PD-1单抗联合化疗用于初始不能手术的局部晚期转移性老年食管鳞癌病人的转化治疗研究

doi:10.3969/j.issn.1003-9198.2025.12.013

Abstract

Abstract: Objective To evaluate the efficacy and safety of programmed death-1 (PD-1) monoclonal antibody combined with cisplatin and 5-fluorouracil in elderly patients with initially unresectable advanced esophageal squamous cell carcinoma (ESCC), as well as the surgical conversion rate. Methods The study enrolled 26 elderly patients and 21 non-elderly patients, all of whom received three cycles of induction therapy with PD-1 monoclonal antibody, cisplatin, and 5-fluorouracil. PD-L1 expression and tumor mutational burden (TMB) were recorded. Primary endpoints were the incidence of grade 3 or higher adverse events, major pathological response (MPR) rate, and pathological complete response (pCR) rate. Secondary endpoints included surgical conversion rate, R0 resection rate, progression-free survival (PFS), and overall survival (OS). Results The incidence rate of grade 3 or higher adverse events was 15.4% in the elderly group and 14.3% in the non-elderly group (P=0.916). The MPR rate was 46.2% and 33.3% (P=0.373), and the pCR rate was 42.3% and 23.8% (P=0.237) in the elderly group and the non-elderly group, respectively. For secondary endpoints, the surgical conversion rate was 56.5% in the elderly group and 50.0% in the non-elderly group (P=0.669); The R0 resection rate was 100% in the elderly group and 90.0% in the non-elderly group (P= 0.244). Survival analysis showed that the median PFS was not reached in the elderly group and was 16 months in the non-elderly group (P=0.041), and the median OS was 36 months and 22 months, respectively (P=0.029). In the elderly group, patients who successfully underwent surgery had significantly longer PFS (24 months vs 9 months, P=0.01) and OS (not reached vs 16 months, P=0.007) compared to those who did not undergo surgery. Additionally, patients with TMB ≥10 mutations/Mb in the surgical group showed better PFS (not reached vs 20 months, P=0.049). PD-L1 expression status had no significant impact on survival (P=0.172). Conclusions PD-1 monoclonal antibody combined with chemotherapy is effective and tolerable in elderly patients with ESCC, associated with a superior survival benefit compared to non-elderly patients. PD-1 monoclonal antibody combined with chemotherapy is a promising treatment strategy for surgical conversion therapy in elderly patients with initially unresectable advanced ESCC.

Key words: esophageal squamous cell carcinoma, aged, immunotherapy combined with chemotherapy, induction conversion therapy, programmed death-ligand 1 antibody

CLC Number:

R 735.1

SHEN Hairui, XU Tongpeng. Conversion therapy for elderly patients with unresectable local advanced esophageal squamous cell carcinoma by PD-1 antibody plus chemotherapy[J]. Practical Geriatrics, 2025, 39(12): 1253-1258.

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Conversion therapy for elderly patients with unresectable local advanced esophageal squamous cell carcinoma by PD-1 antibody plus chemotherapy

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