Current status and advances in the medical treatment of esophageal cancer

doi:10.3760/cma.j.cn371439-20250704-00040

Abstract

Abstract:

The systemic treatment landscape has undergone profound transformation with breakthroughs in immunotherapy and targeted therapy. In cases of resectable locally advanced esophageal cancer， neoadjuvant therapy strategies continue to be optimized. For patients with unresectable locally advanced cancer， definitive concurrent chemoradiotherapy remains the standard treatment， and the exploration of subsequent immunotherapy consolidation is ongoing. First-line treatment for metastatic or recurrent esophageal cancer has entered the era of immunotherapy combined with chemotherapy， which has significantly improved patient survival. In terms of later-line treatment， immunotherapy alone has shown superior efficacy to chemotherapy in specific populations. Meanwhile， precise treatments targeting HER2， Claudin 18.2， FGFR2b， etc. have also provided new options for selected patients.Analyzing the progress of medical management of esophageal cancer across different disease stages （resectable， unresectable， metastatic or recurrent） and histological subtypes （squamous cell carcinoma and adenocarcinoma）， along with systematically reviewing key clinical evidence and current challenges， aims to provide reference for clinical practice.

Key words: Esophageal neoplasms, Drug therapy, Immunotherapy, Molecular targeted therapy

Tong Xinyu, Yang Jing, Wang Minglei, Huang Chengsuo, Luo Yingshu, Peng Jieqiong, Han Shumei, Liu Bo. Current status and advances in the medical treatment of esophageal cancer[J]. Journal of International Oncology, 2026, 53(4): 240-247.

Figures/Tables 1

试验名称/编号	研究对象（例数）	治疗方案	中位OS（月）	中位PFS（月）	作者
免疫治疗+化疗比化疗
CheckMate 648	ESCC（n=970）	纳武利尤单抗+化疗（顺铂+氟尿嘧啶）比化疗	13.2比10.7（HR=0.74， 99.1%CI为0.58~0.96）	5.8比5.6（HR=0.81， 98.5%CI为0.64~1.04）	Doki等^[34]
		纳武利尤单抗+伊匹木单抗比化疗	12.7比10.7（HR=0.78， 98.2%CI为0.62~0.98）	2.9比5.6（HR=1.26， 95%CI为1.04~1.52）
ESCORT-1st	ESCC（n=596）	卡瑞利珠单抗+化疗（顺铂+紫杉醇）比安慰剂+化疗	15.6比12.6（HR=0.70， 95%CI为0.58~0.84）	7.6比5.8（HR=0.54， 95%CI为0.45~0.65）	He等^[35]
SKYSCRAPER-08	ESCC（n=461）	tiragolumab+阿替利珠单抗+化疗（顺铂+紫杉醇）比安慰剂+化疗	15.7比11.1（HR=0.70， 95%CI为0.55~0.88）	6.2比5.4（HR=0.56， 95%CI为0.45~0.70）	Hsu等^[36]
KEYNOTE-590	ESCC（n=548）， E/GEJ腺癌（n=201）	帕博利珠单抗+化疗（顺铂+氟尿嘧啶）比安慰剂+化疗	12.4比9.8（HR=0.73， 95%CI为0.62~0.86）	6.3比5.8（HR=0.65， 95%CI为0.55~0.76）	Metges等^[37]
KEYNOTE-859	HER2阴性 G/GEJ腺癌（n=1 568）	帕博利珠单抗+化疗（顺铂+氟尿嘧啶，或奥沙利铂+卡培他滨）比安慰剂+化疗	12.9比11.5（HR=0.78， 95%CI为0.70~0.87）	6.9 比 5.6，HR=0.76 （95%CI为0.67~0.85）	Rha等^[38]
CheckMate 649	HER2阴性 G/E/GEJ腺癌（n=1 581）	纳武利尤单抗+化疗（奥沙利铂+氟尿嘧啶+亚叶酸钙，或奥沙利铂+卡培他滨）比化疗	13.8比11.6，（HR=0.80， 99.3%CI为0.68~0.94）	7.7比6.9，（HR=0.77， 95%CI为0.68~0.87）	Janjigian等^[39]
COMPASSION-15	HER2阴性 G/GEJ腺癌（n=610）	卡度尼利单抗+化疗（奥沙利铂+卡培他滨）比安慰剂+化疗	14.1比11.1（HR=0.66， 95%CI为0.54~0.81）	7.0比5.3（HR=0.53， 95%CI为4.5~5.6）	Shen等^[40]
靶向治疗+化疗比化疗
ToGA	HER2阳性 G/GEJ腺癌（n=584）	曲妥珠单抗+化疗（顺铂+卡培他滨/氟尿嘧啶）比化疗	13.8比11.1（HR=0.74， 95%CI为0.60~0.91）	6.7比5.5（HR=0.71， 95%CI为0.59~0.85）	Bang等^[41]
GLOW	Claudin18.2阳性、 HER2阴性G/GEJ腺癌（n=507）	佐妥昔单抗+化疗（奥沙利铂+卡培他滨）比安慰剂+化疗	14.39比12.16（HR=0.771，95%CI为 0.615~0.965）	8.21比6.80（HR=0.687， 95%CI为0.544~0.866）	Shah等^[42]
SPOTLIGHT	Claudin18.2阳性、 HER2阴性G/GEJ腺癌（n=565）	佐妥昔单抗+化疗（奥沙利铂+氟尿嘧啶+亚叶酸钙/左旋亚叶酸钙）比安慰剂+化疗	18.23比15.54（HR=0.75， 95%CI为0.60~0.94）	10.61比8.67（HR=0.75， 95%CI为0.60~0.94）	Shitara等^[43]
免疫治疗+靶向治疗+ 化疗比靶向治疗+化疗
KEYNOTE-811	HER2阳性GEJ腺癌（n=698）	帕博利珠单抗+曲妥珠单抗+化疗（顺铂+氟尿嘧啶，或奥沙利铂+卡培他滨）比安慰剂+曲妥珠单抗+化疗	20.0比16.8（HR=0.84， 95%CI为0.70~1.01）	10.0比8.1（HR=0.73， 95%CI为0.61~0.87）	Janjigian等^[44]

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