Both single and dual immunotherapy regimens offer improved overall survival for select patients with advanced oesophageal cancer

Priscilla Lynch presents a round-up of some of the most topical research presented at this year’s ASCO Annual Meeting

Compared to standard of care chemotherapy, both a dual immunotherapy regimen and a single immunotherapy agent added to chemotherapy extends overall survival (OS) for patients with advanced oesophageal squamous cell carcinoma, particularly those positive for the immune checkpoint protein PD-L1, according to data from a phase 3 trial presented at the 2021 ASCO Annual Meeting.

“Certain patients with advanced oesophageal cancer, who currently have few treatment options, now stand to gain from immunotherapy. The dual immunotherapy combination of nivolumab and ipilimumab is the first chemotherapy-free first-line treatment showing benefit for these patients,” said ASCO Chief Medical Officer and Executive Vice President, Dr Julie R Gralow.

In the CheckMate 648 trial, nivolumab plus chemotherapy (cisplatin and 5-fluorouracil) and nivolumab plus ipilimumab both significantly improved OS compared with standard chemotherapy. The co-primary endpoint, OS among patients with PD-L1 ≥1 per cent, was significantly better for patients who received nivolumab plus chemotherapy and nivolumab plus ipilimumab compared to chemotherapy alone – 15.4 and 13.7 months respectively, compared with 9.1 months.

OS was significantly better among all randomised patients with both nivolumab plus chemotherapy and nivolumab plus ipilimumab compared with chemotherapy alone, 13.2, 12.8, and 10.7 months, respectively. Progression-free survival (PFS) with nivolumab plus chemotherapy was significantly better than with chemotherapy alone in patients with PD-L1 ≥ 1 per cent. Adverse events (AEs) and serious AEs (≥ grade 3) were comparable between the three groups. Discontinuations (due to any component of a regimen) were more likely for patients receiving nivolumab plus chemotherapy.

Treatment advances for recurrent or metastatic oesophageal squamous cell carcinoma or upper GI cancers have been slower than for other cancers. Chemotherapy with cisplatin and 5-fluorouracil is currently the standard of care for initial treatment in patients with advanced oesophageal squamous cell carcinoma; however, their prognosis remains poor.
Nivolumab has been shown to improve survival in patients with advanced oesophageal squamous cell carcinoma that is refractory or intolerant to previous chemotherapy.

The combination of nivolumab with ipilimumab has demonstrated significant clinical activity across several tumour types, leading investigators to examine the combination for the treatment of oesophageal squamous cell carcinoma.
“The clinically meaningful improvements in survival of these two treatment regimens highlight immunotherapy’s impact on cancer care and should bring new therapeutic options to a group of patients that are often diagnosed when disease has already spread,” said lead author Dr Ian Chau, Consultant Medical Oncologist, Royal Marsden Hospital, Sutton, UK.