Neoadjuvant arterial infusion chemotherapy combined with immunotherapy in treating locally advanced lower esophageal and esophagogastric junction cancer.

Background: The treatment of locally advanced lower esophageal cancer/esophagogastric junction cancers still has certain limitations. This study shares a new therapeutic strategy, namely neoadjuvant arterial infusion chemotherapy combined with immunotherapy (neo-AICIT).

Methods: The data of patients who received neoadjuvant arterial infusion chemotherapy (docetaxel + cisplatin) combined with immunotherapy (tislelizumab) for locally advanced lower esophageal cancer or esophagogastric junction cancers from October 2021 to May 2023 were collected. The indicators of these patients, such as the clinical staging of tumors, treatment-related adverse events (TRAEs), the effect of neoadjuvant therapy, operative complications, tumor regression grade (TRG), progression-free survival (PFS), and follow-up time, were recorded.

Results: A total of 12 patients received a complete neoadjuvant regimen, sequential surgery, and postoperative maintenance immunotherapy. The median age was 61.5 years. All patients suffered from squamous cell carcinoma; eight of them had lower esophageal cancer and four had esophagogastric junction cancer. The clinical staging in all patients was cT3N0-2M0G1-3. The median tumor proportion score (TPS) was 32.5%. Only grade 1 TRAEs occurred during adjuvant therapy, and the incidence was 58.3% (7/12). Postoperative complications included pulmonary infection 16.7% (2/12) and recurrent laryngeal nerve injury 16.7% (2/12). The postoperative pathology showed that 11 (91.7%, 11/12) patients had major pathological remission (MPR) with a TRG of 1-2, while 7 (58.3%, 7/12) patients had pathological complete response (pCR) with a TRG of 1. The objective response rate (ORR) was 100%. The median follow-up time was 19.5 months. Two patients had mediastinal lymph node metastasis at 18 and 20 months after operation, respectively. Tumor recurrence or metastasis was not found in other patients.

Conclusions: Observations of small case series suggest that neo-AICIT has good safety and efficacy in the treatment of locally advanced lower esophageal/esophagogastric cancer, and may be a promising neoadjuvant treatment option.