Qin, Jianjun, Xue, Liyan, Hao, Anlin, Guo, Xiaofeng, Jiang, Tao, Ni, Yunfeng, Liu, Shuoyan, Chen, Yujie, Jiang, Hongjing, Zhang, Chen, Kang, Mingqiang, Lin, Jihong, Li, Hecheng, Li, Chengqiang, Tian, Hui, Li, Lin, Fu, Junke, Zhang, Yong, Ma, Jianqun, Wang, Xiaoyuan, Fu, Maoyong, Yang, Hao, Yang, Zhaoyang, Han, Yongtao, Chen, Longqi, Tan, Lijie, Dai, Tianyang, Liao, Yongde, Zhang, Weiguo, Li, Bin, Chen, Qixun, Guo, Shiping, Qi, Yu, Wei, Li, Li, Zhigang, Tian, Ziqiang, Kang, Xiaozheng, Zhang, Ruixiang, Li, Yong, Wang, Zhen, Chen, Xiankai, Hou, Zhiguo, Zheng, Rongrong, Zhu, Wenqing, He, Jie, and Li, Yin
Recent single-arm studies involving neoadjuvant camrelizumab, a PD-1 inhibitor, plus chemotherapy for resectable locally advanced esophageal squamous cell carcinoma (LA-ESCC) have shown promising results. This multicenter, randomized, open-label phase 3 trial aimed to further assess the efficacy and safety of neoadjuvant camrelizumab plus chemotherapy followed by adjuvant camrelizumab, compared to neoadjuvant chemotherapy alone. A total of 391 patients with resectable thoracic LA-ESCC (T1b-3N1-3M0 or T3N0M0) were stratified by clinical stage (I/II, III or IVA) and randomized in a 1:1:1 ratio to undergo two cycles of neoadjuvant therapy. Treatments included camrelizumab, albumin-bound paclitaxel and cisplatin (Cam+nab-TP group; n= 132); camrelizumab, paclitaxel and cisplatin (Cam+TP group; n= 130); and paclitaxel with cisplatin (TP group; n= 129), followed by surgical resection. Both the Cam+nab-TP and Cam+TP groups also received adjuvant camrelizumab. The dual primary endpoints were the rate of pathological complete response (pCR), as evaluated by a blind independent review committee, and event-free survival (EFS), as assessed by investigators. This study reports the final analysis of pCR rates. In the intention-to-treat population, the Cam+nab-TP and Cam+TP groups exhibited significantly higher pCR rates of 28.0% and 15.4%, respectively, compared to 4.7% in the TP group (Cam+nab-TP versus TP: difference 23.5%, 95% confidence interval (CI) 15.1–32.0, P< 0.0001; Cam+TP versus TP: difference 10.9%, 95% CI 3.7–18.1, P= 0.0034). The study met its primary endpoint of pCR; however, EFS is not yet mature. The incidence of grade ≥3 treatment-related adverse events during neoadjuvant treatment was 34.1% for the Cam+nab-TP group, 29.2% for the Cam+TP group and 28.8% for the TP group; the postoperative complication rates were 34.2%, 38.8% and 32.0%, respectively. Neoadjuvant camrelizumab plus chemotherapy demonstrated superior pCR rates compared to chemotherapy alone for LA-ESCC, with a tolerable safety profile. Chinese Clinical Trial Registry identifier: ChiCTR2000040034.