Neoadjuvant immunotherapy plus chemotherapy in high altitude natives with resectable esophageal squamous cell carcinoma in Tibet.

Backgroud: Neoadjuvant therapy followed by surgery has been proved to improve the survival of patients with ESCC, and neoadjuvant chemoradiotherapy (nCRT) is the standard of care in most areas of the world. However, multimodality therapy including radiation therapy is actually limited in the current treatment of esophageal cancer in Tibet. The role of neoadjuvant immunotherapy in resectable esophageal cancer has been assessed in multiple phase II clinical trials, but there's lack of evidence of applying neoadjuvant immunotherapy plus chemotherapy in Tibetan residents.

Methods: Patients with previously treatment-naïve, resectable ESCC were included in this study. The preoperative treatment regimen included Tislelizumab, nab-paclitaxel and carboplatin. Surgery was planned for every patient who completed neoadjuvant treatment. Surgical approaches and extent of esophageal resection was chosen depended on tumor location.

Results: 23 patients with resectable ESCC were included from January 2022 to May 2024 in this study. Among all patients, 5 (21.7 %) had thyroid nodules or dysfunction. 19 of 23 (82.6 %) patients finished 2-3 cycles of treatment. 19 (82.6 %) patients experienced treatment-related adverse events (TRAEs), with 11 (47.8 %) patients experiencing grade 3-4 TRAEs. Thyroid toxicity of grade 1-2 was observed in 12 (52.2 %) patients. The objective response rate (ORR) was 69.6 %, and the disease control rate (DCR) was 100 %.。14 (60.9 %) of 23 patients underwent surgery. All patients underwent R0 resection. The pCR rate was 21.4 %. The median follow-up was 22.4 months. During the follow-up period, there were no recurrences, but 3 patients died due to non-tumor-related causes.

Conclusion: Esophagectomy following neoadjuvant immunotherapy plus chemotherapy appears to be safe and feasible in high altitude natives with resectable esophageal squamous cell carcinoma in Tibet.