2212 - Optimal Sequencing of Immune Checkpoint Inhibitors with Definitive Chemoradiotherapy for Unresectable Locally Advanced Esophageal Squamous Cell Carcinoma: A Multicenter Real-World Cohort Study
Presenter(s)
W. Shen1, X. Zhao2, Y. Zhang3, Y. Liu4, J. Cao5, Y. Xu6, X. Ye7, M. Hou8, W. Zhou9, Z. Zeng10, Y. Song11, H. Luo11, and J. Lv12; 1The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, 2the fourth hospital of hebei university, Shijiazhuang, China, 3Anyang Cancer Hospital, Anyang, Henan, China, 4Jiangsu Cancer Hospital, Nanjing, Jiangsu, China, 5Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China, 6Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China, 7Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, 8Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China, 9Chongqing University Cancer Hospital, Chongqing, Chongqing, China, 10the second affliated hospital of Nanchang University, Nanchang, China, 11Huai’an First People’s Hospital, Huai'an, Jiangsu, China, 12Sichuan Clinical Research Center for Cancer,Sichuan Hospital Cancer & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
Purpose/Objective(s): The optimal sequencing of immune checkpoint inhibitors (ICIs) combined with definitive chemoradiotherapy (dCRT) for unresectable locally advanced esophageal squamous cell carcinoma (ESCC) remains unclear.
Materials/Methods: The optimal sequencing of immune checkpoint inhibitors (ICIs) combined with definitive chemoradiotherapy (dCRT) for unresectable locally advanced esophageal squamous cell carcinoma (ESCC) remains unclear.
Results: The ICRT group demonstrated superior survival outcomes, achieving 3-year overall survival (OS) rates of 60.6%, compared to 38.8% in the IC-CRT group and 45.8% in the CRT-IC group. Similarly, 3-year progression-free survival (PFS) was highest in the ICRT group (46.3%) versus 20.8% (IC-CRT) and 32.0% (CRT-IC). Multivariate analysis confirmed treatment sequencing as an independent prognostic factor for both OS and PFS. Failure pattern analysis revealed distinct recurrence profiles: CRT-IC was associated with higher locoregional recurrence, IC-CRT with combined locoregional and distant failures, while ICRT showed balanced disease control. Although ICRT yielded the best survival, it was associated with the highest toxicity burden, particularly grade 3–4 hematologic, pulmonary, and gastrointestinal adverse events. CRT-IC demonstrated the best tolerability profile.
Conclusion: Concurrent administration (ICRT) provides the greatest survival benefit for unresectable locally advanced ESCC and should be considered for fit patients, despite a higher risk of toxicity. For patients prioritizing tolerability, consolidation immunotherapy (CRT-IC) offers a viable alternative but with reduced local control efficacy.