Camrelizumab Improves Survival in Esophageal Squamous-Cell Carcinoma

By Will Boggs MD

June 04, 2020

NEW YORK (Reuters Health) - The anti-PD-1 antibody camrelizumab boosts survival in patients with advanced or metastatic esophageal squamous-cell carcinoma as second-line therapy, compared with chemotherapy, according to results from the ESCORT trial.

"The ESCORT study confirmed that camrelizumab is superior to chemotherapy both in efficacy and safety," Dr. Jianming Xu of Fifth Medical Center General Hospital of PLA, in Beijing, China, told Reuters Health by email. "Regardless of PD-L1 expression, camrelizumab will become a novel standard second-line treatment option for advanced esophageal-squamous cell carcinoma."

There are few second-line treatment options in patients with advanced or metastatic esophageal squamous-cell carcinoma who progress on or are intolerant to first-line standard chemotherapy. Camrelizumab and other immune-checkpoint inhibitors (ICIs) have shown promise in this setting in several clinical studies.

Dr. Xu and colleagues from 43 hospitals in China assessed the efficacy and safety of camrelizumab as second-line therapy in 457 patients with advanced or metastatic esophageal squamous-cell carcinoma. Patients were randomly assigned to treatment with camrelizumab or with the investigator's choice of chemotherapy (docetaxel or irinotecan).

During a median follow-up of 8.3 months in the camrelizumab group and 6.2 months in the chemotherapy group, there were 172 deaths (75%) in the camrelizumab and 191 deaths (87%) in the chemotherapy group.

Median overall survival was significantly longer in the camrelizumab group (8.3 months) than in the chemotherapy group (6.2 months), the researchers report in The Lancet Oncology.

Survival benefits favored camrelizumab over chemotherapy in all tested subgroups (including age, disease stage, PD-L1 expression level, selected chemotherapy, and lymph node status).

Estimated six-month overall survival was 63% with camrelizumab versus 55% with chemotherapy, and estimated six-month progression-free survival was 22% with camrelizumab versus 4% with chemotherapy.

Treatment-related adverse events occurred with similar frequency in the camrelizumab (94%) and chemotherapy (90%) groups, as did serious treatment-related adverse events (16% and 15%, respectively).

Nearly 90% of patients in the camrelizumab group (202/228, 89%) experienced immune-related adverse events, most commonly reactive capillary endothelial proliferation (182 patients) and hypothyroidism (44 patients).

Patients in the camrelizumab group were less likely than patients in the chemotherapy group to experience decreased global health status, decreased functioning and worsening symptoms from baseline to week 8.

Dr. Ken Kato of the National Cancer Center Hospital, in Tokyo, who earlier reported improved overall survival with nivolumab versus chemotherapy in the similar ATTRACTION-3 trial, told Reuters Health by email, "This report indicates that an immune-checkpoint inhibitor showed activity over chemotherapy in second-line treatment of esophageal squamous-cell carcinoma again. These results from the ATTRACTION-3, KN-181, and ESCORT trials are the same and prove the activity of ICIs."

"Patients who failed first-line chemotherapy containing platinum agents and recurred after preoperative therapy followed by surgery within 6 months are candidates for camrelizumab," said Dr. Kato, who was not involved in the new study.

"The toxicity of camrelizumab is relatively mild, but we should take care for immune-related adverse events," he added.

SOURCE: Lancet Oncology, online May 13, 2020.