months in the first line, second line, and third line or later, respectively. The corresponding median OS was 15.5 (95% CI 12.6, 18.4), 12.1 (95% CI 10.0, 14.7), and 10.9 (95% CI 8.1, 14.5) months. Patients with poor performance status (ECOG PS ≥ 2) and with camrelizumab in the second line or later, but not patients with older age (≥ 75 years), were associated with poor survival. Adverse events occurred in 721 (73.0%) patients, with no new safety signals. CONCLUSIONS This study provides an overview of camrelizumab use in unselected AEC patients. The real-world effectiveness and safety of camrelizumab are generally consistent with those observed in pivotal trials.
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Affiliation(s)
- Zhihao Lu
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, China.
| | - Guoping Sun
- Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jun Zhao
- Department of Oncology, Changzhi People's Hospital of Changzhi Medical College, Changzhi, China
| | - Zishu Wang
- Department of Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Dong Qian
- Department of Radiation Oncology, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Hefei, China
| | - Zhe Yang
- Cancer Research and Treatment Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Na Li
- Department of Oncology, Suining Central Hospital, Suining, China
| | - Junsheng Wang
- Department of Internal Medicine, Anyang Cancer Hospital, Anyang, China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
| | - Yusheng Wang
- Department of Gastroenterology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Suyi Li
- Department of Oncology, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Hefei, China
| | - Zhen Yang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fengming Ran
- Department of Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinghua Ji
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Shaojin Zhu
- Department of Thoracic Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Yanqiao Zhang
- Department of Gastroenterology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Chen Wang
- Department of Gastroenterology, Ganzhou People's Hospital - North Hospital, Ganzhou, China
| | - Lixin Wan
- Department of Medial Oncology, Nanyang Central Hospital, Nanyang, China
| | - Rongrong Zheng
- Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Wenjie Deng
- Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Fengzhuo Cheng
- Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, China.
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Huber Y, Moehler M, Högner A. Immunotherapy as a new perspective for the therapy of esophageal cancer. Innov Surg Sci 2025; 10:37-41. [PMID: 40144784 PMCID: PMC11934939 DOI: 10.1515/iss-2023-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/07/2024] [Indexed: 03/28/2025] Open
Abstract
The therapeutic landscape in nearly every therapeutic line in advanced/metastatic patients with squamous cell carcinoma (SCC) and esophagogastric adenocarcinoma (EGC) is enriched by recent approvals of immune checkpoint inhibitors (ICIs). In curative intended therapy, patients without pathological residual disease of SCC or GEJ (esophagogastric junction) cancer after preoperative chemoradiation and complete resection have access to adjuvant immunotherapy (independent of PD-L1 (programmed cell death protein 1) status, nivolumab, CHECKMATE 577). For metastatic SCC in the first-line, nivolumab combined with chemotherapy or with ipilimumab (TPS (tumor proportion score) ≥1 %, SCC, CHECKMATE 648) are approved, as well as second-line nivolumab alone regardless of PD-L1 status (ATTRACTION 03). For both, locally advanced or metastatic SCC and EGC, chemotherapy with pembrolizumab is available for patients with CPS (combined positive score) ≥10 (KEYNOTE 590) and for adenocarcinoma with nivolumab (CPS ≥5, CHECKMATE 649). Recent added approvals are chemotherapy with pembrolizumab in CPS ≥1 patients (KEYNOTE 859) and the addition of trastuzumab for personalized therapy in HER-2 positive/CPS ≥1 gastric and GEJ patients (KEYNOTE 811).
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Affiliation(s)
- Yvonne Huber
- Department of Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Markus Moehler
- Department of Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anica Högner
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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31
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Jiang W, Zhang B, Xu J, Xue L, Wang L. Current status and perspectives of esophageal cancer: a comprehensive review. Cancer Commun (Lond) 2025; 45:281-331. [PMID: 39723635 PMCID: PMC11947622 DOI: 10.1002/cac2.12645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 12/08/2024] [Accepted: 12/10/2024] [Indexed: 12/28/2024] Open
Abstract
Esophageal cancer (EC) continues to be a significant global health concern, with two main subtypes: esophageal squamous cell carcinoma and esophageal adenocarcinoma. Prevention and changes in etiology, improvements in early detection, and refinements in the treatment have led to remarkable progress in the outcomes of EC patients in the past two decades. This seminar provides an in-depth analysis of advances in the epidemiology, disease biology, screening, diagnosis, and treatment landscape of esophageal cancer, focusing on the ongoing debate surrounding multimodality therapy. Despite significant advancements, EC remains a deadly disease, underscoring the need for continued research into early detection methods, understanding the molecular mechanisms, and developing effective treatments.
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Affiliation(s)
- Wei Jiang
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhenGuangdongP. R. China
| | - Bo Zhang
- Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingP. R. China
| | - Jiaqi Xu
- Department of PathologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingP. R. China
| | - Liyan Xue
- Department of PathologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingP. R. China
| | - Luhua Wang
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhenGuangdongP. R. China
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32
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Pyreddy S, Kim S, Miyamoto W, Talib Z, GnanaDev DA, Rahnemai-Azar AA. Current Advances in Immunotherapy Management of Esophageal Cancer. Cancers (Basel) 2025; 17:851. [PMID: 40075698 PMCID: PMC11898678 DOI: 10.3390/cancers17050851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 02/03/2025] [Accepted: 02/10/2025] [Indexed: 03/14/2025] Open
Abstract
Esophageal cancer is one of the most common and deadliest cancers worldwide. Rates of esophageal cancer worldwide have been steadily rising over the past decade due to higher incidence of gastroesophageal reflux disease (GERD). Current therapies include surgical resection, chemotherapy, and limited targeted therapies. One obstacle to care is tumor cells' ability to evade immune surveillance, which can render certain therapeutics ineffective. Immunotherapy provides a new paradigm to cancer treatment, which has proven to be effective in evasive tumors. In recent years, PD-1/PD-L1 and CLTA-4 inhibitors have been used as frontline treatment and have shown to be extremely effective in the treatment of hard-to-treat tumors. Here, we aim to analyze the current literature regarding current therapeutics along with emerging techniques and future receptor targets for immunotherapy.
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Affiliation(s)
- Sagar Pyreddy
- School of Medicine, California University of Science and Medicine, Colton, CA 92324, USA; (S.P.); (S.K.); (W.M.); (Z.T.)
| | - Sarah Kim
- School of Medicine, California University of Science and Medicine, Colton, CA 92324, USA; (S.P.); (S.K.); (W.M.); (Z.T.)
| | - William Miyamoto
- School of Medicine, California University of Science and Medicine, Colton, CA 92324, USA; (S.P.); (S.K.); (W.M.); (Z.T.)
| | - Zohray Talib
- School of Medicine, California University of Science and Medicine, Colton, CA 92324, USA; (S.P.); (S.K.); (W.M.); (Z.T.)
