Neoadjuvant Therapy for Resectable Esophageal Squamous Cell Carcinoma
Neoadjuvant chemoradiotherapy is the current standard treatment for patients with resectable locally advanced esophageal squamous cell carcinoma (LA-ESCC). This study presents results from a randomized phase II trial comparing neoadjuvant camrelizumab (an anti-PD-1 agent) combined with chemotherapy to standard chemoradiotherapy in this patient group.
Study Design and Methods
The multicenter, open-label, phase 2 non-inferiority trial (REVO, NCT05007145) enrolled 104 patients with resectable, locally advanced ESCC. Participants were randomized to receive either:
- Neoadjuvant camrelizumab with chemotherapy (nab-paclitaxel and cisplatin) — referred to as ICT
- Neoadjuvant chemoradiotherapy (nab-paclitaxel, cisplatin, and radiotherapy) — CRT
Results
The primary endpoint was pathologic complete response (pCR). Findings included:
- pCR rates: 32.7% for ICT versus 34.6% for CRT (rate ratio 0.94, 90% confidence interval 0.6–1.49), supporting the non-inferiority of ICT.
- Major pathologic response occurred in 42.3% of patients in the ICT group and 57.7% in the CRT group.
- R0 resection (complete tumor removal) was achieved in 100% of patients in both groups.
- One-year disease-free survival was 89.1% in the ICT arm versus 78% with CRT.
The trial "demonstrates the non-inferiority of neoadjuvant camrelizumab plus chemotherapy compared to chemoradiotherapy" in patients with resectable LA-ESCC.
Conclusion
This phase 2 trial suggests that camrelizumab combined with chemotherapy is a promising, less intensive neoadjuvant option compared to traditional chemoradiotherapy for resectable LA-ESCC, maintaining effective tumor response and resection outcomes.
Author's summary: The REVO trial shows neoadjuvant camrelizumab with chemotherapy offers a non-inferior alternative to chemoradiotherapy in treating resectable esophageal squamous cell carcinoma, achieving comparable tumor response and survival.