Esophageal Cancer
ICD-10 C15 · ICD-11 2B70

First-Line Treatment of Advanced or Metastatic Oesophageal Squamous-Cell Carcinoma with High PD-L1 Expression (CPS ≥ 10)

Clinical Scenario

This protocol addresses patients with advanced or metastatic oesophageal squamous-cell carcinoma (SCC) whose tumours show a PD-L1 combined positive score (CPS) of 10 or more. This biomarker threshold identifies the population with the greatest expected benefit from the recommended first-line approach.

Treatment Approach

First-line management in this PD-L1-high population involves an anti-PD-1 immunotherapy combined with a platinum-based chemotherapy backbone. The complete regimen, evidence grading, sequencing, and dosing guidance are available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2022.07.003

PembrolizumabeChT is recommended for advanced, untreated oesophageal SCC. The greatest benefit is seen in patients with a PD-L1 CPS 10 [I, A; ESMO-MCBS v1.1 score: 4; European Medicines Agency (EMA) approval is for tumours with PD-L1 CPS 10, Food and Drug Administration (FDA) approval is irrespective of PD-L1 expression].

The phase III KEYNOTE-590 trial evaluated addition of the anti-PD-1 antibody pembrolizumab to cisplatine5-FU in patients with untreated, advanced oesophageal or OGJ (Siewert type I) cancer.

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