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Huang J, Xu J, Chen Y, Zhuang W, Zhang Y, Chen Z, Chen J, Zhang H, Niu Z, Fan Q, Lin L, Gu K, Liu Y, Ba Y, Miao Z, Jiang X, Zeng M, Chen J, Fu Z, Gan L, Wang J, Zhan X, Liu T, Li Z, Shen L, Shu Y, Zhang T, Yang Q, Zou J. Camrelizumab versus investigator's choice of chemotherapy as second-line therapy for advanced or metastatic oesophageal squamous cell carcinoma (ESCORT): a multicentre, randomised, open-label, phase 3 study. Lancet Oncol 2020; 21:832-842. [PMID: 32416073 DOI: 10.1016/s1470-2045(20)30110-8] [Citation(s) in RCA: 353] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with advanced or metastatic oesophageal squamous cell carcinoma have poor prognosis and few treatment options after first-line therapy. We aimed to assess efficacy and safety of the anti-PD-1 antibody camrelizumab versus investigator's choice of chemotherapy in previously treated patients. METHODS ESCORT is a randomised, open-label, phase 3 study of patients aged 18 to 75 years with a histological or cytological diagnosis of advanced or metastatic oesophageal squamous cell carcinoma done at 43 hospitals in China. Eligible patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and had progressed on, or were intolerant to, first-line standard therapy. Patients were randomly assigned (1:1) to camrelizumab (200 mg every 2 weeks) or chemotherapy with docetaxel (75 mg/m2 every 3 weeks) or irinotecan (180 mg/m2 every 2 weeks), all given intravenously. Central randomisation was done using the Randomization and Trial Supply Management system with block size randomly generated as four or six and stratified by disease and ECOG performance status. The primary endpoint was overall survival, assessed in randomised patients who had received at least one dose of treatment. Safety was assessed in all treated patients. The trial is registered with ClinicalTrials.gov, NCT03099382, and is closed to new participants. FINDINGS From May 10, 2017, to July 24, 2018, 457 (75%) of 607 screened patients were randomly assigned to treatment, of whom 228 received camrelizumab treatment and 220 received chemotherapy. As of data cutoff on May 6, 2019, with a median follow-up time of 8·3 months (IQR 4·1-12·8) in the camrelizumab group and 6·2 months (3·6-10·1) in the chemotherapy group, median overall survival was 8·3 months (95% CI 6·8-9·7) in the camrelizumab group and 6·2 months (5·7-6·9) in the chemotherapy group (hazard ratio 0·71 [95% CI 0·57-0·87]; two-sided p=0·0010). The most common treatment-related adverse events of grade 3 or worse were anaemia (camrelizumab vs chemotherapy: six [3%] vs 11 [5%]), abnormal hepatic function (four [2%] vs one [<1%]), and diarrhoea (three [1%] vs nine [4%]). Serious treatment-related adverse events occurred in 37 (16%) of 228 patients in the camrelizumab group, and in 32 (15%) of 220 patients in the chemotherapy group. Ten treatment-related deaths occurred, seven (3%) in the camrelizumab group (three deaths from unknown causes, one enterocolitis, one hepatic function abnormal, one pneumonitis, and one myocarditis) and three (1%) in the chemotherapy group (two deaths from unknown causes, and one gastrointestinal haemorrhage). INTERPRETATION Second-line camrelizumab significantly improved overall survival in patients with advanced or metastatic oesophageal squamous cell carcinoma compared with chemotherapy, with a manageable safety profile. It might represent a potential option of standard second-line treatment for patients with oesophageal squamous cell carcinoma in China. FUNDING Jiangsu Hengrui Medicine.