| | - Dev A. GnanaDev
- Department of Surgery, Arrowhead Regional Medical Center, Colton, CA 92324, USA;
| | - Amir A. Rahnemai-Azar
- Division of Surgical Oncology, Department of Surgery, Arrowhead Regional Cancer Center, California University of Science and Medicine, Colton, CA 92324, USA
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33
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Zhang X, Zhao W, Du Y, Su F, Zhang Y, Wang H, Li Y, Liu M, Gao Y, Cai L, Feng T, Wang M, Yao C, Xu N, Wang Y, Song G, Hu W, Zhao J. Immune repertoire sequencing reveals differences in treatment response to camrelizumab plus platinum-based chemotherapy in advanced ESCC. Front Immunol 2025; 16:1526443. [PMID: 40079001 PMCID: PMC11897899 DOI: 10.3389/fimmu.2025.1526443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 01/21/2025] [Indexed: 03/14/2025] Open
Abstract
This study evaluated the efficacy and safety of camrelizumab combined with platinum-based chemotherapy (taxanes [T] or fluorouracil agents [F] plus platinum [P] drugs) as the first-line treatment in advanced esophageal squamous cell carcinoma (ESCC), using immune repertoire sequencing (IRS) to explore treatment response mechanism. In this multi-center, prospective cohort study, 88 patients received camrelizumab plus TP or FP, achieving a 1-year progression-free survival of 56.8% and overall survival of 68.2%. The objective response rate (ORR) was 64.8%, with a disease control rate of 91.1%. While most treatment-related adverse events were mild, 12.5% of patients experienced grade ≥3 toxicities. IRS showed significant differences in T-cell receptor (TCR) β-chain and immunoglobulin heavy chain between patients with (ORR group) or without ORR (non-ORR group), particularly in the distribution and expression of some genes. Specifically, we found the significant differences in the amino acid composition of complementarity determining region 3 (CDR3) polypeptide sequences in TCR and B-cell receptor (BCR) between the ORR and non-ORR groups. For TCR, we observed substantial oligoclonal enrichment and differences in the abundance of specific V and J genes. Similarly, for BCR, we detected differences in the clonotype abundance of CDR3 polypeptide segments and identified several differential V genes. Camrelizumab combined with platinum-based chemotherapy is effective and well-tolerated as the first-line treatment for ESCC, and IRS may reveal mechanism influencing treatment response.
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Affiliation(s)
- Xiaoling Zhang
- Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
- Laboratory Animal Center, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Basic Medical Sciences, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenqi Zhao
- Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Yunyi Du
- Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Fei Su
- Department of Graduate School, Graduate of School of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuexiang Zhang
- Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Hui Wang
- Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Yongai Li
- Imaging Center, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Min Liu
- Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Yangjun Gao
- Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Linlin Cai
- Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Tingting Feng
- Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Mei Wang
- Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Chunmei Yao
- Department of Oncology, Anhui Huaibei Miners General Hospital, Anhui, China
| | - Ning Xu
- Department of Oncology, Fenyang Hospital of Shanxi Province, Fenyang, Shanxi, China
| | - Yu Wang
- Department of Pathology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Guohua Song
- Laboratory Animal Center, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Basic Medical Sciences, Shanxi Medical University, Taiyuan, Shanxi, China
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenqing Hu
- Department of Gastroenterology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Jun Zhao
- Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
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Zeng R, Zhou X, Ou K, Chen W, Yang C, Wang T, Li Y, Zha Y, Li M, Zhang J. Case report: Long-term survival in synchronous double primary malignancies of lung adenocarcinomas and esophageal squamous cell carcinoma treated with definitive chemoradiotherapy and SBRT combined with anti-PD-1. Front Immunol 2025; 16:1548176. [PMID: 40028319 PMCID: PMC11867956 DOI: 10.3389/fimmu.2025.1548176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 01/29/2025] [Indexed: 03/05/2025] Open
Abstract
Background The occurrence of multiple primary cancers has become common, and the treatment of such patients is very complex, so it is necessary to combine a variety of individualized treatment methods to achieve better treatment results. Case description This report describes a patient with double primary tumors of lung and esophageal cancer had more than 36 months survival with non-operation treatment. The patient diagnosed as lung adenocarcinomas (LADC) and esophageal squamous cell carcinoma (ESCC), was treated with albumin-bound paclitaxel, nedaplatin, and anti-programmed death 1 (anti-PD-1). The esophageal lesions achieved complete response (CR) after finishing two courses of induction chemotherapy combined with anti-PD-1 followed by definitive chemoradiotherapy (CRT). Radiation pneumonitis (RP) occurred one month after the completion of CRT. The pneumonia was relieved after dexamethasone and moxifloxacin treatment. Then, the lung lesion was treated with oral chemotherapy followed by stereotactic body radiation therapy (SBRT). As of July 2024, the patient has survived for more than 3 years after the above treatments, and the current efficacy evaluation is CR of esophageal lesions, PR of pulmonary lesions. Conclusion The multi-modality approach of systemic therapy combined with localized radiotherapy is an effective treatment in the patients of the double primary malignant tumors of LADC and ESCC. The safety and toxicity of radiotherapy for the thoracic double primary tumors demonstrate acceptability.
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Affiliation(s)
- Rui Zeng
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, Guangdong, China
- Department of Radiotherapy, People’s Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Xiaoyun Zhou
- Department of Radiotherapy, People’s Hospital of Zhongshan, Zhongshan, Guangdong, China
- Department of Radiation Oncology, Shenzhen University Medical School, Shenzhen, Guangdong, China
| | - Kexin Ou
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, Guangdong, China
- Department of Radiotherapy, People’s Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Wei Chen
- Department of Radiotherapy, People’s Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Chen Yang
- Department of Radiotherapy, People’s Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Ting Wang
- Department of Radiotherapy, People’s Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Yani Li
- Department of Radiotherapy, People’s Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Yawen Zha
- Department of Radiotherapy, People’s Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Minying Li
- Department of Radiotherapy, People’s Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Jingjing Zhang
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, Guangdong, China
- Department of Radiotherapy, People’s Hospital of Zhongshan, Zhongshan, Guangdong, China
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Deng M, Qing Y, Qiu D, Sheng Y, Zhou J, Sun L. The prognostic value of pretreatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with esophageal cancer undergoing immunotherapy: a systematic review and meta-analysis. Front Oncol 2025; 15:1536920. [PMID: 40027124 PMCID: PMC11868166 DOI: 10.3389/fonc.2025.1536920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 01/22/2025] [Indexed: 03/05/2025] Open
Abstract
Background Esophageal cancer (EC) is associated with a high morbidity and mortality rate. Immunotherapy has demonstrated effective antitumor activity in patients with EC, making it imperative to investigate easily accessible prognostic factors. Consequently, we conducted a meta-analysis to explore the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in EC patients treated with immunotherapy. Methods The literature search was conducted across three databases: PubMed, Embase, and Web of Science. The primary deadline for literature retrieval was July 2024. Hazard ratio (HR) with a 95% confidence interval (CI) was utilized to assess the association between NLR or PLR and overall survival (OS) as well as progression-free survival (PFS). Statistical analysis was performed using Review Manager version 5.4 and STATA version 15.0. Results The meta-analysis included a total of 16 studies involving 1,481 patients. The results indicated a significant correlation between high pretreatment NLR and poor PFS (HR=1.76, 95%CI:1.38-2.25, p<0.001) as well as poor OS (HR=2.61,95%CI:1.86-3.67, p<0.001). Subgroup analyses based on tumor stage revealed that the association between elevated NLR and poor PFS was only observed in advanced EC patients. Regarding PLR, an increased PLR was found to be indicative of inferior PFS (HR=1.44, 95%CI: 1.20-1.72, p<0.001) and OS (HR=1.72,95%CI:1.08-2.74, p=0.020). However, the sensitivity analyses suggested that the observed increase in PLR lack robustness in terms of its impact on inferior OS. Conclusion Elevated NLR and PLR are associated with inferior PFS and OS in EC patients receiving immunotherapy. These findings suggest that NLR and PLR levels hold promise as prognostic biomarkers in clinical practice, offering valuable guidance for personalized immunotherapy strategies. Systematic Review Registration PROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42024596737.
