Massaro Giulia, Paulet Alexandra, Lavacchi Daniele, Brugia Marco, Rossini Daniele, Giommoni Elisa, Catalano Martina, Pillozzi Serena, Antonuzzo Lorenzo, Roviello Giandomenico
School of Human Health Sciences, University of Florence, Florence 50134, Tuscany, Italy.
Oncology Unit, Careggi University Hospital, Florence 50134, Tuscany, Italy.
World J Gastrointest Oncol. 2025 Jun 15;17(6):106707. doi: 10.4251/wjgo.v17.i6.106707.
Esophageal cancer is an aggressive malignancy often diagnosed at advanced stages, with esophageal squamous cell carcinoma being the predominant subtype worldwide. Standard first-line chemotherapy provides limited survival benefits, with a median overall survival of less than 1 year. Recent advancements in immunotherapy, particularly immune checkpoint inhibitors (ICIs), have transformed the treatment landscape, improving overall survival and progression-free survival. However, response rates remain variable, with programmed death ligand 1 (PD-L1) expression being the primary predictive biomarker. The variability in PD-L1 testing methods and immune microenvironment alterations after prior treatments complicate patient selection for ICIs. Several phase 3 trials, including KEYNOTE-590 and CheckMate 648, have demonstrated the efficacy of ICIs combined with chemotherapy, particularly in patients positive for PD-L1. Despite these advances, long-term survival remains low, emphasizing the need for better biomarkers and novel therapeutic strategies. This review explored current first-line treatment options for esophageal squamous cell carcinoma, challenges in biomarker-based patient selection, and emerging therapeutic approaches.
食管癌是一种侵袭性恶性肿瘤，通常在晚期才被诊断出来，食管鳞状细胞癌是全球主要的亚型。标准一线化疗提供的生存益处有限，中位总生存期不到1年。免疫疗法的最新进展，尤其是免疫检查点抑制剂（ICIs），改变了治疗格局，提高了总生存期和无进展生存期。然而，缓解率仍然存在差异，程序性死亡配体1（PD-L1）表达是主要的预测生物标志物。PD-L1检测方法的差异以及先前治疗后免疫微环境的改变使ICI的患者选择变得复杂。包括KEYNOTE-590和CheckMate 648在内的几项3期试验已经证明了ICIs联合化疗的疗效，特别是在PD-L1阳性的患者中。尽管有这些进展，长期生存率仍然很低，这凸显了对更好的生物标志物和新型治疗策略的需求。本综述探讨了食管鳞状细胞癌目前的一线治疗选择、基于生物标志物的患者选择中的挑战以及新兴的治疗方法。
