Each tumor has its history and its course also linked to the characteristics of the patient, but for some the treatment path is more tortuous and with less chance. This has been the case up to now for esophageal cancer, one of the neoplasms with the worst prognosis also because more than 50% of diagnoses arrive at an advanced stage. In fact, the 5-year survival is 12% in men and 17% in women. But from the Congress of the American Society of Clinical Oncology (ASCO), underway in Chicago, new data arrives that can significantly improve disease control.
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Few effective therapies
In Italy, in 2020, 2,400 new cases were estimated (1,700 men and 700 women). More than half of diagnoses are advanced, when the disease is more difficult to treat. “Squamous cancer of the esophagus is a disease that has been considered for years to have no truly effective options – he explains Sara Lonardi, FF director of Oncology 3 at the Oncological Institute Veneto IRCCS of Padua. In fact, standard first-line chemotherapy, consisting of a doublet of drugs, does not greatly improve the prognosis, which remains unfavorable with a median survival that does not exceed 10 months “.
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Survival doubled thanks to immunotherapy
Hence the need for new weapons capable of controlling the disease in the long term. A result possible thanks to immunotherapy, as evidenced by the updated data of the CheckMate -648 study, presented today at Asco and detailed in the press briefing promoted by Bristol Myers Squibb. The CheckMate-648 study involved 970 people with advanced or metastatic squamous cell cancer of the esophagus and never treated before. “The primary analysis – explains Lonardi – had already highlighted the overall survival benefit, which has almost doubled thanks to the immunotherapy regimens at the forefront compared to chemotherapy alone. In particular, the one-year survival in the population of patients with tumor PD-L1 expression equal to or greater than 1%, increased from 37% with the standard of care to 58% with the combination of immunotherapy and chemotherapy and at 57% with dual immunotherapy “.
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Some patients benefit from the ‘tail of curves’
The new analyzes confirm how the chemotherapy-associated immunological molecule nivolumab and dual immunotherapy consisting of nivolumab plus ipilimumab can change clinical practice in the treatment of advanced disease. “This type of carcinoma – continues the oncologist – is very aggressive and, with the progression of the disease, it becomes more and more symptomatic and difficult to treat. Therefore any improvement in disease control in its early stages is of great value. As in many immunotherapy studies in various neoplasms, also in esophageal carcinoma, the study demonstrates a benefit of this prolonged approach throughout the history of the disease, with a group of patients presenting a long-term survival advantage. , the so-called ‘tail of curves’. In addition, the new analysis demonstrates that the risk of progression to post-first lines of therapy (PFS2) was reduced by 36% with the combination of nivolumab and chemotherapy and by 26% with nivolumab and ipilimumab, compared to the chemotherapy alone arm. standard. Furthermore, the excellent tolerability of this approach is confirmed “.
The importance of acting on prevention
In 2020, 7,100 people lived in Italy after diagnosis. Alcohol abuse and cigarette smoking are closely related to the scaly form. “Too many patients – concludes Lonardi – discover the disease in an advanced stage, no longer operable. And they are very fragile people, sometimes marginalized by alcohol addiction, often also affected by other diseases, with a low quality of life. Hence the need for effective and tolerable therapies. Dual immunotherapy with nivolumab and ipilimumab is the first ‘chemo-free’ treatment to have demonstrated survival benefit and disease control which, according to updated data from the CheckMate -648 study, is prolonged into subsequent lines of therapy. It can therefore represent an effective therapeutic alternative in people who cannot tolerate chemotherapy due to compromised general health conditions “.