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Affiliation(s)
| | | | | | | | | | - Lan Sun
- Department of Oncology, Bishan Hospital of Chongqing Medical University, Chongqing, China
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Lorch JH, Stein S, Edelman MJ. Are all programmed cell death protein 1 inhibitors the same? Front Oncol 2025; 15:1535030. [PMID: 40027132 PMCID: PMC11867946 DOI: 10.3389/fonc.2025.1535030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 01/27/2025] [Indexed: 03/05/2025] Open
Abstract
Programmed cell death protein 1 (PD-1) inhibitors have revolutionized the treatment of many cancers, seven of which are approved by the US Food and Drug Administration (FDA). No head-to-head phase 3 randomized controlled trials (RCTs) comparing PD-1 inhibitors have been conducted so it remains unknown whether clinically meaningful differences exist between them. Preclinical studies that have directly compared PD-1 inhibitors support a differentiating profile associated with toripalimab compared to pembrolizumab and nivolumab with regard to their PD-1 binding sites, binding orientations, and impact on T cell function. Findings of similar or greater benefit among patients with low/no PD-L1 expression versus high/intermediate PD-L1 expression with toripalimab plus chemotherapy were also observed in advanced nasopharyngeal carcinoma and non-small cell lung cancer for both overall survival and progression-free survival. However, determination of clinically-meaningful differences between PD-1 inhibitors requires sufficiently powered head-to-head RCTs.
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Affiliation(s)
- Jochen H. Lorch
- Department of Medicine, Hematology/Oncology Division, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Stacey Stein
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Martin J. Edelman
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
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Liu D, Liu A, Guo L, Li Y, Li Y, Chi Y, Lin H, Yu J, Li M. Postoperative Adjuvant Therapy Benefits Non-pCR Patients Rather Than pCR Patients for Locally Advanced ESCC: A Multicenter Real-World Study. Thorac Cancer 2025; 16:e70021. [PMID: 39988453 PMCID: PMC11847616 DOI: 10.1111/1759-7714.70021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 02/04/2025] [Accepted: 02/08/2025] [Indexed: 02/25/2025] Open
Abstract
BACKGROUND There is no unified standard in adjuvant therapy (AT) for patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant therapy and surgery. We evaluated the significance of AT for these patients and explored its influencing factors. METHODS ESCC patients who underwent neoadjuvant therapy and surgery from 2019 to 2022 at three centers were divided into AT (n = 227) and non-AT groups (n = 435). Baseline characteristics were balanced using propensity score matching (PSM). Primary endpoints were disease-free survival (DFS) and overall survival (OS), assessed using the Kaplan-Meier method. Subgroup analyses and univariate and multivariate Cox regression analyses were conducted to identify the prognostic factors. RESULTS The median follow-up period is 36 (2-72) months. After PSM, the total population had 1-, 2-, and 3-year OS rates of 71.3%, 66.0%, and 64.1%, respectively. There were no statistically significant differences in DFS (HR: 0.79; 95% CI: 0.55-1.14, p = 0.21) or OS (HR: 0.75; 95% CI: 0.49-1.13, p = 0.17) between AT and non-AT groups. Subgroup analysis revealed that non-pCR patients benefited from AT in DFS (p = 0.042) and OS (p = 0.033). Moreover, in non-pCR patients who received AT, BMI ≥ 21.5 kg/m2 and ypN0 were independent protective factors of DFS. ypN0 was an independent protective factor of OS. In terms of AT regimens, the Kaplan-Meier analysis revealed that adjuvant immunochemotherapy (AICT) provided superior survival benefits than adjuvant radiotherapy and adjuvant chemotherapy. CONCLUSIONS Postoperative AT benefited ESCC patients with non-pCR, while AICT may be a relatively better AT regimen in real-world data, which deserves further exploration.
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Affiliation(s)
- Defeng Liu
- Cheeloo College of MedicineShandong UniversityJinanChina
- Department of Radiation Oncology, Shandong Cancer Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Ao Liu
- Cheeloo College of MedicineShandong UniversityJinanChina
- Department of Radiation Oncology, Shandong Cancer Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Longxiang Guo
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
- Department of OncologyDongying People's HospitalDongyingChina
| | - Yi Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Yuanlin Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Yuxiang Chi
- Cheeloo College of MedicineShandong UniversityJinanChina
- Institute of Oncology, Shandong Provincial HospitalShandong UniversityJinanChina
| | - Haiqun Lin
- Department of Radiation OncologyThe Second Hospital of Shandong UniversityJinanChina
| | - Jinming Yu
- Cheeloo College of MedicineShandong UniversityJinanChina
- Department of Radiation Oncology, Shandong Cancer Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Minghuan Li
- Cheeloo College of MedicineShandong UniversityJinanChina
- Department of Radiation Oncology, Shandong Cancer Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
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Obermannová RL, Leong T. ESMO Clinical Practice Guideline interim update on the treatment of locally advanced oesophageal and oesophagogastric junction adenocarcinoma and metastatic squamous-cell carcinoma. ESMO Open 2025; 10:104134. [PMID: 39986705 PMCID: PMC11889489 DOI: 10.1016/j.esmoop.2025.104134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 01/02/2025] [Indexed: 02/24/2025] Open
Abstract
•This update provides recommendations for perioperative treatment of locally advanced oesophageal and OGJ adenocarcinoma. •Recent phase III data have demonstrated that perioperative ChT should be the preferred approach for most patients. •Updated recommendations are also provided for the use of immune checkpoint inhibitors in advanced squamous-cell carcinoma. •Algorithms for the management of locoregional oesophageal cancer and advanced squamous-cell carcinoma are provided. •Recommendations are based on available scientific data and the authors’ collective expert opinion.
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Affiliation(s)
- R L Obermannová
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - T Leong
- The Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
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Wei H, Zhao D, Zhi Y, Wu Q, Ma J, Xu J, Liu T, Zhang J, Wang P, Hu Y, He X, Guo F, Jiang M, Zhang D, Nie W, Yang R, Zhao T, Dong Z, Liu K. RTN4IP1 Contributes to ESCC via Regulation of Amino Acid Transporters. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2025; 12:e2406220. [PMID: 39757767 PMCID: PMC11848606 DOI: 10.1002/advs.202406220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 10/19/2024] [Indexed: 01/07/2025]
Abstract
Esophageal squamous cell carcinoma (ESCC) accounts for about 90% of esophageal cancer cases. The lack of effective therapeutic targets makes it difficult to improve the overall survival of patients with ESCC. Reticulon 4 Interacting Protein 1 (RTN4IP1) is a novel mitochondrial oxidoreductase. Here, a notable upregulation of RTN4IP1 is demonstrated, which is associated with poor survival in patients with ESCC. RTN4IP1 depletion impairs cell proliferation and induces apoptosis of ESCC cells. Furthermore, c-Myc regulates RTN4IP1 expression via iron regulatory protein 2 (IRP2) at the post-transcriptional level. Mechanistically, RTN4IP1 mRNA harbors functional iron-responsive elements (IREs) in the 3' UTR, which can be targeted by IRP2, resulting in increased mRNA stability. Finally, RTN4IP1 depletion abrogates amino acid uptake and induces amino acid starvation via downregulation of the amino acid transporters SLC1A5, SLC3A2, and SLC7A5, indicating a possible pathway through which RTN4IP1 contributes to ESCC carcinogenesis and progression. In vivo studies using cell-derived xenograft and patient-derived xenograft mouse models as well as a 4-nitroquinoline 1-oxide-induced ESCC model in esophageal-specific Rtn4ip1 knockout mice demonstrate the essential role of RTN4IP1 in ESCC development. Thus, RTN4IP1 emerges as a key cancer-promoting protein in ESCC, suggesting therapeutic RTN4IP1 suppression as a promising strategy for ESCC treatment.
