Efficacy of pembrolizumab combined with chemotherapy in treatment of advanced unresectable esophageal squamous cell carcinoma
Objective To explore the efficacy of pembrolizumab combined with chemotherapy in treatment of advanced unresectable esophageal squamous cell carcinoma(ESCC).Methods A total of 68 patients with advanced ESCC treated in the First Affiliated Hospital of Zhengzhou University from December 2019 to September 2022 were enrolled in this study.According to different treatment methods,patients treated with chemotherapy(taxane+cisplatin)were included in the chemotherapy group and those who adopted pembrolizumab combined with chemotherapy were included in the immune combination group.After propensity score matching,confounding factors such as age and gender were excluded,34 cases were included in each group with 1:1 matching.The short-term solid tumor efficacy and survival status and changes of tumor markers(squamous cell carcinoma antigen(SCCA),carbohydrate antigen 242(CA242),cytokeratin 19 fragment(CYFRA21-1)),serum soluble programmed death protein 1/soluble programmed death protein ligand 1(sPD-1/sPD-L1)and human transforming growth factor-β1(TGF-β1)levels before and after treatment were compared.The adverse reaction of drugs were recorded.Results The objective remission rate of disease was significantly higher in the immune combination group than in the control(67.65%vs 41.18%,P<0.05),but there was no statistical significance in disease control rate between the two groups(88.24%vs 85.29%,P>0.05).The overall survival(OS),disease-free survival(DFS),1-year survival rate and disease-free survival rate were(11.47±0.33)months,(11.03±0.47)months,91.18%and 76.47%in the immune combination group and(11.01±0.48)months,(8.85±1.13)months,85.29%and 61.76%in the chemotherapy group.There was no statistical significance in OS between the two groups(χ2=0.598,P>0.05),but there was a statistical difference in DFS between the two groups(χ2=4.216,P<0.05).After 4 cycles of treatment,the serum levels of SCCA,CA242 and CYFRA21-1 in the immunization combination group((3.14±0.61)ng·mL-1,(50.12±6.88)U·mL-1,(3.57±0.71)μg·L-1)was lower than that in the chemotherapy group((3.81±0.74)ng·mL-1,(57.53±7.14)U·mL-1,(4.43±0.83)μg·L-1)(t=4.074,4.358,4.591,all P<0.05).After 4 cycles of treatment,the serum levels of sPD-1/sPD-L1 and TGF-β1 in the immunization group((0.69±0.07)μg·L-1 and(33.47±6.47)ng·mL-1,respectively)were lower than those in the chemotherapy group((0.75±0.05)μg·L-1,(40.65±7.12)ng·mL-1)(t=4.067,4.067,both P<0.05).The adverse reaction of drugs(gastrointestinal reaction,allergic skin rash,anemia and liver and kidney injury)showed no statistical differences between the two groups(P>0.05).Conclusion Pembrolizumab combined with chemotherapy in the treatment of ESCC can significantly improve tumor marker levels and serum immune status.
Esophageal squamous cell carcinomaPembrolizumabChemotherapySurvival timeTumor markerSerum immune status
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