318 Background: Dysphagia is a common symptom in patients (pts) with metastatic esophageal squamous cell carcinoma (ESCC). Guidelines recommend radiotherapy or palliative chemoradiotherapy (pCRT) for pts with metastatic ESCC harboring dysphagia. On the other hand, fluorouracil plus cisplatin (FP) combined with PD-1 inhibitor is known to be highly effective against ESCC. The present study aimed to compare the efficacy and the safety of FP+ICI and pCRT in metastatic ESCC pts with severe dysphagia. Methods: We retrospectively reviewed 51 metastatic ESCC pts with severe dysphagia treated with FP+ICI (n=33) or pCRT (n=18) between June 2018 and May 2025 in our institution. Severe dysphagia was defined as dysphagia score (DS) of 2 or higher. DS improved survival was defined as the period between DS improvement to ≤1 and DS worsened to ≥2 or survival event. Results: Patient characteristics in the FP+ICI group vs pCRT group were as follows: median age (range), 68 (41-80) vs 70.5 (59-79); gender male, 27 (82%) vs 15 (83%); ECOG PS 0/1-2, 22/11 vs 10/8; DS 2/3, 15/18 vs 10/8; cT stage 3/4, 18/15 vs 5/13; CPS status ≥10/<10/unknown, 10/5/18 vs 6/3/9; TPS status ≥1/<1/unknown, 25/5/3 vs 4/1/13. DS improvement by ≥1 points and DS improved to ≤1 in the FP+ICI group vs pCRT group were observed in 52% vs 61%, and 48% vs 56%, respectively. Median PFS and median OS in the FP+ICI group vs pCRT group were 5.5 months (95% confidence interval CI 2.9-7.7) vs 5.3 months (95% CI 2.3-6.8), and 13.7 months (95% CI 7.0-14.9) vs 11.5 months (95% CI 5.7-12.8), respectively. Median DS improved survival was 8.2 months (95% CI 2.8-NR) in the FP+ICI group and 7.5 months (95% CI 1.7-17.4) in the pCRT group. Severe adverse events included febrile neutropenia (FN) (n=3), esophageal fistura (n=2), and rash (n=1) in the FP+ICI group and FN (n=2), pneumonitis (n=2), and esophagitis (n=2) in the pCRT group. No treatment-related death was observed. Conclusions: Both FP+ICI and pCRT were effective and feasible for metastatic ESCC patients with dysphagia.
Hama et al. (Sat,) studied this question.