Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Front Immunol. 2022 Dec 8;13:1051841. doi: 10.3389/fimmu.2022.1051841. eCollection 2022.
Esophageal cancer (EC) is one of the most common cancers worldwide, especially in China. Despite therapeutic advances, the 5-year survival rate of EC is still dismal. For patients with resectable disease, neoadjuvant chemoradiotherapy (nCRT) in combination with esophagectomy is the mainstay of treatment. However, the pathological complete response (pCR) rate to nCRT of 29.2% to 43.2% is not satisfactory, and approximately half of the patients will develop either a locoregional recurrence or distant metastasis. It is, therefore, necessary to explore novel and effective treatment strategies to improve the clinical efficacy of treatment. Immunotherapy utilizing immune checkpoint inhibitors (ICIs) has significantly changed the treatment paradigm for a wide variety of advanced cancers, including EC. More recently, increasing clinical evidence has demonstrated that neoadjuvant immunotherapy can potentially improve the survival of patients with resectable cancers. Furthermore, accumulating findings support the idea that chemotherapy and/or radiotherapy can activate the immune system through a variety of mechanisms, so a combination of chemotherapy and/or radiotherapy with immunotherapy can have a synergistic antitumor effect. Therefore, it is reasonable to evaluate the role of neoadjuvant immunotherapy for patients with surgically resectable EC. In this review, we discuss the rationale for neoadjuvant immunotherapy in patients with EC, summarize the current results of utilizing this strategy, review the planned and ongoing studies, and highlight the challenges and future research needs.
食管癌（EC）是全球最常见的癌症之一，尤其在中国。尽管治疗方法有所进步，但 EC 的 5 年生存率仍然不容乐观。对于可切除的疾病患者，新辅助放化疗（nCRT）联合食管切除术是主要的治疗方法。然而，nCRT 的病理完全缓解（pCR）率为 29.2%至 43.2%，并不令人满意，约有一半的患者会出现局部区域复发或远处转移。因此，有必要探索新的、有效的治疗策略，以提高治疗的临床疗效。免疫检查点抑制剂（ICIs）的免疫疗法已经显著改变了多种晚期癌症的治疗模式，包括 EC。最近，越来越多的临床证据表明，新辅助免疫疗法可能改善可切除癌症患者的生存。此外，越来越多的研究结果支持这样一种观点，即化疗和/或放疗可以通过多种机制激活免疫系统，因此化疗和/或放疗联合免疫疗法可以产生协同的抗肿瘤作用。因此，评估新辅助免疫疗法在可手术切除 EC 患者中的作用是合理的。在这篇综述中，我们讨论了新辅助免疫疗法在 EC 患者中的理论基础，总结了目前利用这一策略的结果，回顾了计划中的和正在进行的研究，并强调了挑战和未来的研究需求。
