Treatment of Advanced or Metastatic Oesophageal Squamous-Cell Carcinoma with PD-L1–Negative or Low Expression

Advanced or metastatic oesophageal squamous-cell carcinoma (SCC) with PD-L1 CPS below 10 and TPS below 1% represents a clinically distinct subgroup. In these patients, the absence of meaningful PD-L1 expression shapes the treatment strategy from the outset.

Standard first-line chemotherapy for oesophageal SCC is a platinum–fluoropyrimidine doublet. Post hoc analyses have shown no benefit from PD-1 inhibition in patients with PD-L1 CPS < 10, making biomarker-guided treatment selection essential in this population.

Treatment Direction

For fit patients in this PD-L1–negative/low setting, cytotoxic chemotherapy remains the backbone of management, with a specific class of agents guiding regimen selection. Full regimen details, sequencing criteria, and supporting evidence are available in the complete protocol →

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2022.07.003

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.

ChT with a taxane or irinotecan can be considered in ﬁt patients who have been previously treated with platinum–ﬂuoropyrimidine and/or nivolumab or pembrolizumab [II, B].

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