PD04.05. First-Line Treatment Strategies Considering Quality of Life in Unresectable or Recurrent Esophageal Cancer

Abstract

Esophageal Cancer: Non-Surgical Treatment of Esophageal Cancer Immune checkpoint inhibitors (ICIs) are established as standard treatments for unresectable or recurrent esophageal cancer. Nevertheless, a substantial proportion of patients experience severe dysphagia and malnutrition, which significantly impairs quality of life. The optimal first-line treatment strategy that addresses both therapeutic efficacy and symptom relief has yet to be determined. From February 2022 to December 2024, 78 patients with unresectable or recurrent esophageal cancer received either ICI plus chemotherapy or dual ICI therapy. Of these, 54 evaluable patients were retrospectively analyzed. Patients presenting with severe dysphagia (dysphagia score [DS] 4) underwent palliative radiotherapy to the primary tumor (25 Gy in 5 fractions) during treatment interruption. In the ICI plus chemotherapy group, a novel first-line approach incorporating palliative radiotherapy for cases with critical esophageal stenosis was implemented. Treatment response, survival outcomes, adverse events, and changes in dysphagia score were assessed. In the ICI plus chemotherapy group (n=40; unresectable 19, recurrent 21; median age 67.5 years), the best overall responses included complete response (CR) in 3 patients, partial response (PR) in 15, stable disease (SD) in 9, and progressive disease (PD) in 11. The overall response rate (CR+PR) was 47%, and clinical efficacy (CR+PR+SD) reached 76%. Grade 3 or higher hematologic toxicity was observed in 43%, and immune-related adverse events (irAEs) occurred in 58% (Grade 3 or higher: 8%). Among unresectable cases, 50% achieved at least 20% tumor shrinkage at the first evaluation. Dysphagia improved by two or more grades in 80% of evaluable patients, including 82% of those who received palliative radiotherapy. One- and two-year overall survival rates were 72.7% and 60.7%, respectively. In the dual ICI group (n=15), the overall response rate was 15%, and Grade 3 or higher immune-related adverse events occurred in 40%. First-line ICI plus chemotherapy combined with palliative radiotherapy resulted in rapid improvement of dysphagia and favorable clinical outcomes in patients with unresectable or recurrent esophageal cancer. This strategy may offer a valuable treatment option that balances tumor control with preservation of quality of life.