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AbstractRecent 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.
摘要最近的单臂研究涉及PD-1抑制剂新辅助camrelizumab,加上可切除局部晚期食管鳞状细胞癌(LA-ESCC)的化疗,已显示出有希望的结果。这项多中心,随机,开放标签的3期临床试验旨在进一步评估新辅助camrelizumab加化疗后辅助camrelizumab与单独新辅助化疗相比的疗效和安全性。
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.
共有391例可切除的胸部LA-ESCC患者(T1b-3N1-3M0或T3N0M0)按临床分期(I/II,III或IVA)进行分层,并以1:1:1的比例随机接受两个周期的新辅助治疗。治疗包括camrelizumab,白蛋白结合紫杉醇和顺铂(Cam+nab-TP组;n=132);camrelizumab,紫杉醇和顺铂(Cam+TP组;n=130);紫杉醇联合顺铂(TP组;n=129),然后手术切除。
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.
Cam+nab-TP和Cam+TP组也接受佐剂camrelizumab。双主要终点是由盲人独立审查委员会评估的病理完全缓解率(pCR)和研究人员评估的无事件生存率(EFS)。这项研究报告了pCR率的最终分析。
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).
在意向治疗人群中,Cam+nab-TP和Cam+TP组的pCR率分别为28.0%和15.4%,而TP组为4.7%(Cam+nab-TP与TP:差异23.5%,95%置信区间(CI)15.1-32.0,P<0.0001;Cam+TP与TP:差异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% .
该研究达到了pCR的主要终点;但是,EFS尚未成熟。新辅助治疗期间≥3级治疗相关不良事件的发生率Cam+nab-TP组为34.1%,Cam+TP组为29.2%,28.8%。
MainEsophageal cancer is a significant global health issue, ranking seventh in incidence and sixth in mortality among all cancers1, with over half of the global esophageal squamous cell carcinoma (ESCC) cases in China2. In East Asia, neoadjuvant chemotherapy or chemoradiotherapy is standard for resectable locally advanced ESCC (LA-ESCC), with chemotherapy more prevalent3,4.
主要食管癌是一个重要的全球健康问题,在所有癌症中发病率排名第七,死亡率排名第六,中国超过一半的全球食管鳞状细胞癌(ESCC)病例2。在东亚,新辅助化疗或放化疗是可切除的局部晚期ESCC(LA-ESCC)的标准,化疗更为普遍3,4。
Studies such as CROSS and NEOCRTEC5010 highlight neoadjuvant chemoradiotherapy’s survival benefits over surgery alone5,6, whereas the JCOG9907 trial shows neoadjuvant chemotherapy improves overall survival (OS) compared to adjuvant therapy7. Recent phase 3 trials, including CMISG1701 and JCOG1109 (refs.
CROSS和NEOCRTEC5010等研究强调了新辅助放化疗相对于单独手术的生存益处[5,6],而JCOG9907试验显示,与辅助治疗相比,新辅助化疗可改善总生存期(OS)[7]。最近的3期试验,包括CMISG1701和JCOG1109(参考文献)。
8,9), along with a network meta-analysis of randomized controlled trials10, have not demonstrated a significant OS advantage when comparing neoadjuvant chemoradiotherapy to chemotherapy for LA-ESCC, leaving the optimal neoadjuvant treatment strategy in question.Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of ESCC.
8,9),以及随机对照试验的网络荟萃分析10,在比较新辅助放化疗和LA-ESCC化疗时,尚未显示出显着的OS优势,因此最佳的新辅助治疗策略存在疑问。免疫检查点抑制剂(ICI)彻底改变了ESCC的治疗方法。
Camrelizumab, a PD-1 inhibitor, has demonstrated promising efficacy and safety in advanced ESCC, including both chemotherapy-refractory and treatment-naive cases, as evidenced by the ESCORT and ESCORT-1st studies11,12. Following these results, China has approved camrelizumab as a second-line monotherapy for advanced or metastatic ESCC, and in combination with chemotherapy (paclitaxel and cisplatin, TP) as a first-line treatment.
Camrelizumab是一种PD-1抑制剂,在晚期ESCC中显示出有希望的疗效和安全性,包括化疗难治性和未接受治疗的病例,这一点已被ESCORT和ESCORT-1st研究所证实[11,12]。根据这些结果,中国已批准卡姆雷珠单抗作为晚期或转移性ESCC的二线单药治疗,并与化疗(紫杉醇和顺铂,TP)联合作为一线治疗。
Several phase 1b and 2 trials assessing neoadjuvant immunotherapy with camrelizumab and chemotherapy for LA-ESCC report high pathological complete response (pCR) rates of 17.6% to 39.2% (refs. 13,14,15,16,17,18). Our latest retrospective analysis suggests that neoadjuvant chemotherapy plus immunotherapy showed better 3-year OS rates (91.7% ve.
