First-line treatment of advanced or metastatic oesophageal squamous-cell carcinoma with PD-L1 negative / low expression (CPS <10, TPS <1%)

In advanced or metastatic oesophageal squamous-cell carcinoma (SCC), PD-L1 expression level directly shapes first-line treatment selection. When the Combined Positive Score (CPS) is below 10 and the Tumour Proportion Score (TPS) is below 1%, the evidence base points to a specific chemotherapy-led strategy.

Clinical scenario

Advanced or metastatic oesophageal SCC with PD-L1 negative or low expression — CPS <10 and TPS <1%. Post hoc analyses indicate no benefit from immunotherapy-containing first-line regimens in this subgroup, placing platinum-based chemotherapy as the standard approach.

First-line approach

A platinum and fluoropyrimidine combination chemotherapy doublet forms the backbone of first-line treatment; an alternative is available for patients who cannot tolerate the full-dose regimen.

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References

Standard first-line ChT for oesophageal SCC is a platinum–fluoropyrimidine doublet.

A post hoc analysis suggested no benefit in patients with a PD-L1 CPS <10.

First-line ChT with a platinum and fluoropyrimidine is recommended as a standard treatment for advanced untreated oesophageal SCC [II, A]. Dose-reduced oxaliplatin–capecitabine is an alternative option for patients who are unsuitable for full-dose ChT [I, A].

DOI: 10.1016/j.annonc.2022.07.003

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