Anlotinib plus camrelizumab and chemotherapy as first-line treatment in patients with advanced esophageal squamous cell carcinoma

Abstract Advanced esophageal squamous cell carcinoma (ESCC) patients exhibit a ~ 50% objective response rate (ORR) and median progression-free survival (mPFS) of just 5–7 months when undergoing first-line immune-chemotherapeutic treatment, underscoring pronounced unmet clinical need. We assessed the...

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Main Authors: Mingfang Xu, Yu Pu, Yuzhu Jiang, Yingda Liu, Yan Feng, Xiaodong Zhao, Mengxia Li
Format: Article
Language:English
Published: Nature Portfolio 2025-07-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-06625-2
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author Mingfang Xu
Yu Pu
Yuzhu Jiang
Yingda Liu
Yan Feng
Xiaodong Zhao
Mengxia Li
author_facet Mingfang Xu
Yu Pu
Yuzhu Jiang
Yingda Liu
Yan Feng
Xiaodong Zhao
Mengxia Li
author_sort Mingfang Xu
collection DOAJ
description Abstract Advanced esophageal squamous cell carcinoma (ESCC) patients exhibit a ~ 50% objective response rate (ORR) and median progression-free survival (mPFS) of just 5–7 months when undergoing first-line immune-chemotherapeutic treatment, underscoring pronounced unmet clinical need. We assessed the efficacy and safety of Anlotinib plus Camrelizumab and chemotherapy for advanced, unresectable, or metastatic ESCC. This is an open-label, investigator-initiated, phase 2, non-randomized clinical trial enrolled patients from August 3, 2020, to August 10, 2022. Patients with treatment-naive unresectable stage III or IV ESCC received treatment which was patient-selected, including chemotherapy + camrelizumab + Anlotinib (TCAC group) or chemotherapy + Camrelizumab (TCC group) induction therapy for 4–6 cycles, followed by maintenance therapy. The primary endpoint was ORR, while secondary endpoints included mPFS, median overall survival (mOS), disease control rate (DCR), and treatment-related adverse events (TRAEs). 30 patients were included in each group. Over a median 14.5-month follow-up period, the ORR was 90.0%, 43.3%(P < 0 0.001) and the mPFS was 16.03, 7.30 months (HR 0.35, 95%CI, 0.19–0.65; P < 0 0.001) in TCAC and TCC groups, respectively. Grade 3 TRAEs were experienced by 12 patients (40.0%) in TCAC group, including decreased neutrophil counts (5 [16.7%]), decreased white blood cell counts (4 [13.3%]), reduced platelet counts (3 [10%]), and hypertension (2 [6.7%]). No patients experienced grade 4–5 TRAEs. The combination of Anlotinib plus Camrelizumab and chemotherapy had promising efficacy among patients with advanced ESCC in this study, which may be a promising first-line treatment regimen. Trial registration: Registered with ClinicalTrials.gov, NCT04471480. 15/07/2020.
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spelling doaj-art-d67f61947121473e9a80c47fa4d4dfc32025-08-20T04:01:41ZengNature PortfolioScientific Reports2045-23222025-07-0115111210.1038/s41598-025-06625-2Anlotinib plus camrelizumab and chemotherapy as first-line treatment in patients with advanced esophageal squamous cell carcinomaMingfang Xu0Yu Pu1Yuzhu Jiang2Yingda Liu3Yan Feng4Xiaodong Zhao5Mengxia Li6Department of Cancer center, Daping Hospital, Army Medical UniversityDepartment of Cancer center, Daping Hospital, Army Medical UniversityDepartment of Cancer center, Daping Hospital, Army Medical UniversityThe Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Cancer center, Daping Hospital, Army Medical UniversityThe Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Cancer center, Daping Hospital, Army Medical UniversityAbstract Advanced esophageal squamous cell carcinoma (ESCC) patients exhibit a ~ 50% objective response rate (ORR) and median progression-free survival (mPFS) of just 5–7 months when undergoing first-line immune-chemotherapeutic treatment, underscoring pronounced unmet clinical need. We assessed the efficacy and safety of Anlotinib plus Camrelizumab and chemotherapy for advanced, unresectable, or metastatic ESCC. This is an open-label, investigator-initiated, phase 2, non-randomized clinical trial enrolled patients from August 3, 2020, to August 10, 2022. Patients with treatment-naive unresectable stage III or IV ESCC received treatment which was patient-selected, including chemotherapy + camrelizumab + Anlotinib (TCAC group) or chemotherapy + Camrelizumab (TCC group) induction therapy for 4–6 cycles, followed by maintenance therapy. The primary endpoint was ORR, while secondary endpoints included mPFS, median overall survival (mOS), disease control rate (DCR), and treatment-related adverse events (TRAEs). 30 patients were included in each group. Over a median 14.5-month follow-up period, the ORR was 90.0%, 43.3%(P < 0 0.001) and the mPFS was 16.03, 7.30 months (HR 0.35, 95%CI, 0.19–0.65; P < 0 0.001) in TCAC and TCC groups, respectively. Grade 3 TRAEs were experienced by 12 patients (40.0%) in TCAC group, including decreased neutrophil counts (5 [16.7%]), decreased white blood cell counts (4 [13.3%]), reduced platelet counts (3 [10%]), and hypertension (2 [6.7%]). No patients experienced grade 4–5 TRAEs. The combination of Anlotinib plus Camrelizumab and chemotherapy had promising efficacy among patients with advanced ESCC in this study, which may be a promising first-line treatment regimen. Trial registration: Registered with ClinicalTrials.gov, NCT04471480. 15/07/2020.https://doi.org/10.1038/s41598-025-06625-2Esophageal squamous cell carcinomaAnlotinibICIsFirst-line treatment
spellingShingle Mingfang Xu
Yu Pu
Yuzhu Jiang
Yingda Liu
Yan Feng
Xiaodong Zhao
Mengxia Li
Anlotinib plus camrelizumab and chemotherapy as first-line treatment in patients with advanced esophageal squamous cell carcinoma
Scientific Reports
Esophageal squamous cell carcinoma
Anlotinib
ICIs
First-line treatment
title Anlotinib plus camrelizumab and chemotherapy as first-line treatment in patients with advanced esophageal squamous cell carcinoma
title_full Anlotinib plus camrelizumab and chemotherapy as first-line treatment in patients with advanced esophageal squamous cell carcinoma
title_fullStr Anlotinib plus camrelizumab and chemotherapy as first-line treatment in patients with advanced esophageal squamous cell carcinoma
title_full_unstemmed Anlotinib plus camrelizumab and chemotherapy as first-line treatment in patients with advanced esophageal squamous cell carcinoma
title_short Anlotinib plus camrelizumab and chemotherapy as first-line treatment in patients with advanced esophageal squamous cell carcinoma
title_sort anlotinib plus camrelizumab and chemotherapy as first line treatment in patients with advanced esophageal squamous cell carcinoma
topic Esophageal squamous cell carcinoma
Anlotinib
ICIs
First-line treatment
url https://doi.org/10.1038/s41598-025-06625-2
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