Is chemotherapy for advanced or metastatic oesophageal squamous cell carcinoma no longer needed?

[...]treatment decisions have been derived from small phase 2 studies,1 or from results of phase 3 randomised studies that included patients with adenocarcinoma histology or a mix of both histologies.2,3 In those trials, patients with squamous cell carcinoma consistently had inferior survival outcom...

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Veröffentlicht in:The lancet oncology 2020-06, Vol.21 (6), p.743-745
1. Verfasser: van Laarhoven, Hanneke WM
Format: Artikel
Sprache:eng
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Zusammenfassung:[...]treatment decisions have been derived from small phase 2 studies,1 or from results of phase 3 randomised studies that included patients with adenocarcinoma histology or a mix of both histologies.2,3 In those trials, patients with squamous cell carcinoma consistently had inferior survival outcomes compared with those with adenocarcinoma.4 The randomised KEYNOTE-181 and ATTRACTION-3, trials have led to important changes in the treatment landscape with the introduction of PD-1 inhibitors. In the KEYNOTE-181 trial, although second-line treatment with pembrolizumab did not show improvement of survival in the whole population—including both squamous and adenocarcinomas—when compared with chemotherapy, a significant benefit was found in patients whose tumour had a PD-L1 combined positive score of ten or higher, and this difference was mainly due to squamous cell carcinomas.5 ATTRACTION-3 reported a significant survival benefit in second-line treatment with nivolumab compared with chemotherapy in patients with squamous cell carcinoma who were mainly from Asia.6 The ESCORT study7 adds to this body of evidence, showing that camrelizumab improves survival in patients (in China) with squamous cell carcinoma compared with the investigator's choice of chemotherapy, irrespective of PDL-L1 expression on tumour cells. Unfortunately, microsatellite instability and Epstein-Barr-virus positivity—two of the most consistent predictors for response to checkpoint inhibition in oesophagogastric cancer—are almost absent in patients with squamous cell carcinomas.9 In fact, in addition to novel biomarkers reflecting tumour biology, biomarkers that characterise the tumour host, such as patients' gut microbiome composition, might be as relevant to explore.
ISSN:1470-2045
1474-5488
DOI:10.1016/S1470-2045(20)30182-0