Neoadjuvant immunochemoradiotherapy versus chemoradiotherapy in esophageal cancer: a systematic review and meta-analysis of reconstructed individual patient data
A partir d'une revue systématique de la littérature publiée jusqu'au 30 octobre 2024 (37 études, 2 607 patients), cette méta-analyse évalue l'efficacité, du point de vue de la survie globale et de la survie sans progression, et la sécurité d'une immunochimioradiothérapie néoadjuvante par rapport à une chimioradiothérapie néoadjuvante standard chez des patients atteints d'un cancer de l'oesophage résécable
Purpose: Neoadjuvant immunochemoradiotherapy (nICRT) is emerging as a promising treatment for resectable esophageal cancer, but comprehensive analyses comparing it to standard neoadjuvant chemoradiotherapy (nCRT) are limited. This meta-analysis aimed to evaluate the efficacy, safety, and survival outcomes of nICRT versus nCRT.
Methods and Materials: A systematic search of PubMed, Embase, the Cochrane Library, and major conference proceedings up to October 30, 2024, identified studies involving resectable esophageal cancer treated with nICRT or nCRT. Data on pathological complete response (pCR), major pathological response (MPR), treatment-related adverse events (TRAEs), overall survival (OS), and progression-free survival (PFS) were extracted. A one-stage meta-analysis using reconstructed individual patient data was performed, calculating hazard ratios (HRs) with 95% confidence intervals (CIs).
Results: Thirty-seven studies were included, comprising 811 patients treated with nICRT and 1,796 with nCRT. nICRT demonstrated significantly longer OS than nCRT (HR = 0.714, 95% CI 0.550–0.926, p = 0.011). The 1-year, 2-year and 3-year OS rates were 89.9%, 76.0% and 66.4% for nICRT, compared to 85.0%, 66.5% and 57.3% for nCRT. The pCR rate was significantly higher in nICRT (50% vs. 38%; p = 0.040) for squamous cell carcinoma. Safety profiles were comparable, with no significant differences in grade 3–4 TRAEs or postoperative complications between the groups.
Conclusion: nICRT showed potential for superior survival compared to standard nCRT in resectable esophageal cancer and showed enhanced pathological response in squamous cell carcinoma, with a possibly acceptable safety profile. These findings support future trials integrating immunotherapy into neoadjuvant treatment regimens for esophageal cancer.
International Journal of Radiation Oncology, Biology, Physics , résumé 2025