386 Background: The combination of immunotherapy and chemotherapy has become the standard first-line treatment for advanced esophageal cancer. Meanwhile, emerging evidence from studies such as ESCORT-NEO has unveiled a novel therapeutic paradigm utilizing the combination of chemotherapy and immunotherapy for preoperative therapy in esophageal cancer. This study aims to explore the efficacy and safety of pembrolizumab combined with chemotherapy as conversion therapy for advanced esophageal squamous cell carcinoma patients with cervical lymph node metastasis. Methods: We conducted this single-center, prospective, single-arm, open-label, real-world study to evaluate the efficacy and safety of pembrolizumab combined with nab-paclitaxel and cisplatin as conversion therapy in patients with esophageal squamous cell carcinoma and cervical lymph node metastasis. Eligible participants, fulfilling predefined inclusion and exclusion criteria, initiated the treatment regimen. After 3-4 cycles of treatment, patients were reevaluated for eligibility to undergo surgical resection. Postoperative maintenance immunotherapy was continued. The primary endpoint of the study is the 12-month overall survival (OS) rate. Results: From Jun 1st 2023 to Sep 1st 2025, a total of 17 patients were enrolled in this study. The median age was 62 years (range: 56-77), with a median follow-up time of 18.9 months. The 12-month OS rate was 76.5%, and the median OS was not reached. The median progression-free survival (PFS) was 10.5 months, with a 12-month PFS rate of 44.4%. The overall objective response rate (ORR) was 58.5%, and the disease control rate (DCR) reached 88.2%. Ten patients underwent surgical resection, resulting in a surgical conversion rate of 58.8%. One patient was lost to follow-up due to surgery at an external facility. Major pathological response (MPR) was observed in 3 patients (33.3%), including one case achieving pathological complete response (pCR). The 1-year recurrence-free survival (RFS) rate was 70%. The safety profile was consistent with known adverse events associated with pembrolizumab. One patient experienced grade 4 immune-mediated hepatitis, and another presented with immune-mediated encephalitis. Both patients showed improvement after receiving symptomatic treatment with corticosteroids. Preoperative immunotherapy combined with chemotherapy did not increase the incidence of surgical complications. The data is still being updated. Conclusions: Pembrolizumab combined with nab-paclitaxel and cisplatin as a conversion therapy strategy for esophageal squamous cell carcinoma with cervical lymph node metastasis significantly improves treatment outcomes in advanced patients, representing an effective and well-tolerated therapeutic approach. Clinical trial information: NCT06863779 .
Ding et al. (Sat,) studied this question.