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Affiliation(s)
- Huifang Wei
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou University, China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Dengyun Zhao
- Department of PathophysiologySchool of Basic Medical Sciences, Zhengzhou UniversityChina‐US (Henan) Hormel Cancer InstituteChest Hospital of Zhengzhou UniversityZhengzhou450000China
| | - Yafei Zhi
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou University, China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Qiong Wu
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou University, China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Jing Ma
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou UniversityZhengzhou450000China
| | - Jialuo Xu
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou UniversityZhengzhou450000China
| | - Tingting Liu
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou University, China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Jing Zhang
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou University, China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Penglei Wang
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou University, China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Yamei Hu
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou University, China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Xinyu He
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou University, China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Fangqin Guo
- Department of PathophysiologySchool of Basic Medical SciencesZhengzhou University, China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Ming Jiang
- China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Dandan Zhang
- China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Wenna Nie
- China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Ran Yang
- China‐US (Henan) Hormel Cancer InstituteZhengzhou450000China
| | - Tongjin Zhao
- Department of PathophysiologySchool of Basic Medical SciencesTianjian Laboratory of Advanced Biomedical SciencesZhengzhou UniversityZhengzhou450000China
- State Key Laboratory of Genetic EngineeringShanghai Key Laboratory of Metabolic Remodeling and HealthInstitute of Metabolism and Integrative BiologyZhongshan HospitalShanghai Qi Zhi InstituteFudan UniversityShanghai200438China
| | - Zigang Dong
- Department of PathophysiologySchool of Basic Medical SciencesThe Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, State Key Laboratory of EsophagealCancer Prevention and TreatmentProvincial Cooperative Innovation Center for Cancer ChemopreventionChina‐US (Henan) Hormel Cancer Institute, Tianjian Laboratory of Advanced Biomedical SciencesZhengzhou UniversityZhengzhou450000China
| | - Kangdong Liu
- Department of PathophysiologySchool of Basic Medical SciencesThe Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, State Key Laboratory of EsophagealCancer Prevention and TreatmentProvincial Cooperative Innovation Center for Cancer ChemopreventionChina‐US (Henan) Hormel Cancer Institute, Tianjian Laboratory of Advanced Biomedical SciencesZhengzhou UniversityZhengzhou450000China
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Hong Z, Xie S, Xu H, Ke S, Liu W, Huang S, Chen S, Xie J, Xu J, Kang M. Major pathologic response as a prognostic surrogate in esophageal squamous cell carcinoma patients receiving neoadjuvant chemotherapy/chemoimmunotherapy: A multi-center cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109500. [PMID: 39647444 DOI: 10.1016/j.ejso.2024.109500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 11/10/2024] [Accepted: 11/23/2024] [Indexed: 12/10/2024]
Abstract
PURPOSE To determine the prognostic and survival surrogate value of major pathologic response (MPR) in esophageal squamous cell carcinoma (ESCC) patients undergoing neoadjuvant chemotherapy/chemoimmunotherapy(nCT/nICT) and surgery. METHOD A retrospective multi-center study cohort study enrolled 305 ESCC patients who underwent neoadjuvant chemotherapy/chemoimmunotherapy followed by esophagectomy. Endpoints included recurrence-free survival (RFS), locoregional recurrence-free survival(L-RFS), distant metastasis-free survival(D-MFS), and recurrence patterns. The Cox regression analysis and Harrell's C-index were used to analyze survival differences and surrogate endpoints. The Kaplan-Meier method was used for the subgroup analysis in two subgroups(the patients receiving nICT and patients receiving nCT) and the prognostic value analysis of adjuvant therapy in non-MPR and MPR patients. RESULT Of the 305 patients, 105 achieved MPR, demonstrating a significantly improved RFS (P value < 0.001), L-RFS (P value < 0.001), and D-MFS (P value = 0.003). MPR was identified as an independent risk factor for RFS(HR:0.415, 95%CI:[0.227, 0.759], P value = 0.004) and demonstrated equal predictive capacity to be a surrogate of survival endpoints with T stage and N stage(Harrell's C-index: 0.613). In subgroup analysis, patients with MPR showed better survival outcomes in subgroups that received neoadjuvant chemoimmunotherapy (P value = 0.012) and neoadjuvant chemotherapy(P value < 0.001). Additionally, adjuvant therapy did not confer additional survival benefits to both MPR and non-MPR patients. Compared with patients who achieved MPR, non-MPR patients exhibited a higher recurrence rate, although the recurrence sites were similar between the two groups. CONCLUSION MPR can serve as an independent prognostic factor and a surrogate of survival endpoints in ESCC patients undergoing nCT/nICT. Besides, as a potential indicator for postoperative management, MPR can provide reference basis and evidence support in clinical practice.
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Affiliation(s)
- Zhinuan Hong
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery(Fujian Medical University), Fujian Province University, Fuzhou, China; Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Shuhan Xie
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery(Fujian Medical University), Fujian Province University, Fuzhou, China; Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hui Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery(Fujian Medical University), Fujian Province University, Fuzhou, China; Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Sunkui Ke
- Department of Thoracic Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wenyi Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Shijie Huang
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Shuchen Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery(Fujian Medical University), Fujian Province University, Fuzhou, China; Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
| | - Jinbiao Xie
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Putian University, Putian, China.
| | - Jinxin Xu
- Department of Thoracic Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery(Fujian Medical University), Fujian Province University, Fuzhou, China; Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Guo W, Zhou B, Dou L, Guo L, Li Y, Qin J, Wang Z, Huai Q, Xue X, Li Y, Ying J, Xue Q, Gao S, He J. Single-cell RNA sequencing and spatial transcriptomics of esophageal squamous cell carcinoma with lymph node metastases. Exp Mol Med 2025; 57:59-71. [PMID: 39741182 PMCID: PMC11799171 DOI: 10.1038/s12276-024-01369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 09/25/2024] [Accepted: 09/26/2024] [Indexed: 01/02/2025] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) patients often face a grim prognosis due to lymph node metastasis. However, a comprehensive understanding of the cellular and molecular characteristics of metastatic lymph nodes in ESCC remains elusive. In this study involving 12 metastatic ESCC patients, we employed single-cell sequencing, spatial transcriptomics (ST), and multiplex immunohistochemistry (mIHC) to explore the spatial and molecular attributes of primary tumor samples, adjacent tissues, metastatic and non-metastatic lymph nodes. The analysis of 161,333 cells revealed specific subclusters of epithelial cells that were significantly enriched in metastatic lymph nodes, suggesting pro-metastatic characteristics. Furthermore, stromal cells in the tumor microenvironment, including MMP3+IL24+ fibroblasts, APLN+ endothelial cells, and CXCL12+ pericytes, were implicated in ESCC metastasis through angiogenesis, collagen production, and inflammatory responses. Exhausted CD8+ T cells in a cycling status were notably prevalent in metastatic lymph nodes, indicating their potential role in facilitating metastasis. We identified distinct cell-cell communication networks and specific ligand-receptor pathways. Our findings were validated through a spatial transcriptome map and mIHC. This study enhances our comprehension of the cellular and molecular aspects of metastatic lymph nodes in ESCC patients, offering potential insights into novel therapeutic strategies for these individuals.
