3469 - Clinical Benefits of Postoperative Adjuvant Immunotherapy for Resectable Locally Advanced Esophageal Cancer
Presenter(s)
C. Li Jr1, C. O. Fan2, Q. Lei3, Q. Luo1, Q. Guo1, and Y. Luo4; 1Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China, 2chongqing uninersity cancer hospital, chongqing, chongqing, China, 3Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, chongqing, China, 4Department of Radiation Center, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
Purpose/Objective(s): The phase III CheckMate-577 trial was the pioneering study that established the efficacy of adjuvant immunotherapy in enhancing disease-free survival for patients with resected esophageal or gastroesophageal junction cancer who had undergone neoadjuvant chemoradiotherapy but failed to achieve a pathological complete response. However, a significant number of patients in clinical practice undergo radical resection without prior neoadjuvant chemoradiotherapy. It remains uncertain whether this subset would benefit from adjuvant immunotherapy. This investigation seeks to evaluate disease control and long-term survival outcomes between standard adjuvant chemoradiotherapy with and without supplementary adjuvant immunotherapy post-surgery for esophageal cancer.
Materials/Methods: We conducted a retrospective analysis of clinical data from patients with thoracic esophageal cancer who underwent surgical intervention without neoadjuvant chemoradiotherapy at our institution between January 2020 and December 2022. Patients were divided into two cohorts based on their adjuvant treatment regimen: one cohort received conventional adjuvant therapy or no adjuvant intervention, while the other cohort received adjuvant immunotherapy, either alone or in conjunction with conventional adjuvant treatment. We assessed baseline characteristics prior to treatment, the occurrence of adverse events during adjuvant therapy, and variations in postoperative disease-free survival (DFS) and overall survival (OS) between the two groups.
Results: The study included 88 patients with thoracic esophageal cancer, all of whom underwent radical esophagectomy following surgical assessment. The cohort consisted of 74 males and 14 females. Regarding disease staging, 31 patients were classified as stage II, 37 as stage III, and 20 as stage IVa. Postoperatively, 47 patients received adjuvant immunotherapy or a combination of therapies, while 41 did not. The median follow-up period was 25 months. Disease progression was recorded in 48 patients, and 26 patients succumbed to the illness, with no follow-up losses. Patients receiving postoperative adjuvant treatment that included immunotherapy or combined therapy exhibited significantly improved disease-free survival (DFS) compared to those who did not (median DFS: 30 months vs. 13 months; p<0.001). Although overall survival (OS) did not reach statistical significance, a trend favoring the treatment was noted (median OS: not reached vs. 30 months; p=0.076). Importantly, the rate of adverse events during adjuvant treatment did not show significant differences between the cohorts.
Conclusion: The incorporation of immunotherapy in the postoperative adjuvant therapy for locally advanced thoracic esophageal cancer offers significant clinical benefits.