Perioperative tislelizumab with four cycles of neoadjuvant chemotherapy for resectable locally advanced esophageal squamous cell carcinoma: a phase 2 study

Abstract

Background: The application of neoadjuvant immunotherapy in the treatment of esophageal cancer needs further exploration. This study aimed to investigate the safety and effectiveness of tislelizumab, an anti-PD-1 antibody, combined with chemotherapy as neoadjuvant treatment for locally advanced esophageal squamous cell carcinoma (LA-ESCC).

Methods: In this phase II study, patients with clinical stages of II-IVA (T3-T4 and/or node positive) potentially resectable LA-ESCC were enrolled. Patients received neoadjuvant tislelizumab and chemotherapy every 3 weeks for 4 cycles before surgery and adjuvant tislelizumab for 9 months. The primary endpoint was pathological complete response (pCR) rate. Secondary endpoints included R0 resection, disease free survival (DFS), adverse events (AE), and biomarkers for predicting efficacy.

Results: The study included 30 patients. 25 patients completed neoadjuvant chemoimmunotherapy and underwent surgery, 96% with R0 resection. The pCR and MPR rate was 44% and 52%. The 6-month and 1-year DFS rate was 100% and 75.3%. 43.3% patients experienced severe (grade 3-4) treatment-related adverse events (TRAEs) and 5 patients developed severe immune-related adverse events (irAEs). Further exploration found that a group of peripheral lymphocyte subsets increased significantly after 2 cycles of neoadjuvant therapy in patients who achieved pCR, suggesting the importance of dynamic monitoring of circulating lymphocyte.

Conclusions: The combination of perioperative tislelizumab and neoadjuvant chemotherapy has achieved an encouraging pCR rate and demonstrated a manageable safety profile in patients with potentially resectable ESCC.

Clinical trial registration: https://www.chictr.org.cn/, identifier ChiCTR2100043772.

Keywords: esophageal squamous cell carcinoma; immunotherapy; neoadjuvant chemotherapy; perioperative treatment; tislelizumab.

Figure 1

Consort diagram.

Figure 2

Changes of overall tumor staging, T staging and N staging before and after neoadjuvnat treatment according to the TNM classification.

Figure 3

The Kaplan-Meier analysis for disease-free survival (A) and overall survival (B) in the treated population.

Figure 4

Difference of changes in lymphocyte subsets before and after 2 cycles of neoadjuvant treatment between pCR and non-pCR group. (A) Lymph cells, (B) NK cells, (C) CD8+T cells, (D) CD8+CD28+T cells, (E) CD8+DR+T cells, and (F) CD8+CD38+T cells.