Case sharing|Treplimumab combined with chemotherapy has significant benefits in the treatment of esophageal squamous cell carcinoma

Tuoyi (Treprizumab Injection), as China's first domestically-developed PD-1 inhibitor approved for marketing, has played an anti-tumor effect in many cancer types.

Today, Professor Gao Ming from the Oncology Department of the First Affiliated Hospital of Zhengzhou University brought a case of esophageal cancer immunotherapy combined with chemotherapy to share with doctors.

Case profile Medical history and auxiliary examination The patient, female, 68 years old, was admitted to the hospital on July 31, 2019.

Main complaint: coughing, choking for more than 20 days after eating.

History of present illness: The patient had coughing without obvious cause more than 20 days ago, choking after eating, no sputum, chest tightness, and chest pain.

A chest CT performed at a local hospital on July 23, 2019 showed that the upper and middle esophagus was poorly filled, and the wall was thickened.
Please combine with the clinic and perform gastroscopy if necessary; aortic calcification.

Gastroscopy tips: Consider esophageal cancer, it is recommended to repeat biopsy to confirm the diagnosis; chronic erythematous pangastritis.

Pathological tips: (esophageal biopsy) high-grade squamous intraepithelial lesions, please combine clinical and endoscopy.

He then went to our hospital for treatment, and the outpatient department was admitted to our department with "esophageal space occupation".

Past history: I have been suffering from diabetes for more than 5 years.
I was given "Insulin lispro 6u early, 6u late 6u, and insulin degludec 16u before going to bed" to control blood sugar, and the control was OK.

Suffered from hypertension for 5 years, the highest is 180/100mmHg, oral medication, blood pressure can be controlled.

Auxiliary examination: consultation pathology showed: (esophageal biopsy) high-grade squamous intraepithelial neoplasia.

The sampling is superficial, please combine the findings of the endoscopy, and then take it when necessary.

Gastroscopy prompts: esophageal cancer; pathology prompts: (esophageal biopsy) squamous cell carcinoma.

Figure 1 Gastroscopy results Figure 2 Pathological results Neck + chest + whole abdomen CT showed: space-occupying lesions in the upper part of the esophagus.

There were no obvious abnormalities.

Figure 3 The results of enhanced chest CT (baseline) on August 1, 2019.
Bronchoscope mediastinal mass biopsy pathology showed: squamous cell carcinoma.

Figure 4 Clinical diagnosis of esophageal squamous cell carcinoma by bronchoscopy and pathological results (T4bNxMx ⅣA stage AJCC 8th stage).

 Treatment after first-line treatment (simultaneous radiotherapy and chemotherapy): from August 9 to December 1, 2019, 6 cycles of chemotherapy with the "Docetaxel 60 mg d1, d5 + lobaplatin 40 mg d2" regimen; August 15 to 9, 2019 On the 13th, local radiotherapy was given 19 times.

Efficacy evaluation after first-line treatment: After 2 cycles of chemotherapy + full course of radiotherapy, the condition improved; after the continued 4 cycles of chemotherapy, the condition was stable.

Figure 5 Comparison of chest enhanced CT results on December 25, 2019 and August 1, 2019.
On January 6, 2021, a re-examination of chest enhanced CT results showed that the esophagus occupied space and the upper esophagus wall was thickened, compared with May 26, 2020 Film progress.

Figure 6 Comparison of chest enhanced CT results on January 6, 2021 and May 26, 2020.
Second-line treatment (immune + chemotherapy): From January 7 to April 13, 2021, give "Treprizumab + Lei Tetroxed" regimen was treated with 5 cycles of chemotherapy.

Efficacy evaluation after second-line treatment: After 2 cycles of immunization + chemotherapy, the condition improved; after the continued 2 cycles of immunization + chemotherapy, the condition was stable.

Figure 7 Comparison of chest enhanced CT results on February 24, 2021 and April 12, 2021 Figure 8 Case analysis of changes in tumor markers The patient was diagnosed as "esophageal squamous cell carcinoma (T4bNxMx IVA stage AJCC 8th stage)", and the first-line treatment is Concurrent radiotherapy and chemotherapy, including 2 cycles of chemotherapy + full course of radiotherapy, the tumor was significantly reduced, and the disease was stable after 4 cycles of chemotherapy.

After the disease progresses, the patient's second-line treatment is immune + chemotherapy, that is, teriprizumab + raltitrexed for 5 cycles, of which the esophageal cancer lesions shrink after 2 cycles of chemotherapy + immunotherapy, and then 3 cycles of chemotherapy + immunotherapy.
stable.

The adverse reactions that occurred during the treatment of this patient were concentrated in the first-line concurrent radiotherapy and chemotherapy stage, mainly including second-degree myelosuppression and first-degree radiation dermatitis.
Toxic and side effects caused by chemotherapy and radiotherapy were considered.

During the second-line treatment, there were no obvious immune-related adverse reactions, and the overall safety was controllable.

Experts comment that the first-line treatment of esophageal cancer is mainly simultaneous radiotherapy and chemotherapy, and the second-line treatment recommends immunotherapy combined with chemotherapy.

PD-1 inhibitors are a new type of immunotherapy that relieves tumor cells from escaping the immune system.
Combined with chemotherapy, they can synergistically kill tumors.

At the ASCO meeting in 2019, in the Phase II clinical study of teriprizumab for solid tumors (NCT02915432), the results of the esophageal squamous cell carcinoma cohort showed that the objective response rate (ORR) in patients with chemotherapy-resistant esophageal squamous cell carcinoma It is 18.
6%, the disease control rate (DCR) is 47.
5%, and its safety and anti-tumor activity are good1.

After the patient was treated with teriprizumab combined with chemotherapy, the condition was stable and there were no immune-related adverse reactions, suggesting that immunotherapy combined with chemotherapy has good application prospects in the second-line treatment of advanced esophageal cancer, and patients with esophageal cancer can learn from it More benefits! References: 1.
Association of frequent amplification of chromosome 11q13 in esophageal squamous cell cancer with clinical benefit to immune check point blockade.
2019 ASCO, abs 4036.