3479 - Maximizing Survival Benefits with Precision Therapy Based on Progressive Patterns after First-Line Immunochemotherapy Failure in Metastatic Esophageal Cancer: A Retrospective Multicenter Study

02:30pm - 03:45pm PT

Hall F

Screen: 9

POSTER

Presenter(s)

Yingnan Liu, - Shandong Cancer Hospital, Jinan, Shandong

Y. Liu^1,2, S. Cheng¹, B. Li³, T. Dong⁴, C. Jiang⁵, J. Yu⁶, and L. Wang⁷; ¹Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China, ²Shandong University Cancer Center, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China, ³Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China, ⁴Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, China, ⁵Department of Otorhinolaryngology & Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China, ⁶Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences Department of Radiation Oncology, Jinan, Shandong, China, ⁷Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China, Jinan, Shandong, China

Purpose/Objective(s): Oligoprogression and polyprogression of metastatic esophageal cancer (EC) could result in the different prognosis after first-line immunochemotherapy failure, and effective precision treatment options are urgently needed. This study aims to explore the optimal treatment strategy in metastatic EC with different progressive patterns.

Materials/Methods: Based on ESTRO/EORTC consensus, metastatic EC patients with cancer progression after immunotherapy (IO) resistance were divided into oligoprogression and polyprogression. Subsequently, oligoprogression was further divided into repeat oligoprogression (REO, oligoprogression with a history of oligometastatic disease) and induced oligoprogression (INO, oligoprogression with a history of polymetastatic disease), while polyprogression was divided into de-novo polyprogression (DNP, polyprogression with a history of oligometastatic disease) and repeat polyprogression (REP, polyprogression with a history of polymetastatic disease). Patients with metastatic EC who progress between July 2016 to February 2023 at three hospitals were included. The next-line progression-free survival (PFS) and overall survival (OS) were investigated stratified by treatment strategies. PFS and OS were calculated using the Kaplan-Meier method.

Results: A total of 335 metastatic EC patients developed progression, 53.7% (180/335) developed oligoprogression and 46.3% (155/335) developed polyprogression. Specifically, 43.0% (144/335) patients were REO, 10.7% (36/335) patients were INO, 23.3% (78/335) patients were DNP, and 23.0% (77/335) patients were REP. In multivariable analysis, polyprogression was significantly correlated with baseline polymetastase state (OR, 2.69; 95% CI, 1.47-4.91; P = 0.001). Lymph nodes (63.6%), primary lesion (25.6%), liver (21.2%), and lung (17.0%) were the common sites of progression. Second-line treatment strategies often involve IO rechallenge and radiotherapy (RT). Oligoprogression patients receiving RT (vs. non-RT) had longer PFS (9.4 vs. 5.8 months, P=0.018) and OS (21.9 vs. 9.2 months, P=0.012), especially in REO group (PFS: 9.4 vs. 5.7 months, P = 0.025; OS: 21.9 vs. 8.7 months, P = 0.018). Polyprogression patients using IO rechallenge (vs. non-IO) showed improved PFS (4.7 vs. 2.8 months, P=0.006) and OS (8.5 vs. 4.8 months, P=0.001), particularly in REP group (PFS: 5.6 vs. 2.8 months, P = 0.008; OS: 5.6 vs. 2.8 months, P < 0.001).

Conclusion: Metastatic EC patients experience oligoprogression and polyprogression after IO resistance, with common progression sites being lymph nodes, primary lesion, and liver. Polyprogression were significantly correlated with their baseline greater tumor burden. RT is more important for patients with REO, while IO rechallenge could still play a dominant role in patients with REP.