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Affiliation(s)
- Wei Guo
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Minimally Invasive Therapy Research for Lung Cancer, Chinese Academy of Medical Sciences, Beijing, China
| | - Bolun Zhou
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lizhou Dou
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Guo
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianjun Qin
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qilin Huai
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuemin Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianming Ying
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Minimally Invasive Therapy Research for Lung Cancer, Chinese Academy of Medical Sciences, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Key Laboratory of Minimally Invasive Therapy Research for Lung Cancer, Chinese Academy of Medical Sciences, Beijing, China.
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Fan S, Yuan Y, Su Y, Sang D. Advanced anaplastic thyroid carcinoma with positive expression of PD-L1 response to immune checkpoint inhibitors: A case report. SAGE Open Med Case Rep 2025; 13:2050313X241313084. [PMID: 39877673 PMCID: PMC11773542 DOI: 10.1177/2050313x241313084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 12/17/2024] [Indexed: 01/31/2025] Open
Abstract
Anaplastic thyroid carcinoma (ATC) is one rare type of thyroid carcinoma without standard systemic treatment for advanced disease. Recent evidence has demonstrated promising efficacy of immune checkpoint inhibitors, particularly those targeting programmed death-1 (PD-1)/programmed death ligand 1 (PD-L1), in a variety of solid tumors. However, there have been no research of immune checkpoint inhibitors plus chemotherapy in ATC. Here, we present the case of a 37-year-old man with metastatic ATC with positive PD-L1 expression, who achieved long-term remission of 34 months after later-line treatment with zimberelimab (a PD-1 inhibitor) and nab-paclitaxel, followed by single-agent zimberelimab maintenance therapy. After three cycles of the combination treatment, the thyroid lesion and the liver metastases shrank dramatically, leading to the best overall response of partial remission. PD-L1 expression may serve as a potential biomarker for tumor response to immune checkpoint inhibitors in ATC. Our review highlights the need for further studies investigating the role of PD-L1 status as biomarker to predict the prognosis of immunotherapy in the treatment of ATC.
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Affiliation(s)
- Shanmin Fan
- Department of Medical Oncology, Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing, China
| | - Yang Yuan
- Department of Pathology, Emergency General Hospital, Beijing, China
| | - Yanfang Su
- Department of Medical Oncology, Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing, China
| | - Die Sang
- Department of Medical Oncology, Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing, China
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Zhan T, Betge J, Schulte N, Dreikhausen L, Hirth M, Li M, Weidner P, Leipertz A, Teufel A, Ebert MP. Digestive cancers: mechanisms, therapeutics and management. Signal Transduct Target Ther 2025; 10:24. [PMID: 39809756 PMCID: PMC11733248 DOI: 10.1038/s41392-024-02097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 10/20/2024] [Accepted: 11/29/2024] [Indexed: 01/16/2025] Open
Abstract
Cancers of the digestive system are major contributors to global cancer-associated morbidity and mortality, accounting for 35% of annual cases of cancer deaths. The etiologies, molecular features, and therapeutic management of these cancer entities are highly heterogeneous and complex. Over the last decade, genomic and functional studies have provided unprecedented insights into the biology of digestive cancers, identifying genetic drivers of tumor progression and key interaction points of tumor cells with the immune system. This knowledge is continuously translated into novel treatment concepts and targets, which are dynamically reshaping the therapeutic landscape of these tumors. In this review, we provide a concise overview of the etiology and molecular pathology of the six most common cancers of the digestive system, including esophageal, gastric, biliary tract, pancreatic, hepatocellular, and colorectal cancers. We comprehensively describe the current stage-dependent pharmacological management of these malignancies, including chemo-, targeted, and immunotherapy. For each cancer entity, we provide an overview of recent therapeutic advancements and research progress. Finally, we describe how novel insights into tumor heterogeneity and immune evasion deepen our understanding of therapy resistance and provide an outlook on innovative therapeutic strategies that will shape the future management of digestive cancers, including CAR-T cell therapy, novel antibody-drug conjugates and targeted therapies.
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Affiliation(s)
- Tianzuo Zhan
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Johannes Betge
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Junior Clinical Cooperation Unit Translational Gastrointestinal Oncology and Preclinical Models, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nadine Schulte
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lena Dreikhausen
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Michael Hirth
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Moying Li
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philip Weidner
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Antonia Leipertz
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Teufel
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias P Ebert
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- DKFZ Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany.
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany.
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Tian JZ, Zhang L, Lin FY, He RJ, Tian WR, Yan L, Huang GX, Ai JW, Pei B, Li DS. The efficacy and safety of PD-1 inhibitors combined with chemotherapy treatment for advanced esophageal cancer: a network meta-analysis. Front Med (Lausanne) 2025; 11:1515263. [PMID: 39867925 PMCID: PMC11759289 DOI: 10.3389/fmed.2024.1515263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 12/27/2024] [Indexed: 01/28/2025] Open
Abstract
Objective This study systematically evaluated the efficacy of programmed death 1 (PD-1) inhibitors combined with chemotherapy for advanced esophageal cancer (EC). Methods PubMed, Embase, Web of Science, Scopus, and Cochrane Library were searched to identify related randomized controlled trials (RCTs). Results Seven RCTs involving 4,363 participants were included. The results of the direct comparison showed that, compared with chemotherapy alone, PD-1 inhibitors combined with chemotherapy significantly improved overall survival (OS) (HR = 0.69, 95%CI = 0.63-0.74), progression-free survival (PFS) (HR = 0.63, 95%CI = 0.58-0.67), objective response rate (ORR) (RR = 1.41, 95%CI = 1.28-1.57), but were associated with a slight increase in treatment-related adverse events (AEs) (RR = 1.08, 95%CI = 1.03-1.14). The results of the network meta-analysis showed that toripalimab, sintilimab or camrelizumab, and nivolumab combined with chemotherapy were the best in OS, PFS, and ORR, respectively, with camrelizumab showing the lowest incidence of AEs. Conclusion These results suggest that PD-1 inhibitors combined with chemotherapy provide superior clinical benefits over chemotherapy alone, albeit with a moderate increase in AEs. However, further verification through multi-center, high-quality RCTs with larger sample sizes is needed to confirm these findings. Systematic review registration https//wwwcrdyorkacuk/prospero/display_recordphp?ID=CRD42024627485
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Affiliation(s)
