2063 - Medium Dose of TPF Chemotherapy with Concurrent Radiotherapy and Immunotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma: A Real-World Study

03:00pm - 04:00pm ET

Poster Hall - Exhibit Hall A

Screen: 22

POSTER

Presenter(s)

Xingwen Fan, MD, PhD - Fudan University Shanghai Cancer Center, Shanghai, Shanghai

X. Fan¹, and K. Wu²; ¹Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China, ²Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China

Purpose/Objective(s):

Concurrent chemoradiotherapy is the standard treatment for local advanced esophageal squamous cell carcinoma (ESCC), yet the survival is still poor. Triple drug chemotherapy containing taxane, such as DCF or FLOT, exhibits good anti-tumor activity for ESCC, however, high toxicity limits its application. We hope to improve its tolerance by reducing the dosage, and enhance efficacy by combination of immunotherapy.

Materials/Methods:

ESCC patients with Local advanced or stage IV without hematogenous metastasis were enrolled. The 4/9 dose in the dual drug chemotherapy was adopted, in detail: paclitaxel, 60mg/m²; cisplatin, 30mg/m²; fluorouracil, 1000mg/m², civ 24h; q3w (TPF). One cycle of TPF induction chemotherapy and anti-PD1 monoclonal antibody (pembrolizumab, 200mg; or sintilimab, 200mg) was used 3 weeks before concurrent chemoradiotherapy with 2 cycles of TPF, and one cycle of TPF consolidation chemotherapy and immunotherapy was used 4 weeks after radiotherapy. And immunotherapy was maintained for 2 years.

Results:

From March 2021 to October 2023, 46 patients were enrolled. The median age was 68 (range: 50-79) years, 34 (73.9%) patients were male, 23 (50%) patients were stage IV, and 11 (23.9%) patients were with a history of previous tumors. Thirty-three (71.7%) patients received simultaneous integrated boost (SIB) radiotherapy, with 61.6Gy for PTV-G, and 50.4Gy for PTV-C. As of February 2026, the median follow-up time was 40 months. The 1-year, 2-year, and 3-year progression free survival (PFS) were 80.4%, 63.0%, and 57.9% respectively, and the median PFS was 46 months. The 1-year, 2-year and 3-year overall survival (OS) were 87.0%, 73.9%, and 71.7% respectively, and the median OS was not achieved. Compared with our historical control group of cisplatin and fluorouracil concurrent chemoradiotherapy (ChiCTR-OIC-17010485), this TPF group of patients had better PFS (HR: 0.586, p=0.03) and OS (HR: 0.520, p=0.018). There were no grade IV bone marrow toxicity, except 11 (23.9%) patients with grade IV lymphopenia. One (2.2%) patient experienced grade II radiation pneumonitis, and 1 (2.2%) patient experienced grade IV radiation pneumonitis.

Conclusion:

The medium dose TPF concurrent chemoradiotherapy combined with immunotherapy has shown good tumor control and tolerability, and is worthy for further study.