PMID- 36591306 OWN - NLM STAT- MEDLINE DCOM- 20230103 LR - 20230117 IS - 1664-3224 (Electronic) IS - 1664-3224 (Linking) VI - 13 DP - 2022 TI - Efficacy and safety of neoadjuvant immunotherapy in resectable esophageal or gastroesophageal junction carcinoma: A pooled analysis of prospective clinical trials. PG - 1041233 LID - 10.3389/fimmu.2022.1041233 [doi] LID - 1041233 AB - Neoadjuvant chemoradiotherapy (NCRT) plus radical esophagectomy is currently the standard treatment for resectable esophageal or gastroesophageal junction (GEJ) carcinoma. The aim of this study is to evaluate the efficacy and safety of neoadjuvant immunotherapy in resectable esophageal or GEJ carcinoma. Prospective clinical trials investigating efficacy and/or safety of neoadjuvant immunotherapy with immune checkpoint inhibitors (ICIs) followed by radical esophagectomy in patients with newly diagnosed resectable esophageal or GEJ carcinoma were identified through literature search. Quality assessment was performed by using the Newcastle-Ottawa scale. Preliminary treatment outcomes of pathologically complete response (pCR, ypT0N0) and grade 3-4 adverse effects (AEs) were pooled together and then compared with standard NCRT of the historical control CROSS study by Chi-square (chi(2)) test. A two-sided P value < 0.05 was considered statistically significant. A total of 17 eligible non-randomized trials with 455 participants were included into analysis. The most common primary endpoint was pCR (n = 7, 41%), and the median sample size and follow-up period was 23 patients and 7.9 months, respectively. For patients receiving neoadjuvant immunotherapy, the overall pCR, R0 resection, and grade 3-4 AE rates were 33.2%, 95.5%, and 35.1%, respectively. For esophageal squamous cell carcinoma (ESCC) and adenocarcinoma (EAC), neoadjuvant immunochemoradiotherapy showed no significant improvement in pCR rate than NCRT (ESCC, 50% vs 48.7%, P = 0.9; EAC, 32.6% vs 23.1%, P = 0.22). Grade 3-4 AEs were the most common in patients with neoadjuvant immunochemoradiotherapy, significantly higher than immunochemotherapy (46.7% vs 32.8%, P = 0.04) and NCRT (46.7% vs 18.1%, P < 0.0001). In conclusion, for patients with resectable esophageal or GEJ carcinoma, the addition of ICIs to standard NCRT could not improve pCR rate in both ESCC and EAC, but significantly increased the risk of severe AEs. Large-scale phase 3 randomized trials were urgently needed to further confirm the survival benefit and safety profile of neoadjuvant immunotherapy. CI - Copyright (c) 2022 Zhu, Leng, Gao, Wang, Zhang, Wu, Ma, Tan, Peng, Han and Wang. FAU - Zhu, Jie AU - Zhu J AD - Radiation Oncology Key Laboratory of Sichuan Province, Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. FAU - Leng, Xuefeng AU - Leng X AD - Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. FAU - Gao, Binyang AU - Gao B AD - Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China. FAU - Wang, Bo AU - Wang B AD - Kidney Research Institute, Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China. FAU - Zhang, Hanlin AU - Zhang H AD - Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Wu, Lei AU - Wu L AD - Radiation Oncology Key Laboratory of Sichuan Province, Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. FAU - Ma, Jiabao AU - Ma J AD - Radiation Oncology Key Laboratory of Sichuan Province, Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. FAU - Tan, Yan AU - Tan Y AD - Radiation Oncology Key Laboratory of Sichuan Province, Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. FAU - Peng, Lin AU - Peng L AD - Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. FAU - Han, Yongtao AU - Han Y AD - Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. FAU - Wang, Qifeng AU - Wang Q AD - Radiation Oncology Key Laboratory of Sichuan Province, Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. LA - eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't DEP - 20221216 PL - Switzerland TA - Front Immunol JT - Frontiers in immunology JID - 101560960 SB - IM MH - Humans MH - Neoadjuvant Therapy/adverse effects MH - *Esophageal Neoplasms/pathology MH - *Esophageal Squamous Cell Carcinoma/therapy/pathology MH - Prospective Studies MH - Esophagogastric Junction/pathology PMC - PMC9800859 OTO - NOTNLM OT - immune checkpoint inhibitor OT - immunochemoradiotherapy OT - immunotherapy OT - neoadjuvant OT - resectable esophageal carcinoma COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2023/01/03 06:00 MHDA- 2023/01/04 06:00 PMCR- 2022/01/01 CRDT- 2023/01/02 04:50 PHST- 2022/09/10 00:00 [received] PHST- 2022/12/05 00:00 [accepted] PHST- 2023/01/02 04:50 [entrez] PHST- 2023/01/03 06:00 [pubmed] PHST- 2023/01/04 06:00 [medline] PHST- 2022/01/01 00:00 [pmc-release] AID - 10.3389/fimmu.2022.1041233 [doi] PST - epublish SO - Front Immunol. 2022 Dec 16;13:1041233. doi: 10.3389/fimmu.2022.1041233. eCollection 2022.