- Jian-Zhou Tian
- Evidence-Based Medicine Center, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Li Zhang
- Department of Central Sterile Supply, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fu-Yong Lin
- Department of Plastic Surgery and Regenerative Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ren-Jiao He
- Department Three of Orthopedics/Plastic Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Wen-Rong Tian
- Department of Plastic Surgery and Regenerative Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liu Yan
- Department of Plastic Surgery and Regenerative Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guo-Xin Huang
- Evidence-Based Medicine Center, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jin-Wei Ai
- Evidence-Based Medicine Center, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- Department of Plastic Surgery and Regenerative Medicine, Fujian Medical University Union Hospital, Fuzhou, China
- Department Three of Orthopedics/Plastic Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Bin Pei
- Evidence-Based Medicine Center, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- Department Three of Orthopedics/Plastic Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - De-Sheng Li
- Department Three of Orthopedics/Plastic Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
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Li J, Wang X, Cao J, Fan C, Xiao Q, Zheng Z, Gao W, Liu X, Feng P, Liu F, Ouyang S, Zhang T, Chen X, Yuan Z, Pang Q, Wang P, Wang Q, Zhang W. Immunochemotherapy plus radiotherapy versus immunochemotherapy alone as first-line treatment for treatment-naïve, advanced esophageal squamous cell carcinoma (AEC-ICR-1st): A multi-center cohort study. Cancer Lett 2024; 611:217411. [PMID: 39736452 DOI: 10.1016/j.canlet.2024.217411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 12/17/2024] [Accepted: 12/21/2024] [Indexed: 01/01/2025]
Abstract
Immunochemotherapy is Currently the standard first-line treatment for advanced esophageal squamous cell carcinoma (ESCC). However, its prognosis remains unsatisfactory. We aimed to evaluate the efficacy and safety of immunochemotherapy plus radiotherapy (ICR) compared with immunochemotherapy (IC) alone as a first-line treatment for advanced ESCC. This multicenter cohort study was conducted across five cancer centers (NCT06190652). We evaluated the outcomes in patients with advanced ESCC who received first-line therapy of IC, with or without radiotherapy (RT), between 2018 and 2023. Propensity score matching (PSM) was performed to control for potential confounders. Sensitivity analysis was conducted to evaluate the robustness of the results. Overall, 23,641 patients were screened, and 702 patients were finally eligible. 270 patients included in ICR cohort, and 432 patients in IC alone cohort. Both before and after PSM, the ICR cohort had a longer median OS compared to IC alone cohort (20.4 versus 16.8 months, P = 0.001; 21.3 versus 17.5 months, P = 0.008; respectively); multivariate analysis further supported that RT was associated with a better OS (HR: 0.695, 95%CI: 0.558-0.867, P = 0.001; HR: 0.729, 95%CI: 0.561-0.947, P = 0.018; respectively). Exploratory analysis revealed that the survival benefits were most pronounced in the subgroup that received IC concurrently combined with definitive dose RT to the primary tumor, with a median OS of 23.6 months (HR: 0.515, 95%CI: 0.308-0.862, P = 0.011) and PFS of 14.4 months (HR: 0.567, 95%CI: 0.370-0.870, P = 0.009). The grade ≥3 treatment-related adverse events (TRAEs) were esophagitis (4.10 % versus 0.41 %; P = 0.006), anemia (6.97 % versus 1.64 %; P = 0.004), leukopenia (12.70 % versus 6.56 %; P = 0.021) and lymphopenia (38.52 % versus 4.92 %, P < 0.001) in the ICR and IC cohorts. The addition of RT to IC as a first-line treatment for advanced ESCC could bring benefits, and was well-tolerated.
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Affiliation(s)
- Jiacheng Li
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Xiaofeng Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Jianzhong Cao
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, China
| | - Chengcheng Fan
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Qin Xiao
- Key Laboratory of Translational Radiation Oncology, The First Department of Thoracic Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410000, China; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Zhunhao Zheng
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Wenyan Gao
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Xiao Liu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Peixin Feng
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, China
| | - Fang Liu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Shuyu Ouyang
- Key Laboratory of Translational Radiation Oncology, The First Department of Thoracic Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410000, China
| | - Tian Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Xi Chen
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Zhiyong Yuan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Qingsong Pang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Ping Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Qifeng Wang
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610000, China.
| | - Wencheng Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
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Zhong J, Fei K, Wu L, Li B, Wang Z, Cheng Y, Li X, Wang X, Han L, Wu X, Fan Y, Yu Y, Lv D, Shi J, Huang J, Zhou S, Han B, Sun G, Guo Q, Ji Y, Zhu X, Hu S, Zhang W, Wang Q, Jia Y, Wang Z, Song Y, Wu J, Shi M, Li X, Han Z, Liu Y, Yu Z, Liu AW, Wang X, Zhou C, Zhong D, Miao L, Zhang Z, Zhao H, Yang J, Wang D, Wang Y, Li Q, Zhang X, Ji M, Yang Z, Cui J, Gao B, Wang B, Liu H, Nie L, He M, Jin S, Gu W, Shu Y, Zhou T, Feng J, Yang X, Huang C, Zhu B, Yao Y, Yao S, Yu J, Cai SL, Cai Y, Xu J, Zhuang W, Luo X, Duan J, Wang J. Toripalimab plus chemotherapy for first line treatment of advanced non-small cell lung cancer (CHOICE-01): final OS and biomarker exploration of a randomized, double-blind, phase 3 trial. Signal Transduct Target Ther 2024; 9:369. [PMID: 39715755 DOI: 10.1038/s41392-024-02087-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 11/09/2024] [Accepted: 12/01/2024] [Indexed: 12/25/2024] Open
Abstract
A randomized double-blind phase 3 trial (CHOICE-01, NCT03856411) demonstrated that combining toripalimab with chemotherapy substantially improves progression-free survival (PFS) in advanced non-small cell lung cancer (NSCLC) patients without pretreatment. This study presents the prespecified final analysis of overall survival (OS) and biomarkers utilizing circulating tumor DNA (ctDNA) and tissue-based sequencing. Additionally, the analysis revealed a higher median overall survival (OS, 23.8 months) in the toripalimab group than that in the control group (17.0 months). (HR = 0.69, 95%CI: 0.57-0.93, nominal P = 0.01). This survival benefit was particularly notable in the non-squamous subgroup. As the first phase 3 study to perform both baseline tissue whole-exome sequencing (WES) and peripheral blood ctDNA testing, we investigated efficacy predictive biomarkers based on both tissue and ctDNA, Genomic sequencing of ctDNA showed high concordance with tumor tissue independently confirmed that individuals exhibiting a high tumor mutational burden, as well as mutations in the FA-PI3K-Akt and IL-7 signaling pathways benefited more from the toripalimab treatment. Furthermore, a ctDNA response observed on cycle 3 day 1, was associated with improved clinical outcomes for patients treated with the combination therapy. In conclusion, Toripalimab plus chemotherapy yields significant improvements in OS as a first-line treatment. The study highlights the utility of ctDNA as a proxy for tumor tissue, providing novel prospects for predicting efficacy of immuno-chemotherapy through continuous ctDNA monitoring.
