A case study of combined neoadjuvant chemotherapy and neoadjuvant immunotherapy in resectable locally advanced esophageal cancer

Abstract

Background: The prognosis of patients under existing neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy requires improvement. Whereas programmed cell death 1 (PD-1) inhibitors have shown promising response in advanced esophageal cancer, they have not been used in the perioperative treatment of resectable locally advanced esophageal cancer. Whether immunotherapy can be incorporated into neoadjuvant therapy has became a challenging question for researchers.

Case presentation: We present a case of a 65-year-old male who had a history of progressive dysphagia for approximately 1 month. He underwent pertinent studies including computed tomography (CT)，gastroscopy，and pathological biopsy resulting in a diagnosis of medium-low differentiated squamous carcinoma of the thoracic segment of the esophagus (cT2N2M0 stage III). After 4 cycles of neoadjuvant chemotherapy combined with immunotherapy, gastroscopy showed the lesion in the esophagus was no longer present. Subsequently, the patient received thoracoscopic radical resection of esophageal cancer and achieved a pathological complete response (pCR) in postoperative pathological evaluation. During the whole treatment, no adverse effect was recorded and to date no evidence of recurrence has been recorded.

Conclusion: Our report suggest that neoadjuvant chemotherapy combined with immunotherapy not only improve the R0 resection and pCR rate in patients with resectable locally advanced esophageal cancer, but also the adverse effects are within the control range. However, the selection of therapeutic strategy, predictors of response to treatment, and interval time between neoadjuvant treatment and surgery still await more reliable evidence-based studies with large prospective samples.

Keywords: Esophageal cancer; Immunotherapy; Neoadjuvant therapy; PD-1 inhibitor.

Fig. 1

Pre-treatment examination: Gastroscopic findings (A, B)

Fig. 2

Pre-treatment examination: computed tomography. A, B The red arrows indicate the esophageal cancer lesions. C–E The red arrows indicate the swollen lymph nodes

Fig. 3

Pre-treatment examination: histopathological findings (A, B). The images were obtained after H&E staining under a magnification of respectively 50× and 200×

Fig. 4

The doses and schedules of the neoadjuvant chemotherapy combined neoadjuvant immunotherapy

Fig. 5

Post-treatment examination: gastroscopic findings (A, B), respectively middle esophagus and lower esophagus

Fig. 6

Post-treatment examination: computed tomography (A, B). The red arrows indicate the esophageal cancer lesions. C–E The red arrows indicate lymph nodes. All of them became smaller compared with pre-treatment

Fig. 7

Post-treatment examination: postoperative histopathological findings (A, B). The images were obtained after H&E staining under a magnification of respectively 40× and 40×. The squamous epithelium is intact, and subepithelial proliferation of fibrous connective tissue with vasodilatation and inflammatory cell infiltration