Huang YH, Yang GZ, Chen HG, Li XJ, Wu YH, Zhang K, Xu JN, Zhang J. Impact of baseline steroids on the efficacy of neoadjuvant immunochemotherapy in locally advanced esophageal squamous cell carcinoma. World J Gastrointest Oncol 2024; 16(9): 3887-3897 [DOI: 10.4251/wjgo.v16.i9.3887]
Corresponding Author of This Article
Jian Zhang, MD, PhD, Chief Doctor, Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. sumszhangjian@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yuan-Heng Huang, Guo-Zhen Yang, Hui-Guo Chen, Xiao-Jun Li, Yong-Hui Wu, Kai Zhang, Jian-Nan Xu, Jian Zhang, Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Yuan-Heng Huang, Guo-Zhen Yang, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, Guangdong Province, China
Yuan-Heng Huang, Guo-Zhen Yang, Guangdong Esophageal Cancer Institute, Guangzhou 510060, Guangdong Province, China
Co-first authors: Yuan-Heng Huang and Guo-Zhen Yang.
Co-corresponding authors: Hui-Guo Chen and Jian Zhang.
Author contributions: Huang YH conceived the study; Huang YH and Yang GZ collected clinical samples and analyzed clinical data, and wrote articles; Li XJ, Wu YH, Zhang K, Xu JN participated in clinical samples collection; Zhang J and Chen HG were responsible for overseeing and leading the planning and execution of the research activities; All authors have read and approved the final manuscript. Huang YH and Yang GZ made crucial and indispensable contributions to the project design, sample collection, data analysis, and took primary responsibility for writing the manuscript, thus qualifying as co-first authors. Zhang J and Chen HG played essential and indispensable roles in the overall design of the study, data interpretation, and manuscript preparation, serving as co-corresponding authors. Zhang J focused on guiding the overall direction and strategy of the research, while Chen HG concentrated on the accuracy of data analysis and research outcomes. Their collaboration was critical to the successful completion and publication of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Sun Yat-sen University Cancer Center Institutional Review Board (Approval No. B2023-226-01).
Informed consent statement: All study participants provided written informed consent prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All the data are available without restriction. Researchers can obtain data by contacting the corresponding sumszhangjian@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian Zhang, MD, PhD, Chief Doctor, Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. sumszhangjian@163.com
Received: June 3, 2024 Revised: July 31, 2024 Accepted: August 12, 2024 Published online: September 15, 2024 Processing time: 97 Days and 13.7 Hours
Abstract
BACKGROUND
Immunochemotherapy involving the combination of programmed cell death 1/programmed cell death ligand 1 inhibitors with chemotherapy has advanced the treatment of locally advanced esophageal squamous cell carcinoma (ESCC). The use of corticosteroids as pretreatment might reduce immunotherapy efficacy.
AIM
To investigate the impact of baseline corticosteroid use on neoadjuvant immunochemotherapy (nIC) outcomes in locally advanced ESCC patients.
METHODS
Patients with locally advanced ESCC who received nIC at Sun Yat-sen University Cancer Center and the Third Affiliated Hospital of Sun Yat-sen University were included. Patients were divided into dexamethasone and antihistamine groups on the basis of the administered pretreatment. Antiallergic efficacy and safety were evaluated, as well as its impact on short-term efficacy [complete pathological response (pCR), major pathological response (MPR)] and long-term efficacy [overall survival (OS), progression-free survival (PFS)] of nIC.
RESULTS
From September 2019 to September 2023, 142 patients were analyzed. No severe treatment-related adverse events or deaths were observed. Allergy occurrence was greater in the antihistamine group (P = 0.014). Short-term efficacy was not significantly different: The pCR rates were 29.9% and 40.0%, and the MPR rates were 57.9% and 65.7% in the dexamethasone and antihistamine groups, respectively. The long-term efficacy was not significantly different: The 2 years OS rates were 95.2% and 93.5%, and the 2 years PFS rates were 90.3% and 87.8%. Subgroup analysis revealed no difference in OS between the 20 mg dexamethasone group and the < 20 mg dexamethasone group, but PFS was significantly greater in the 20 mg dexamethasone group (93.9% vs 56.4%, P = 0.001).
CONCLUSION
Dexamethasone or antihistamines can be used before nIC in locally advanced ESCC without affecting short- or long-term efficacy. Administering 20 mg dexamethasone before nIC may improve PFS in ESCC.
Core Tip: This study evaluated the impact of baseline corticosteroid use on the outcomes of neoadjuvant immunochemotherapy (nIC) in patients with locally advanced esophageal squamous cell carcinoma (ESCC). These findings indicate that low-dose dexamethasone or antihistamines can be used for pretreatment without compromising short-term or long-term efficacy. Notably, administering 20 mg of dexamethasone before nIC significantly improved progression-free survival in ESCC patients, highlighting the potential benefit of optimizing the corticosteroid dose in clinical practice. These results support further investigations in larger, prospective trials.
