Clinical Observation Of PD-1 Inhibitor Combined With Chemotherapy In The Treatment Of Recurrent Or Metastatic Esophageal Squamous Cell Carcinoma

Objective To observe the efficacy and adverse reactions of programmed death receptor-1(PD-1)inhibitors combined with chemotherapy in the treatment of patients with recurrent or metastatic esophageal squamous cell carcinoma,exploring new treatments for these patients in China,and providing more clinical data.Also,to explore the relationship between patients’ peripheral blood NLR and d NLR and the efficacy of PD-1 inhibitors.Methods A total of 72 patients with recurrent or metastatic advanced esophageal squamous cell carcinoma admitted to the Department of Oncology,Jingzhou Central Hospital from August 1,2019 to Dexember 31,2021 were restrospectively observed.They were divided into 2 groups according to the different treatment plans of the patients.The observation group consisted of 27 patients treated with PD-1 inhibitors combined with chemotherapy using docetaxel and nedaplatin,and the control group consisted of 45 patients treated with chemotherapy using docetaxel and nedaplatin.Patient’s clinical baseline characteristics,treatment regimen,treatment effect and adverse reactions after treatment were collected.All patients received at least two cycles of treatment,and the efficacy and safety were evaluated every two cycles.Results As of the last follow-up data on January 31,2021,the median follow-up time of the observation group was 8.7 months(4.3-13.7),and the median follow-up time of the control group was 8 months(3.9-15.1).The objective response rate(ORR)of the observation group was 51.8%,which was higher than 31.1% of the control group,but the difference was not statistically significant(P =0.081).And the disease control rate(DCR)of showed that the observation group was 66.6%,which was significantly higher than that of the control group,the difference was statistically significant(P =0.045).The median progression-free survival time(m PFS)of the observation group and the control group respectively was 8.9 months(95% CI: 4.3 to 14.2 months)and6.1 months(95% CI: 3.7 to 8.3 months),respectively,the difference was statistically significant scientific significance(P =0.014).There was a significant difference in PFS time between the two groups(HR = 0.402,P = 0.045<0.05),and the observation group had a 60% lower risk of progression of disease or death than the control group.The results of the COX risk model showed that the ECOG score,whether accompanied by distant metastasis or not,and the cycles of treatment are independent prognostic factors of PFS in patients with advanced esophageal cancer(in each case,P<0.05).The adverse drug reactions of the two groups of patients were mainly bone marrow suppression,fatigue,and hair loss.Among the 27 patients in the observation group who received PD-1 inhibitor combined with chemotherapy,15 patients(55.6%)developed reactive skin capillary hyperplasia RCCEP,all of which were grade 1 to 2adverse reactions.It usually occurred in the first and second cycles after medication.Three patients were clinically considered to have immune-related pneumonia,which was considered to berade 3 AEs as seen in one of these three patients.After regular glucocorticoid treatment,the pulmonary symptoms were relieved,and the drug was permanently discontinued.There were no grade 4-5 AEs and PD-1 related death occurred.All the adverse reactions were alleviated clinically after active treatment,and they could be tolerated generally.The relationship between peripheral blood NLR and d NLR and the efficacy of PD-1 inhibitors was not statistically significant(P<0.05).Conclusion PD-1 inhibitors combined with docetaxel and nedaplatin for the first-line treatment of recurrent or metastatic esophageal cancer demonstrated good efficacy and safety,and can be an option for the treatment of advanced esophageal cancer.ECOG score,whether it is accompanied by distant metastasis or not and cycles of treatment are independent prognostic factors of PFS in patients with advanced esophageal cancer.The relationship between NLR and d NLR and efficacy in the group treated with PD-1inhibitors was not statistically significant.