Single-center phase 2 trial of chemoradiotherapy and immunochemotherapy as conversion therapy in unresectable locally advanced ESCC

Due to the absence of early symptoms and lack of robust diagnostic markers, only approximately 50% of patients with esophageal squamous cell carcinoma (ESCC) present with potentially resectable disease. The phase 2 NEXUS trial, at the Chinese Academy of Medical Sciences and Peking Union Medical College (Beijing), evaluated chemoradiotherapy (CRT) and subsequent immunochemotherapy (iCT) as conversion therapy for initially unresectable locally advanced ESCC. Patients received radiotherapy and nab-paclitaxel plus cisplatin, followed by tislelizumab and nab-paclitaxel plus cisplatin. Twenty of thirty enrolled patients (66.7%) achieved resectability (R0: 95.2%; pathologic complete response: 65%; major pathologic response 90%). One-year progression-free survival rate was 79.4% and one-year overall survival rate was 89.6%. The authors conclude that CRT followed by iCT was a promising treatment strategy for initially unresectable locally advanced ESCC.