The following is a summary of “Clinical Benefit of First-Line Programmed Death-1 Antibody Plus Chemotherapy in Low Programmed Cell Death Ligand 1–Expressing Esophageal Squamous Cell Carcinoma: A Post Hoc Analysis of JUPITER-06 and Meta-Analysis,” published in the March 2023 issue of Oncology by Wu, et al.

The efficacy of programmed death-1 (PD-1) antibody plus chemotherapy in patients with low programmed cell death ligand 1 (PD-L1)–expressing esophageal squamous cell carcinoma (ESCC) remains uncertain. While the European Medicines Agency approved using pembrolizumab or nivolumab plus chemotherapy as a first-line treatment for high PD-L1–expressing ESCC, the US Food and Drug Administration approved this regimen regardless of PD-L1 expression. For a study, researchers sought to investigate the efficacy of PD-1 antibody plus chemotherapy in patients with low PD-L1–expressing ESCC.

A post hoc analysis of the Chinese JUPITER-06 study was conducted to evaluate the efficacy of PD-1 antibody plus chemotherapy according to PD-L1 tumor proportion score (TPS) using JS311 antibody. Additionally, a meta-analysis of eligible randomized controlled trials was performed to evaluate the hazard ratios (HRs) for overall survival and progression-free survival and the odds ratios for objective response rate, according to PD-L1 expression.

The post hoc analysis of JUPITER-06 showed that PD-1 antibody plus chemotherapy provided greater clinical benefit than chemotherapy alone, regardless of PD-L1 expression. The meta-analysis included five randomized controlled trials that analyzed two PD-L1 expression scoring criteria: TPS (≥ 1%/< 1%) and combined positive score (CPS, ≥ 10/< 10). The addition of PD-1 antibody to chemotherapy resulted in a significant improvement in overall survival and progression-free survival in both the TPS < 1% (HR, 0.74; 95% CI, 0.56 to 0.97) and CPS < 10 (HR, 0.77; 95% CI, 0.66 to 0.89) subgroups. Furthermore, the odds ratio for the objective response rate was significantly improved in the TPS < 1% subgroup (1.71; 95% CI, 1.27 to 2.29). The pooled benefit of PD-1 antibody plus chemotherapy was significantly better than chemotherapy alone in all high PD-L1–expressing subgroups.

The study suggested that PD-1 antibody plus chemotherapy is superior to chemotherapy alone in patients with advanced ESCC with low PD-L1 expression. Further studies were needed to identify predictive biomarkers.

Reference: ascopubs.org/doi/full/10.1200/JCO.22.01490