Patients with metastatic or advanced oesophageal squamous cell carcinoma often face poor prognosis and few treatment options after first-line treatment. In the newly published study by dr. Huang and colleagues, the anti-PD-1 immune checkpoint inhibitor camrelizumab was investigated in this population and compared to chemotherapy. The study was published in the Lancet Oncology last week.
The randomised, open label, phase III ESCORT-trial included 607 Chinese patients with advanced or metastatic oesophageal squamous cell carcinoma. These patients had an ECOG-performance status of 0 or 1 and showed progression on or intolerance to first-line treatment. The patients were randomised (1:1) and 228 patients received camrelizumab (200 mg every 2 weeks) and 220 patients chemotherapy; either docetaxel (75 mg/m2 per 3 weeks) or irinotecan (180 mg/m2 per 2 weeks).
After a median follow-up time of 8.3 months (interquartile range: 4.1-12.8), the median overall survival (OS) was 8.3 months (95% CI: 6.8-9.7) in the camrelizumab group and 6.2 months (95% CI: 5.7-6.9) in the chemotherapy group (HR: 0.71, 95% CI: 0.67-0.87, two-sided p=0.0010).
The most common treatment-related adverse events of grade 3 or worse were anaemia (3% with camrelizumab, 5% with chemotherapy), abnormal hepatic function (2% with camrelizumab, <1% with chemotherapy) and diarrhoea (1% versus 4%). Serious treatment-related adverse events arose in 37 (16%) of 228 camrelizumab-treated patients and in 32 (15%) of 220 chemotherapy-treated patients. Moreover, 7 patients (3%) in the camrelizumab group passed away, compared to 3 (1%) in the chemotherapy group.
Camrelizumab as a second-line therapy significantly prolonged the overall survival of patients with metastatic or advanced oesophageal squamous cell carcinoma, compared to chemotherapy. The safety profile of camrelizumab was manageable and this together makes camrelizumab a potential second-line option for this population.
Huang J., Xu J, Chen Y, Zhuang, W, Zhang, Y, Chen, Z. … & Lin, L. (2020). Camrelizumab versus investigator’s choice of chemotherapy as second-line therapy for advanced or metastatic oesophageal squamous cell carcinoma (ESCORT): a multicentre, randomised, open-label, phase 3 study. The Lancet Oncology.