Comparison of neoadjuvant nab‐paclitaxel plus immunotherapy versus paclitaxel plus immunotherapy for esophageal squamous cell carcinoma

Abstract

AbstractBackgroundThis study aimed to compare the feasibility of nab‐paclitaxel plus platinum‐based chemotherapy (nabTP) versus paclitaxel plus platinum‐based chemotherapy (TP) with immune checkpoint inhibitors (ICIs) as a neoadjuvant modality for locally resectable esophageal squamous cell carcinoma (ESCC).MethodsBetween April 2019 and March 2022, we identified ESCC patients who received neoadjuvant immunotherapy with both nabTP (n = 213) and TP (n = 98) at our institution and Henan Cancer Hospital. The patients in the ICIs‐nabTP and ICIs‐TP groups were pair‐matched (1:1) for tumor location, sex, smoking, drinking, clinical T and N stage. The primary endpoint was the hazard of 30‐day major postoperative complications. Second, logistic models were applied to estimate the risk factors for pathological complete response (pCR) rate.ResultsAll patients underwent esophagectomy with R0 resection. A statistically significant increase in the risk of developing major pulmonary (odds ratio [OR], 1.182; 95% confidence interval [CI]: 0.530–2.635; p = 0.683), anastomotic (OR, 1.881; 95% CI: 0.607–5.830; p = 0.267), cardiac (OR, 1.000; 95% CI: 0.426–2.349; p = 1.000) complications after neoadjuvant immunotherapy plus nabTP was not observed. The median interval to surgery was 39 days in the ICIs‐nabTP group versus 44 days in the ICIs‐TP group (p = 0.119). There was no 30‐day mortality in each group. However, there was a slight difference in the 30‐day readmission rate (p = 0.043) and the incidence of hydropneumothorax (p = 0.027) between the two groups. The pCR rates of the ICIs‐nabTP and ICIs‐TP group were 36.7 and 21.4%, respectively (p = 0.018).ConclusionsIt appears to be feasible to add immunotherapy to nabTP regimen for locally advanced ESCC. Compared with TP, nabTP plus ICIs can achieve a better pCR rate in ESCC.