。我们最近的回顾性分析表明,新辅助化疗加免疫治疗显示出更好的3年OS率(91.7%ve)。
Data availability
数据可用性
Due to intellectual property and confidentiality obligations, individual deidentified participant data that underlie the results reported in this article can be requested 24 months after study completion. Qualified researchers must submit a proposal to the corresponding author at liyin@cicams.ac.cn, outlining the reasons for requesting the data.
由于知识产权和保密义务,可以在研究完成后24个月要求提供本文报告结果的个人身份不明参与者数据。合格的研究人员必须向通讯作者提交提案liyin@cicams.ac.cn,概述请求数据的原因。
The leading clinical site and sponsor will review the request to ensure compliance with intellectual property and confidentiality obligations and will respond within two weeks. A signed data access agreement with the sponsor is required before any data can be shared. The study protocol and statistical analysis plan are available alongside the published article..
领先的临床网站和赞助商将审查该请求,以确保遵守知识产权和保密义务,并将在两周内做出回应。在共享任何数据之前,需要与赞助商签署数据访问协议。研究方案和统计分析计划与已发表的文章一起提供。。
Code availability
代码可用性
No custom code was used for data analysis in this study.
。
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Download referencesAcknowledgementsThis study was funded by Jiangsu Hengrui Pharmaceuticals. The sponsor was involved in the collection, analysis and interpretation of data, as well as in the preparation of the manuscript. We extend our gratitude to all patients who participated in this trial and their families, as well as the researchers and staff at each study center for their invaluable contributions.
下载参考文献致谢本研究由江苏恒瑞制药资助。赞助商参与了数据的收集,分析和解释,以及手稿的准备。我们感谢所有参与该试验的患者及其家属,以及每个研究中心的研究人员和工作人员做出的宝贵贡献。
We thank Chi Ma, Feng Zhao, Jin Yan, Aichun Chen (Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals) and Chenxuan Liu (former employee of Jiangsu Hengrui Pharmaceuticals) for data interpretation, and Ni Guan (Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals) for statistical support.
我们感谢Chi Ma,Feng Zhao,Jin Yan,Aichun Chen(江苏恒瑞制药医务部)和Chenxuan Liu(江苏恒瑞制药前员工)的数据解释,以及Ni Guan(江苏恒瑞制药医务部)的统计支持。
Medical writing support was provided by Fangzhou Xia and Zhongjiang Chen (Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals) according to good publication practice guidelines.Author informationAuthor notesThese authors contributed equally: Jianjun Qin, Liyan Xue.Authors and AffiliationsSection of Esophageal and Mediastinal Oncology, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaJianjun Qin, Xiaozheng Kang, Ruixiang Zhang, Yong Li, Zhen Wang, Xiankai Chen, Jie He & Yin LiDepartment of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaLiyan Xue & Zhaoyang YangDepartment of Thoracic Surgery, Anyang Cancer Hospital, Anyang, ChinaAnlin Hao & Xiaofeng GuoDepartment of Thoracic Surgery, Tangdu Hospital, Air Force Military Medical University, Xi’an, ChinaTao Jiang .
夏方舟和陈中江(江苏恒瑞制药医务部)根据良好出版实践指南提供了医学写作支持。作者信息作者注意到这些作者做出了同样的贡献:秦建军,薛丽燕。作者和所属单位中国医学科学院北京协和医学院国家癌症中心/国家癌症临床研究中心/北京协和医院胸外科食管和纵隔肿瘤科秦建军、康晓正、张瑞祥、李勇、王震、陈先凯、何洁和尹丽中国医学科学院北京协和医学院国家癌症中心/国家癌症临床研究中心病理科北京安阳肿瘤医院胸外科,安阳,中国空军军事医科大学唐都医院胸外科中国西安陶江。
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PubMed Google ScholarContributionsJ.Q. and L.X. contributed equally to this work. Yin Li, J.H., J.Q., Z.H., and R. Zheng were responsible for the conception and design of the study. Yin Li, J.Q., L.X., A.H., X.G., T.J., Y.N., S.L., Y.C., H.J., C.Z., M.K., J.L., H.L., C.L., H.T., L.L., J.F., Y.Z., J.M., X.W., M.F., H.Y., Z.Y., Y.H., L.C., L.T., T.D., Y.