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Affiliation(s)
- Jia Zhong
- State Key Laboratory of Molecular Oncology, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kailun Fei
- State Key Laboratory of Molecular Oncology, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Wu
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Baolan Li
- Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Zhijie Wang
- State Key Laboratory of Molecular Oncology, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Xiaoling Li
- Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Xicheng Wang
- The First Affiliated Hospital, School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, China
| | - Liang Han
- Xuzhou Central Hospital, Xuzhou, China
| | - Xiaohong Wu
- Jiangnan University Affiliated Hospital, Wuxi, China
| | - Yun Fan
- Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, China
| | - Yan Yu
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Dongqing Lv
- Taizhou Hospital of Zhejiang Province, Linhai, China
| | | | - Jianjin Huang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shaozhang Zhou
- Guangxi Medical University Affiliated Tumor Hospital, Nanning, China
| | - Baohui Han
- Shanghai Chest Hospital, Shanghai, China
| | - Guogui Sun
- Tangshan People's Hospital, Tangshan, China
| | - Qisen Guo
- Shangdong Cancer Hospital, Jinan, China
| | - Youxin Ji
- Qingdao Central Hospital, Qingdao, China
| | - Xiaoli Zhu
- Zhongda Hospital Southeast University, Nanjing, China
| | - Sheng Hu
- Hubei Cancer Hospital, Wuhan, China
| | - Wei Zhang
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | | | - Yuming Jia
- The Second People's Hospital of Yibin, Yibin, China
| | - Ziping Wang
- Peking University Cancer Hospital, Beijing, China
| | - Yong Song
- Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jingxun Wu
- The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Meiqi Shi
- Jiangsu Cancer Hospital, Nanjing, China
| | - Xingya Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhigang Han
- Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Yunpeng Liu
- The First Hospital of China Medical University, Shenyang, China
| | - Zhuang Yu
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - An-Wen Liu
- The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiuwen Wang
- Qilu Hospital of Shandong University, Jinan, China
| | - Caicun Zhou
- Shanghai Pulmonary Hospital, Shanghai, China
| | | | - Liyun Miao
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | | | - Hui Zhao
- The Second Hospital of Anhui Medical University, Hefei, China
| | - Jun Yang
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dong Wang
- Army Medical Center of PLA, Daping Hospital, Daping, China
| | - Yingyi Wang
- Peking Union Medical College Hospital, Beijing, China
| | - Qiang Li
- Shanghai East Hospital of Tongji University, Shanghai, China
| | | | - Mei Ji
- The First People's Hospital of Changzhou, Changzhou, China
| | - Zhenzhou Yang
- The Second Affiliated Hospital of Chongqing University, Chongqing, China
| | - Jiuwei Cui
- The First Hospital of Jilin University, Jilin, China
| | - Beili Gao
- Ruijin Hospital Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Buhai Wang
- Subei People's Hospital of Jiangsu Province, Yanghzou, China
| | - Hu Liu
- Anhui Provincial Cancer Hospital, Hefei, China
| | - Lei Nie
- Shaanxi Provincial Cancer Hospital, Xian, China
| | - Mei He
- Shanxi Provincial People's Hospital, Taiyuan, China
| | - Shi Jin
- Cancer Hospital of Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, China
| | - Wei Gu
- Nanjing First Hospital, Nanjing, China
| | - Yongqian Shu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tong Zhou
- ChangZhou Cancer Hospital, Changzhou, China
| | - Jian Feng
- Affiliated Hospital of Nantong University, Nantong, China
| | | | | | - Bo Zhu
- Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Yu Yao
- First Affiliated Hospital of Xi'an Jiaotong University, Xian, China
| | - Sheng Yao
- TopAlliance Biosciences, Rockville, MD, USA
- Shanghai Junshi Biosciences, Shanghai, China
| | - Jianjun Yu
- TopAlliance Biosciences, Rockville, MD, USA
- Shanghai Junshi Biosciences, Shanghai, China
| | | | - Yiran Cai
- Burning Rock Biotech, Guangdong, China
| | - Jiachen Xu
- State Key Laboratory of Molecular Oncology, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhuang
- State Key Laboratory of Molecular Oncology, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianmin Luo
- Shanghai Junshi Biosciences, Shanghai, China
| | - Jianchun Duan
- State Key Laboratory of Molecular Oncology, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Department of Respiratory Medicine, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Department of Respiratory Medicine, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China.
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Qi L, Sun M, Liu W, Zhang X, Yu Y, Tian Z, Ni Z, Zheng R, Li Y. Global esophageal cancer epidemiology in 2022 and predictions for 2050: A comprehensive analysis and projections based on GLOBOCAN data. Chin Med J (Engl) 2024; 137:3108-3116. [PMID: 39668405 PMCID: PMC11706580 DOI: 10.1097/cm9.0000000000003420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Indexed: 12/14/2024] Open
Abstract
BACKGROUND The burden of esophageal cancer varies across different regions of the world. The aim of this study is to analyze the current burden of esophageal cancer in 185 countries in 2022 and to project the trends up to the year 2050. METHODS We extracted data on primary esophageal cancer cases and deaths from the GLOBOCAN 2022 database, which includes data from 185 countries. Age-standardized incidence rates (ASIR) and mortality rates (ASMR) per 100,000 person-years were calculated by stratifying by Human Development Index (HDI) levels and regions. Considering changes in population size and age structure, we assumed that the risks of incidence and mortality remain constant at the levels of 2022 to forecast the number of new cases and deaths from esophageal cancer globally by 2050. RESULTS In 2022, an estimated 511,054 people were diagnosed with esophageal cancer globally, and 445,391 died from the disease. The global ASIR and ASMR for esophageal cancer were 5.00 and 4.30 per 100,000, respectively. The highest rates were observed in East Africa (7.60 for incidence, 7.20 for mortality per 100,000), East Asia (7.60 for incidence, 5.90 for mortality per 100,000), Southern Africa (6.30 for incidence, 5.90 for mortality per 100,000), and South Central Asia (5.80 for incidence, 5.50 for mortality per 100,000). Among the 185 countries worldwide, esophageal cancer was among the top five causes of cancer incidence in 18 countries and among the top five causes of cancer mortality in 25 countries. In 2022, China had 224,012 new cases and 187,467 deaths from esophageal cancer, accounting for approximately 43.8% and 42.1% of the global total, respectively, which is higher than the proportion of China's population to the global population (17.9%). ASIR was 8.30 per 100,000, and ASMR was 6.70 per 100,000. The highest burden of esophageal cancer was in high HDI countries, with new cases and deaths accounting for 51.3% and 50.0% of the global total, respectively. The ASIR and ASMR were highest in the high HDI group (6.10 and 5.10 per 100,000, respectively), also exceeding the global averages. There was a trend of decreasing mortality to incidence ratio with increasing HDI, but no correlation was observed between HDI and ASIR or ASMR. In all regions worldwide, the incidence and mortality rates were higher in males than in females (with a male-to-female ASR ratio ranging from 1.10 to 28.7). Compared to 2022, it is projected that by 2050, the number of new esophageal cancer cases will increase by approximately 80.5%, and deaths will increase by 85.4% due to population growth and aging. CONCLUSIONS The burden of esophageal cancer remains heavy. Adopting a healthy lifestyle, including reducing tobacco and alcohol intake, avoiding moldy foods, and increasing intake of fresh fruits and vegetables, can help reduce the risk of stomach and esophageal cancer. In addition, the development and implementation of evidence-based and effective public health policies are critical to reducing the global disease burden of esophageal cancer.
