345. ADJUVANT IMMUNOTHERAPY IN CURATIVE INTENT ESOPHAGEAL CANCER RESECTION PATIENTS

Abstract

Abstract Background Despite ongoing therapeutic innovations, esophageal cancer remains a disease with one of the poorest survival rates with an overall 5 year survival of 20%. Recent clinical trials have demonstrated the role of adjuvant immunotherapy to improve patient survival. However, these therapies are often not completed in their entirety due to side effects or disease progression. We report our real world experience with immunotherapy and esophageal cancer within an integrated health care system. Methods All adult patients undergoing minimally invasive esophagectomy (MIE) in our large integrated health care system between September 1, 2017 and November 15, 2021 were reviewed. Patients with multiple cancers were excluded for a final patient cohort of 37 patients who received immunotherapy and 139 who did not. Patients who received immunotherapy were reviewed for the number of doses they received, if they were able to complete therapy, side effects, and disease progression. Baseline characteristics and outcomes, including 90 day and 1 year mortality, were compared between the two patient groups. Logistic regression was performed to identify factors that impacted survival. Results Of 37 patients who received immunotherapy, 17 received nivolumab, 17 received pembrolizumab, 11 received trastuzumab, 2 received ipilimumab, and 9 received combination. Only 5 patients successfully completed therapy. Therapy was terminated in 7 patients due to side effects, most commonly colitis. Furthermore, 18 patients stopped therapy due to disease progression, and 4 patients expired during treatment. There were no significant differences in 90 day or 1 year mortality between patients who received immunotherapy and those who did not. At a maximum of three year follow up, patients with late stage disease who received immunotherapy had a significantly worse survival. Conclusion Immunotherapy has been shown to have a promising impact on patient survival in esophageal cancer. However, outside of a clinical trial, there are numerous barriers to successful treatment in a real-world setting. At our regionalized center of excellence, we found that most patients are unable to complete immunotherapy treatment due to disease progression or side effects, and immunotherapy did not improve survival. Further work is required to tailor immunotherapy delivery to diverse patient populations.