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Affiliation(s)
- Jing Huang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianming Xu
- Department of Gastrointestinal Oncology, Cancer Center, Fifth Medical Center General Hospital of PLA, Beijing, China.
| | - Yun Chen
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Wu Zhuang
- Department of Thoracic Medical Oncology, Fujian Province Cancer Hospital, Fuzhou, China
| | - Yiping Zhang
- Department of Thoracic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Zhendong Chen
- Oncology Department, The Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Jia Chen
- Department of Oncology, Jiangsu Cancer Hospital, Nanjing, China
| | - Helong Zhang
- Oncology Department, Tangdu Hospital of the Fourth Military Medical University, Xi'an, China
| | - Zuoxing Niu
- Internal Medicine Ward 4, Shandong Cancer Hospital, Jinan, China
| | - Qingxia Fan
- Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lizhu Lin
- Oncology Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kangsheng Gu
- Medical Oncology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Ying Liu
- Medical Oncology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Ba
- Medical Oncology, Tianjin Cancer Hospital, Tianjin, China
| | - Zhanhui Miao
- Oncology Department, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xiaodong Jiang
- Oncology Department, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Ming Zeng
- Oncology Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Jianhua Chen
- Department of Medical Oncology, Cancer Hospital of Central South University, Changsha, China
| | - Zhichao Fu
- Department of Radiotherapy, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Lu Gan
- The Oncology Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Wang
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xianbao Zhan
- Department of Medical Oncology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Tianshu Liu
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiping Li
- Integrated Chinese and Western Medical Oncology, Jiangxi Cancer Hospital, Nanchang, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yongqian Shu
- Medical Oncology, Jiangsu Province Hospital, Nanjing, China
| | - Tao Zhang
- Jiangsu Hengrui Medicine, Shanghai, China
| | - Qing Yang
- Jiangsu Hengrui Medicine, Shanghai, China
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Vivaldi C, Catanese S, Massa V, Pecora I, Salani F, Santi S, Lencioni M, Vasile E, Falcone A, Fornaro L. Immune Checkpoint Inhibitors in Esophageal Cancers: are we Finally Finding the Right Path in the Mist? Int J Mol Sci 2020; 21:E1658. [PMID: 32121290 PMCID: PMC7084692 DOI: 10.3390/ijms21051658] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/26/2022] Open
Abstract
Esophageal cancer remains a challenging disease due to limited treatment options and poor prognosis. In recent years, immune checkpoint inhibitors (ICI) have been proven to be safe and effective in the treatment of highly lethal malignancies, such as non-small cell lung cancer and melanoma. Recent clinical trials also showed promising activity in immune checkpoint inhibitors in pretreated advanced esophageal carcinoma and a potentially significant impact on the outcome of selected patients, independently of histology. Combination studies evaluating immunotherapy and chemotherapy and, in localized disease, radiotherapy are in progress and will hopefully confirm their promises in the near future. However, reliable predictive biomarkers are still lacking. Indeed, at present, the role of programmed cell death ligand 1 expression and other factors (such as microsatellite instability and tumor mutational burden) as predictive biomarkers of benefit to immune checkpoint inhibitors is still controversial. Our aim was to explore the rationale of ICIs in esophageal cancer, review the results already available in multiple settings, and investigate future perspectives with single-agent and combination strategies.
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Affiliation(s)
- Caterina Vivaldi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via savi 10, 56126 Pisa PI, Italy;
| | - Silvia Catanese
- Unit of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy; (S.C.); (V.M.); (I.P.); (F.S.); (M.L.); (E.V.); (L.F.)
| | - Valentina Massa
- Unit of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy; (S.C.); (V.M.); (I.P.); (F.S.); (M.L.); (E.V.); (L.F.)
| | - Irene Pecora
- Unit of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy; (S.C.); (V.M.); (I.P.); (F.S.); (M.L.); (E.V.); (L.F.)
| | - Francesca Salani
- Unit of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy; (S.C.); (V.M.); (I.P.); (F.S.); (M.L.); (E.V.); (L.F.)
| | - Stefano Santi
- Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy;
| | - Monica Lencioni
- Unit of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy; (S.C.); (V.M.); (I.P.); (F.S.); (M.L.); (E.V.); (L.F.)
| | - Enrico Vasile
- Unit of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy; (S.C.); (V.M.); (I.P.); (F.S.); (M.L.); (E.V.); (L.F.)
| | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via savi 10, 56126 Pisa PI, Italy;
| | - Lorenzo Fornaro
- Unit of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy; (S.C.); (V.M.); (I.P.); (F.S.); (M.L.); (E.V.); (L.F.)
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