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Affiliation(s)
- Ling Qi
- Department of Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Mengfei Sun
- College of Pharmacy, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010110, China
| | - Weixin Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Xuefeng Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Yongjun Yu
- Department of Thoracic Surgery, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010110, China
- Department of Cardio-Thoracic Surgery, The Second Hospital of Chifeng, Chifeng, Inner Mongolia Autonomous Region 024099, China
| | - Ziqiang Tian
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 110000, China
| | - Zhiyu Ni
- Central Laboratory, Hebei Collaborative Innovation Center of Tumor Microecological Metabolism Regulation, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
- Medical College, Hebei University of Engineering, Handan, Hebei 056038, China
- Affiliated Hospital of Hebei Engineering University, Handan, Hebei 056002, China
| | - Rongshou Zheng
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yong Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China
- Central Laboratory, Hebei Collaborative Innovation Center of Tumor Microecological Metabolism Regulation, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
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Chen K, Li Y, Ni J, Yang X, Zhou Y, Pang Y, Ye R, Chen H, Yu S, Wang P, Zhu Z. Identification of a novel subtype of SPP1 + macrophages expressing SIRPα: implications for tumor immune evasion and treatment response prediction. Exp Hematol Oncol 2024; 13:119. [PMID: 39696410 DOI: 10.1186/s40164-024-00587-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Accepted: 12/02/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND SPP1 + macrophages are among the major phagocytic cells, yet promoting tumor immune evasion and predicting unfavorable prognosis, in various cancer types. Meanwhile, the predictive value of the abundance of SPP1 + macrophages in patients receiving immunotherapy remains debatable, indicating the potential existence of subtypes of SPP1 + macrophages with diverse biological functions. METHODS The single cell RNA sequencing data of myeloid cells integrated from several cancers including esophageal squamous cell carcinoma was analyzed for characterizing the function and cellular interactions of SPP1 + macrophages expressing SIRPα. Multiplexed immunohistochemistry was used to quantify the quantity and spatial distribution of SPP1 + macrophages expressing SIRPα. Kaplan-Meier method was used for survival analysis. In vitro and in vivo studies investigating the function of SPP1 + macrophages were performed. RESULTS SPP1 + macrophages possessed a high phagocytic signature and could engulf more tumor cells in vitro and in vivo. SIRPα expression could represent the phagocytic activity of SPP1 + macrophages and delineated subsets of SPP1 + macrophages with different functions. SPP1 + SIRPα + macrophages showed close spatial distance to tumor cells and positively correlated with PD1 + CD8 + T cells. A high abundance of SPP1 + SIRPα + macrophages at baseline corresponded to patients' response to PD-1/PD-L1 inhibitors. CONCLUSION A novel subtype of SPP1 + macrophages expressing SIRPα was identified and their abundance predicted patients' response to PD-1/PD-L1 inhibitors.
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Affiliation(s)
- Kun Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yida Li
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jianjiao Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yue Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yechun Pang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Ruiting Ye
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Hongru Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Silai Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Peng Wang
- Department of Hepatic Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China.
- Institute of Thoracic Oncology, Fudan University, Shanghai, China.
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Qiu H, Gao L, Shi W, Wang J, Li B, Ke S, Chen J, Gong Y, Wu Y, Zhao W, Chen Y. Elaiophylin targets EIF4B to suppress the growth of esophageal squamous cell carcinoma via the PI3K/AKT signaling pathway. Cancer Lett 2024; 611:217401. [PMID: 39694222 DOI: 10.1016/j.canlet.2024.217401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/19/2024] [Accepted: 12/14/2024] [Indexed: 12/20/2024]
Abstract
Elaiophylin is known to exert antitumor effects through certain signaling pathways; however, no reports regarding its effects on esophageal cancer are available. This study explored the effects of elaiophylin in esophageal squamous cell carcinoma (ESCC) cells. Transwell and immunofluorescence assays confirmed that elaiophylin inhibited the migration and proliferation of ESCC cells, and western blotting assays showed that it affected apoptosis-related gene expression in ESCC cells. Based on RNA-seq analyses, Single-cell RNA-seq, a human cancer pathway phosphorylation antibody array, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomics analyses, we found that elaiophylin was related to low expression of EIF4B and activation of the phosphoinositide 3-kinase (PI3K)/AKT signaling pathway. In both in vitro and in vivo experiments, ESCC cells treated with elaiophylin showed low EIF4B expression, which inhibited their proliferation and promoted apoptosis by activating the PI3K/AKT signaling pathway; EIF4B overexpression could reverse these effects of elaiophylin on ESCC cells. Therefore, our results indicate that elaiophylin targets EIF4B to inhibit ESCC cell proliferation via the PI3K/AKT signaling pathway. Targeting elaiophylin or the EIF4B/PI3K/AKT signaling pathway may produce new methods for ESCC treatment.
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Affiliation(s)
- Hu Qiu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Lijuan Gao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Wei Shi
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Jing Wang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Bin Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Shaobo Ke
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Jiamei Chen
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Yi Gong
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Yong Wu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Wensi Zhao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Yongshun Chen
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430064, China; Cancer Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China.
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Noronha V, Patil VM, Menon N, Goud S, Singh A, Shah M, More S, Shah S, Yadav A, Sonawane S, Nawale K, Chowdhury OR, Kaushal RK, Ghosh-Laskar S, Agarwal JP, Yadav S, Pai T, Janu A, Mahajan A, Purandare N, Banavali S, Badwe R, Prabhash K. Phase III randomized trial comparing palliative systemic therapy to best supportive care in advanced esophageal/GEJ cancer. Int J Cancer 2024; 155:2232-2245. [PMID: 39093841 DOI: 10.1002/ijc.35111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/20/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024]
Abstract
No study has unequivocally proven that chemotherapy prolongs overall survival (OS) in advanced esophageal cancer. We conducted a Phase III randomized study in first-line advanced unresectable/metastatic esophageal/GEJ cancer. Patients aged 18-70 years, with performance status 0-2, were randomized to best supportive care (BSC) alone, or BSC with weekly paclitaxel 80 mg/m2. BSC comprised, as indicated, education, counselling, radiation, stenting, feeding tube placement, nutritional supplementation, medications like analgesics, and referral to a support group and palliative care. The primary endpoint was OS; secondary endpoints included progression free survival (PFS), response, toxicity, and QoL. Between May 2016-December 2020, we recruited 281 patients: 143 to chemotherapy and 138 to BSC. Histopathology was squamous in 269 (95.7%) patients. Median number of paclitaxel doses was 12 (IQR, 7-23). Median OS was 4.2 months (95% CI, 3.42-5.32) in BSC, and 9.2 months (95% CI, 8.02-10.48) in chemotherapy; HR, 0.49 (95% CI, 0.39-0.64); p < .001. As compared to BSC, chemotherapy increased response (2.9% to 39%), median PFS (2.1 to 4.2 months), 1-year OS (11% to 32%), 2-year OS (0 to 9%), median dysphagia-free survival (2.9 to 14.8 months), and global and esophagus-specific QoL, without significantly increasing all-grade or grade ≥3 toxicities. Using ESMO clinical benefit scale and ASCO Value Framework, palliative chemotherapy scored as having "substantial value." Our study provides the first level 1 evidence that chemotherapy prolongs survival in advanced esophageal/GEJ carcinoma. BSC alone is no longer appropriate. Weekly paclitaxel is an attractive option, especially in LMICs with limited access to immunotherapy.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Maruti Patil
- Department of Medical Oncology, P D Hinduja Hospital & Medical Research Centre, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Goud
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Ajaykumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Minit Shah
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sucheta More
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Srushti Shah
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Akanksha Yadav
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sonali Sonawane
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Oindrila Roy Chowdhury
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Subhash Yadav
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Trupti Pai
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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