Outcomes of Chemotherapy for Advanced Esophageal Squamous Cell Carcinoma: A Study Using Real-World Data.

Abstract

Chemotherapy options for patients with advanced esophageal cancer had been limited until immune checkpoint inhibitors (ICIs) were approved for this indication. In recent years, ICI alone and ICI-combined chemotherapy have been approved, which prolonged the overall survival (OS) of patients with advanced esophageal cancer. We retrospectively analyzed 265 patients with unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma (ESCC) who received chemotherapy with and without ICIs at Tohoku University Hospital from January 2013 to March 2022. Cisplatin plus fluorouracil therapy was the most frequently administered regimen as first-line treatment, and their administration frequency did not significantly differ between before 2019 and after 2020. Nivolumab was the most frequently used treatment as second-line therapy since its first approval in 2020 (74%), whereas taxanes were the most frequently used regimen before 2019 (55%). The median OS was 13.9 months over the entire observation period. Among patients who received second-line therapy, those receiving ICIs at any line demonstrated significantly longer OS from the start of second-line treatment than the others (p = 0.03). Univariate analysis revealed that a G8 score of < 11 (hazard ratio: 1.62, p = 0.02) was a prognostic factor in patients aged ≥ 65 years. Among each components of the G8 score, a decrease in food intake, weight loss, impaired mobility, and self-perceived poor health status were shown to be particularly associated with shorter OS. Our real-world data demonstrated that ICI administration contributed to improved OS after initiating second-line treatment for unresectable, advanced, or recurrent ESCC. Additionally, we revealed that the G8 score could be a useful prognostic factor in elderly patients with advanced ESCC treated with chemotherapy.