Efficacy and safety of camrelizumab in patients with first-line and second- line therapy for esophageal squamous cell carcinoma: A multicenter, prospective, real-world study

AbstractBackground In this study, we aimed to evaluate the real-world efficacy and safety of camrelizumab and identify clinicolaboratory factors that predict treatment outcomes in patients with unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma (ESCC) receiving camrelizumab. Methods Herein, 174 patients with unresectable advanced, recurrent, or metastatic ESCC treated with camrelizumab monotherapy (n = 30), camrelizumab + chemotherapy (CT; n = 91), and camrelizumab + radiotherapy (RT; n = 53) between October 1, 2019 and October 1, 2022 were included. Results The median follow-up time was 20 months (range, 1–34 months). The median progression-free survival (PFS) and overall survival (OS) of the whole cohort were 8 months [95% confidence interval (CI), 6.5–9.5 months] and 14 months (95% CI, 11.2–16.8 months), respectively. After multivariate analysis, receiving > 4 cycles of camrelizumab and having a good lung immune prognostic index (LIPI) were identified as independent predictors of better PFS and OS. The objective response rate of patients in the camrelizumab monotherapy group, camrelizumab + CT group, and camrelizumab + RT group was 46.2%, 47.1%, and 37.3%, respectively. The treatment-related adverse events (AEs) of grade 3 or higher were reported in 67 patients (38.5%). The most common treatment-related AEs were decreased neutrophil count (23.0%), decreased white blood cell count (19.5%), anemia (7.5%), and pneumonitis (4.6%). One patient (0.6%) died from a treatment-related AE of immune checkpoint inhibitor-induced myocarditis. Conclusion Camrelizumab was safe and effective as both monotherapy and part of a combination therapy. Longer PFS and OS were associated with receiving > 4 cycles of camrelizumab and having a good LIPI. LIPI can be used as a prognostic biomarker for ESCC patients receiving camrelizumab + RT.