312. EFFICACY AND SAFETY OF NEOADJUVANT IMMUNOTHERAPY IN LOCALLY ADVANCED ESOPHAGEAL CANCER: A META-ANALYSIS OF CLINICAL TRIALS

Abstract

Abstract There recently have been great achievements in immunotherapy for locally advanced esophageal cancer (LAEC), but the efficacy and safety of neoadjuvant immunotherapy for LAEC have not been clearly demonstrated. This meta-analysis of clinical trials, based on the data available so far, aims to demonstrate the efficacy and safety of neoadjuvant immunotherapy for LAEC, to provide further treatment options for LAEC in the future, and obtain better survival benefits. Original articles or Unpublished updated data of clinical trials describing the safety and efficacy of neoadjuvant immunotherapy in LAEC were researched from PubMed, Embase and Cochrane Library, ASCO, and ESMO. before April 25, 2022. The efficacy outcomes were pathological complete response (pCR) and major pathological response (MPR). The safety outcomes were treatment-related adverse events (TRAEs), and surgical resection rate. The risk differences and 95% confidence interval (CI) were calculated. Heterogeneity was determined by the χ2 test and I2 test. Subgroup analysis was performed based on pathology, immune checkpoints inhibitors and treatment modes. A total of 351 patients from 16 clinical trials were included. The risk differences of pCR and MPR in neoadjuvant immunotherapy were 0.31 (95% CI: 0.26–0.35) and 0.61 (0.52–0.70), respectively. The incidences of all-grade TRAEs, grade ≥ 3 TRAEs, and surgical resection rate were 0.37 (0–0.77), 0.32 (0.18, 0.46), and 0.86 (0.82, 0.89), respectively. The better pCR and MPR in immunotherapy was shown in the immunotherapy combined with radio-chemotherapy, compared with immunotherapy combined with chemotherapy (pCR: 0.41 [0.31–0.51] vs. 0.28 [0.23–0.33]; MPR: 0.89 [0.74–1.03] vs. 0.61 [0.55, 0.68]). There were similar outcomes in other subgroups. Neoadjuvant immunotherapy is effective and safe for LAEC.