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<p>Multimodal therapy for esophageal squamous cell carcinoma has made significant progress in recent years through the integration of immune checkpoint inhibitors. Nevertheless, the prognosis remains poor, particularly in advanced or initially unresectable disease. This review article summarizes current developments and standards of systemic therapy, with a&#xa0;special focus on predictive biomarkers. A&#xa0;key predictive marker for the use of immunotherapies is PD-L1 expression, which is determined using various scores (tumor proportion score, TPS; combined positive score, CPS; tumor area positivity score, TAP score). In curative therapy, the ARTDECO trial confirms the established radiation dose of 50.4 Gy in combination with carboplatin and paclitaxel in definitive radiochemotherapy. New studies are investigating the integration of checkpoint inhibitors into this setting. Initial data, including those from the SKYSCRAPER-07 trial, suggest a&#xa0;potential clinical benefit of adjuvant immunotherapy, especially in cases of high PD-L1 expression. In the operable stage, neoadjuvant chemoradiotherapy according to the CROSS protocol remains the standard of care, followed by adjuvant therapy with nivolumab if pathological complete remission is not achieved. In first-line palliative therapy, the combination of chemotherapy and immune checkpoint inhibition has become the new standard. Studies such as KEYNOTE-590, CheckMate-648, RATIONALE-306, and JUPITER-06 demonstrate significant survival benefits, particularly in patients with elevated PD-L1 expression. Agents such as pembrolizumab, nivolumab, tislelizumab, and toripalimab expand the therapeutic spectrum. In second-line therapy, in addition to conventional chemotherapeutic agents, immune checkpoint inhibitors are also available for immunotherapy-naïve patients, although the benefit after prior immunotherapy is currently unclear. In summary, immunotherapy has fundamentally changed the treatment landscape for esophageal squamous cell carcinoma. Treatment decisions should increasingly be biomarker based, with future studies contributing to optimization of the sequence and combination of therapies.</p>

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Medikamentöse Systemtherapie des ösophagealen Plattenepithelkarzinoms

  • 期刊论文

  • 发表日期：

    2026年7月22日

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  • Peter Thuss-Patience,
  • Anica Loth

摘要

Multimodal therapy for esophageal squamous cell carcinoma has made significant progress in recent years through the integration of immune checkpoint inhibitors. Nevertheless, the prognosis remains poor, particularly in advanced or initially unresectable disease. This review article summarizes current developments and standards of systemic therapy, with a special focus on predictive biomarkers. A key predictive marker for the use of immunotherapies is PD-L1 expression, which is determined using various scores (tumor proportion score, TPS; combined positive score, CPS; tumor area positivity score, TAP score). In curative therapy, the ARTDECO trial confirms the established radiation dose of 50.4 Gy in combination with carboplatin and paclitaxel in definitive radiochemotherapy. New studies are investigating the integration of checkpoint inhibitors into this setting. Initial data, including those from the SKYSCRAPER-07 trial, suggest a potential clinical benefit of adjuvant immunotherapy, especially in cases of high PD-L1 expression. In the operable stage, neoadjuvant chemoradiotherapy according to the CROSS protocol remains the standard of care, followed by adjuvant therapy with nivolumab if pathological complete remission is not achieved. In first-line palliative therapy, the combination of chemotherapy and immune checkpoint inhibition has become the new standard. Studies such as KEYNOTE-590, CheckMate-648, RATIONALE-306, and JUPITER-06 demonstrate significant survival benefits, particularly in patients with elevated PD-L1 expression. Agents such as pembrolizumab, nivolumab, tislelizumab, and toripalimab expand the therapeutic spectrum. In second-line therapy, in addition to conventional chemotherapeutic agents, immune checkpoint inhibitors are also available for immunotherapy-naïve patients, although the benefit after prior immunotherapy is currently unclear. In summary, immunotherapy has fundamentally changed the treatment landscape for esophageal squamous cell carcinoma. Treatment decisions should increasingly be biomarker based, with future studies contributing to optimization of the sequence and combination of therapies.