Discussion
immunotherapy-related adverse reactions, tumor, esophageal squamous carcinoma, tumors, OS
TUMOR, RECURRENCE, OROPHARYNGEAL CANCER, CPS, SECONDARY, REGRESSION, TUMORS, COMPLICATIONS
As was shown, sintilimab maintenance therapy after CCRT provided significant and clinically meaningful improvements in OS, PFS, and the ORR compared with the historical data and promising antitumor activity in patients with local/regional recurrence of advanced esophageal squamous carcinoma. Most TRAEs were manageable, and no new safety signals were observed. The use of sintilimab after concurrent radiotherapy and chemotherapy does play a crucial role in the consolidation treatment stage. It can be intuitively demonstrated through the following historical data and regression studies. Our study included patients of previously radially treated (surgery or CCRT). For patients with recurrence after CCRT, Chinese data show a 1-year OS rate of 51% and a median survival of 12 months (The risk factors for serious complications of secondary radiotherapy include Carlisle score ≤ 70, total dose > 100 Gy, concurrent chemoradiotherapy (CCRT), and age < age 60, Stage T4 (The OS benefit (20.6 months) and PFS benefit (11.5 months) were observed in patients accepting sintilimab maintenance therapy after CCRT, and the ORR reached 63.6%, the median DOR was 19.5 months. It may relate to that radiation increasing the probability of tumor recognition by the host immune system, activating the cGAS-STING pathway to trigger an immune response, and reconstructing the tumor microenvironment mechanism. Kelly et al. reported that neoadjuvant chemoradiotherapy may upregulate PD-L1 expression and thus improve the response to the PD-1/L1 antibody (Immune checkpoint inhibitors have changed the treatment landscape of tumors in recent years. In the phase III PACIFIC trial (EC is a highly immunogenic tumor (The different therapies of neoadjuvant or adjuvant treatment using CRT plus immunotherapy are developing rapidly, but there is still currently a lack of biomarkers to accurately predict the efficacy of EC to guide perioperative immunotherapy. In addition, immunotherapy-related adverse reactions (irAEs) should be vigilant and closely monitored, and the update of multidisciplinary treatment concepts and strategies will allow more patients to benefit from immunotherapy.Ng et al. has proven that the NLR before radiotherapy is a prognostic indicator of oropharyngeal cancer, and OS is higher in patients with NLR < 3 than in patients with NLR ≥ 3 (5-year OS 85 vs. 74%) (Multiple studies of immune checkpoint inhibitors have confirmed that the efficacy of PD-L1-positive patients is better than that of PD-L1 negative patients in different tumor types. Li ZC et al. conducted a meta-analysis of multiple phase III clinical trials in EC; subgroup analyses suggested significant OS advantage in PD-L1 tumor-positive score (TPS) ≥ 10% groups and obviously longer PFS in the PD-L1 combined positive score (CPS) ≥ 10 groups (This clinical study still has some limitations: first, as a phase II single-arm, single-center clinical study, the number of included 36 patients is not convincing enough. Secondly, as the tumor tissue of patients was difficult to obtain, further comprehensive detection of PD-L1, TMB, or other biomarkers cannot be conducted, and a detailed subgroup analysis cannot be conducted either. The exception is that, due to the epidemic influence in China in 2022, part of patients showed poor compliance and thus cannot take the examinations during the follow-up according to the protocol, which had impact on the results to some extent.