PubMed谷歌学术贡献。Q、 和L.X.对这项工作做出了同样的贡献。Yin Li,J.H.,J.Q.,Z.H。和R.Zheng负责这项研究的概念和设计。尹丽,J.Q.,L.X.,A.H.,X.G.,T.J.,Y.N.,S.L.,Y.C.,H.J.,C.Z.,M.K.,J.L.,H.L.,C.L.,H.T.,L.L.,J.F.,Y.Z.,J.M.,X.W.,M.F.,H.Y.,Z.Y.,Y.H.,L.C.,L.T.,T.D.,Y。
Liao, W.Z., B.L., Q.C., S.G., Y.Q., L.W., Z.L., Z.T., X.K., R. Zhang, Yong Li, Z.W., and X.C. contributed to data collection. W.Z. directed the statistical analysis. All authors were involved in data interpretation, manuscript writing, review, and approved the final manuscript for submission.Corresponding authorsCorrespondence to.
Liao,W.Z.,B.L.,Q.C.,S.G.,Y.Q.,L.W.,Z.L.,Z.T.,X.K.,R.Zhang,Yong Li,Z.W。和X.C.为数据收集做出了贡献。W、 Z.指导统计分析。所有作者都参与了数据解释,稿件撰写,审查,并批准了最终稿件的提交。通讯作者通讯。
Jie He or Yin Li.Ethics declarations
何洁或尹莉。道德宣言
Competing interests
相互竞争的利益
Z.H., R. Zheng and W.Z. are employees of Jiangsu Hengrui Pharmaceuticals. The other authors declare no competing interests.
Z、 H.,R.Zheng和W.Z.是江苏恒瑞制药的员工。其他作者声明没有利益冲突。
Peer review
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Peer review information
同行评审信息
Nature Medicine thanks Ken Kato, Nataliya Uboha and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary Handling Editor: Saheli Sadanand, in collaboration with the Nature Medicine team.
《自然医学》感谢Ken Kato、Nataliya Uboha和另一位匿名审稿人为这项工作的同行评审做出的贡献。主要处理编辑:Saheli Sadanand,与《自然医学》团队合作。
Additional informationPublisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Extended dataExtended Data Fig. 1 Post hoc subgroup analysis of pCR between Cam+nab-TP group and TP group.The central points on each bar represent the mean difference in pCR rates between the two groups, while the bars indicate the 95% CI.
Additional informationPublisher的注释Springer Nature在已发布的地图和机构隶属关系中的管辖权主张方面保持中立。扩展数据扩展数据图1 Cam+nab-TP组和TP组之间pCR的事后亚组分析。每个条上的中心点代表两组之间pCR率的平均差异,而条表示95%CI。
pCR, pathological complete response; ECOG PS, Eastern Cooperative Oncology Group performance status; TPS, tumor proportion score; CPS, combined positive score; CI, confidence interval.Extended Data Fig. 2 Post hoc subgroup analysis of pCR between Cam+TP group and TP group.The central points on each bar represent the mean difference in pCR rates between the two groups, while the bars indicate the 95% CI.
;ECOG PS,东部肿瘤协作组的表现状况;TPS,肿瘤比例评分;CPS,综合阳性评分;CI,置信区间。扩展数据图2 Cam+TP组和TP组之间pCR的事后亚组分析。每个条上的中心点代表两组之间pCR率的平均差异,而条表示95%CI。
pCR, pathological complete response; ECOG PS, Eastern Cooperative Oncology Group performance status; TPS, tumor proportion score; CPS, combined positive score; CI, confidence interval.Extended Data Fig. 3 Depth of pathological regression in primary tumor.(a) Cam+nab-TP group, (b) Cam+TP group and (c) TP group.
;ECOG PS,东部肿瘤协作组的表现状况;TPS,肿瘤比例评分;CPS,综合阳性评分;CI,置信区间。扩展数据图3原发肿瘤病理消退的深度。(a) Cam+nab-TP组,(b)Cam+TP组和(c)TP组。
RVT, residual viable tumor cells; IQR, interquartile range.Supplementary informationSupplementary InformationSupplementary Tables 1–5, study protocol and statistical analysis plan.Reporting SummaryRights and permissions.
RVT,残留的活肿瘤细胞;IQR,四分位间距。补充信息补充信息补充表1-5,研究方案和统计分析计划。。
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Reprints and permissionsAbout this articleCite this articleQin, J., Xue, L., Hao, A. et al. Neoadjuvant chemotherapy with or without camrelizumab in resectable esophageal squamous cell carcinoma: the randomized phase 3 ESCORT-NEO/NCCES01 trial.
转载和许可本文引用本文Qin,J.,Xue,L.,Hao,A。等人。在可切除的食管鳞状细胞癌中使用或不使用camrelizumab的新辅助化疗:随机3期ESCORT-NEO/NCCES01试验。
Nat Med (2024). https://doi.org/10.1038/s41591-024-03064-wDownload citationReceived: 29 March 2024Accepted: 13 May 2024Published: 02 July 2024DOI: https://doi.org/10.1038/s41591-024-03064-wShare this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.
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