Good news spreads frequently, the domestically developed PD-1 carrelizumab has been approved as a new first-line indication for advanced esophageal cancer!

On December 10, 2021, China’s self-developed PD-1 monoclonal antibody Carrelizumab (trade name: Erica®) was approved for the second-line treatment of advanced esophageal squamous cell carcinoma and again approved for advanced esophageal squamous cell carcinoma The first-line treatment for cancer has become the first domestically developed PD-1 drug to be approved as the first-line immune checkpoint inhibitor for advanced esophageal cancer
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Speaking of esophageal cancer, on December 12, 2021, the well-known mainland actor Tu died of esophageal cancer at the age of 61
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It is reported that Tumen checked and diagnosed advanced esophageal cancer in early November.
Although he had received two chemotherapy in Beijing, the treatment was still ineffective.
It took only more than a month from diagnosis to death, which also made us aware of the dangers of esophageal cancer
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What kind of malignant disease is esophageal cancer? Esophageal cancer is a malignant tumor that occurs on the esophagus, derived from the cancerous transformation of esophageal epithelial cells
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The main symptoms of esophageal cancer are progressive dysphagia and mucus-like sputum.
In severe cases, it is difficult to drink water.
The patient is thin, dehydrated, and weak
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There will be pain behind the breastbone or in the scapular region.
If persistent chest pain or back pain indicates that the tumor may invade outside the esophagus, it is already in the advanced stage of esophageal cancer
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The occurrence of esophageal cancer is the result of a comprehensive effect of internal and external factors.
The main causes are: 01 gastroesophageal reflux disease, the reflux of stomach contents and gastric acid into the esophagus, which can cause esophageal damage, due to gastroesophageal reflux The mutation of esophageal cells caused by it has the risk of developing esophageal adenocarcinoma; 02 Smoking, secondhand smoke and drinking, smoking and heavy drinking are important causes of esophageal squamous cell carcinoma; 03 Unhealthy diet, such as long-term lack of trace elements, vitamins, and vitamins E, selenium, etc.
, can also increase the risk of esophageal cancer; 04 love to eat hot foods and drink kung fu tea, etc.
, can also easily cause esophageal damage and increase the risk of esophageal cancer; 05 genetic factors, cancers with certain family history Patients are prone to esophageal cancer
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The number of new cases and deaths of esophageal cancer in China last year was divided into 320,000 and 300,000 [1].
The proportion of new cases and deaths exceeded 50% of the world's total.
Every 10 cases of esophageal cancer died in the world.
Five of them are Chinese patients
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The study also found that 70% of esophageal cancers in China are diagnosed in the middle and advanced stages, and the five-year survival rate is less than 20% [2]
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At the same time, there are differences in the types of esophageal cancer between China and other countries.
More than 90% of esophageal cancers in China are squamous cell carcinomas, while about 70% in Europe and the United States are adenocarcinomas [3], and the treatment methods are very different
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Therefore, European and American treatment models cannot fully meet the treatment needs of Chinese patients, and there is an urgent need to explore new and effective treatment options to improve the survival status of Chinese patients with esophageal cancer
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From ESCORT to ESCORT-1st, immunotherapy has brought new options to Chinese patients with advanced esophageal cancer.
For many years, Chinese scholars have been walking in the field of esophageal cancer and have achieved remarkable results
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In 2019, a landmark study in the field of esophageal cancer immunotherapy-ESCORT research achieved breakthrough success, and Carrelizumab was approved as a second-line treatment indication for esophageal squamous cell carcinoma
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The approval of the new indication of Karelizumab is based on the ESCORT-1st study.
The results of the study were listed in the 2021 ASCO Conference Oral[4], and were also recognized by international authoritative journals and one of the four top medical journals.
The full text of "Journal of the American Medical Association" (JAMA) was published online, becoming the world's first and only clinical study of esophageal cancer immunotherapy to be listed in JAMA [3], and it has become a domestic PD-1 monoclonal antibody in the field of esophageal cancer treatment.
An important breakthrough! In the new version of "Chinese Society of Clinical Oncology (CSCO) Guidelines for Diagnosis and Treatment of Esophageal Cancer" in 2021, carrelizumab combined with TP chemotherapy is also listed as the first-line treatment recommendation (level II expert recommendation, 1A evidence) [5]
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The ESCORT-1st study, led by Professor Xu Ruihua's team from Sun Yat-sen University Cancer Center, is the first domestic phase III clinical study of PD-1 monoclonal antibody combined with paclitaxel and cisplatin in the first-line treatment of advanced esophageal squamous cell carcinoma.
A total of 596 patients were included
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The results showed that the median overall survival of the carrelizumab combined treatment group was 15.
3 months, while that of the chemotherapy control group was only 12.
0 months.
Compared with chemotherapy, the risk of death was reduced by 30%! It is obvious from the survival curve that, as time goes by, the survival advantage of combination therapy becomes more obvious, and the long-term survival of patients is greatly improved
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You know, for patients with advanced esophageal cancer, the survival time extension of 3 months is a very big leap (Figure 1)
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In addition, the median progression-free survival (PFS) also improved, and the median PFS of the two groups were 6.
9 months and 5.
6 months, respectively (Figure 2)
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Figure 1.
OS data from ESCORT-1st study [3] Figure 2.
PFS data from ESCORT-1st study [3] If overall survival indicates the long-term effectiveness of a treatment plan, then the objective response rate (ORR) and duration The time to remission (DoR) reflects the depth, length and duration of the tumor remission
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The objective response rate (ORR) of the carrelizumab combination group was 72.
1%, and that of the chemotherapy control group was only 62.
1%; the median duration of remission (DoR) of the two groups were 7.
0 months and 4.
6 months, respectively
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The significant increase in ORR and the significant prolongation of DoR time confirm that the carrelizumab combination therapy group has a deeper and longer remission of the disease.
Together with good safety, it brings more hope to patients
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There are many patients with esophageal cancer in China.
With the gradual popularization of innovative drugs like carrelizumab, more and more patients are able to extend their survival time through immunological drugs, which are available and affordable
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In the future, there are many similar clinical trials underway, especially for Chinese patients.
I believe that patients will have more and more treatment options to choose from, so that long-term survival with tumors will be truly realized
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We are more hopeful than ever
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References: 1.
https:// Esophageal cancer diagnosis and treatment specifications (2018 edition) 3.
Luo H, Lu J , Bai Y, et al.
Effect of Camrelizumab vs Placebo Added to Chemotherapy on Survival and Progression-Free Survival in Patients With Advanced or Metastatic Esophageal Squamous Cell Carcinoma: The ESCORT-1st Randomized Clinical Trial[J].
Jama, 2021, 326( 10): 916-925.
4.
2021 ASCO: ESCORT-1st: A randomized, double-blind, placebo-controlled, phase 3 trial of camrelizumab plus chemotherapy versus chemotherapy in patients with untreated advanced or metastatic esophageal squamous cell carcinoma (ESCC).
5 .
CSCO Guidelines for Diagnosis and Treatment of Esophageal Cancer 2021.
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