Evaluation of the efficacy and safety of neoadjuvant immunotherapy in locally advanced esophageal squamous cell carcinoma.

Background: While neoadjuvant therapy combined with surgery remains standard for locally advanced esophageal squamous cell carcinoma (ESCC), survival outcomes remain suboptimal. Refining multimodal neoadjuvant regimens (including chemoradiotherapy, chemotherapy, and emerging immunotherapy) is critical to improving prognosis. This study sought to evaluate the efficacy and safety of neoadjuvant immuno-chemotherapy in the treatment of locally advanced ESCC, and to examine the correlation between tumor regression grade (TRG) and imaging evaluation. Methods: In total, 106 patients diagnosed with ESCC-only received a 21-day cycle of intravenous camrelizumab plus nab-paclitaxel and carboplatin. The efficacy was evaluated after two cycles, and the patients subsequently underwent tumor resection. All patients completed the full treatment regime and underwent surgery. Patients' treatment response after neoadjuvant therapy, R0 resection rate, TRG, and pathologic complete response (pCR) rate were measured. The adverse events (AEs) were also documented. Results: The R0 resection (resection with microscopically negative margins) was 97.2% (103/106). The pCR (ypT0N0) rate was 39.6% (42/106), and 50% (53/106) of the patients had a complete response (CR) of the primary tumor but had residual disease in the lymph nodes (ypT0N+). The major pathologic response (MPR) rate was 49% (52/106). Preoperative imaging evaluation of the patients showed that 33% (35/106) had a CR, 34% (36/106) had a partial response (PR), 21.7% (23/106) had stable disease (SD), and 11.3% (12/106) had progressive disease (PD). Based on the postoperative TRG classification, 47.1% (50/106) of the patients had grade 0, 11.3% (12/106) had grade 1, 18% (19/106) had grade 2, and 23.6% (25/106) had grade 3. Conclusions: This study showed that camrelizumab-based neoadjuvant immuno-chemotherapy was effective in the treatment of locally advanced resectable ESCC. The treatment increased the likelihood of achieving a curative surgical outcome, and the side effects were generally manageable. The treatment warrants further investigation. Moreover, the TRG was found to be significantly associated with imaging assessment; these two approaches can be combined and employed to predict the efficacy of neoadjuvant immuno-chemotherapy.