Effects of anlotinib combined with camrelizumab and chemotherapy as first-line treatment for advanced esophageal squamous cell carcinoma on tumor immune microenvironment

Background: Esophageal squamous cell carcinoma (ESCC) presents significant therapeutic challenges due to limited treatment options. While immune checkpoint inhibitors (ICIs) combined with chemotherapy have demonstrated efficacy, variable response rates underscore the necessity for enhanced therapeutic approaches. Anlotinib, a multi-target tyrosine kinase inhibitor, has shown synergistic effects with ICIs in clinical practice. However, its influence on the tumor immune microenvironment (TIME) in ESCC requires further elucidation. This study aimed to investigate anlotinib's effects on the TIME. Methods: ) were evaluated using multiplex immunofluorescence. Additional mechanistic insights were obtained through RNA sequencing (RNA-seq) and enzyme-linked immunosorbent assay (ELISA). Results: cell levels versus non-pCR cases (P<0.05). RNA-seq and ELISA analyses suggested anlotinib's potential to enhance the immune microenvironment through C-C motif chemokine ligand 5 (CCL5) upregulation. Conclusions: regulatory T cells, possibly mediated through CCL5 induction. These results warrant further investigation of anlotinib's immunomodulatory potential in ESCC combination therapies.