Camrelizumab with chemotherapy improves overall survival in esophageal squamous cell carcinoma: JAMA

China: A recent study in JAMA pointed that an initial treatment of camrelizumab combined with chemotherapy when compared with placebo and chemotherapy resulted in better overall survival and progression-free survival in patients with advanced or metastatic esophageal squamous cell carcinoma. 

Camrelizumab, an anti-programmed death receptor 1 [PD-1] antibody is known to have antitumor activity in previously treated advanced or metastatic esophageal squamous cell carcinoma. Huiyan Luo, Chinese Academy of Medical Sciences, Guangzhou, China, and colleagues aimed to evaluate the efficacy and adverse events of camrelizumab plus chemotherapy vs placebo plus chemotherapy as a first-line treatment in advanced or metastatic esophageal squamous cell carcinoma.

A randomized double-blind, placebo-controlled, multicenter, phase 3 trial (ESCORT-1st study) was conducted for patients from 60 hospitals in China between December 3, 2018, and May 12, 2020, final follow-up, was on October 30, 2020. A total of 751 patients were screened and 596 eligible patients with untreated advanced or metastatic esophageal squamous cell carcinoma were randomized. Patients were randomized 1:1 to receive either camrelizumab 200 mg (n = 298) or placebo (n = 298), combined with up to 6 cycles of paclitaxel (175 mg/m2) and cisplatin (75 mg/m2). All treatments were given intravenously every 3 weeks.

The results of the study were found to be:

• A total of 596 patients were randomized for the study (median age, 62 years; 523 men [87.8%]), 1 patient in the placebo-chemotherapy group did not receive planned treatment. A total of 490 patients (82.2%) had discontinued the study treatment.

• The median follow-up was at 10.8 months. The overall survival for the camrelizumab-chemotherapy group was a median of 15.3 months (135 deaths) vs a median of 12.0 months (174 deaths) for the placebo-chemotherapy group (hazard ratio [HR] for death, 0.70).

• Progression-free survival for camrelizumab plus chemotherapy was a median of 6.9 months (199 progression or deaths) when compared to 5.6 months (229 progression or deaths) for the placebo-chemotherapy group (HR for progression or death, 0.56).

• Treatment-related adverse events of grade 3 or higher occurred in 189 patients (63.4%) in the camrelizumab-chemotherapy group and 201 (67.7%) in the placebo-chemotherapy group, including treatment-related deaths among 9 patients (3.0%) and 11 patients (3.7%), was recorded.

Dr Luo and team concluded that "Among patients with advanced or metastatic esophageal squamous cell carcinoma, the addition of camrelizumab to chemotherapy, compared with placebo and chemotherapy, significantly improved overall survival and progression-free survival."

Reference:

Luo H, Lu J, Bai Y, et al. Effect of Camrelizumab vs Placebo Added to Chemotherapy on Survival and Progression-Free Survival in Patients With Advanced or Metastatic Esophageal Squamous Cell Carcinoma: The ESCORT-1st Randomized Clinical Trial. JAMA. 2021;326(10):916–925. doi:10.1001/jama.2021.12836