The FDA recently approved nivolumab for patients with unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma (ESCC) who have received prior fluoropyrimidine- and platinum-based chemotherapy. Ken Kato, MD, PhD, lead author on the study the approval was based on, spoke to i3 Health about the challenges of treating this patient population, in addition to the significance of this approval.
What are the most challenging aspects of treating patients with advanced ESCC refractory or intolerant to previous chemotherapy?
Ken Kato, MD, PhD: Patients with ESCC who fail prior chemotherapy are often in poor condition with low nutrition and less oral intake. Physicians should be careful not only for monitoring disease but also management of the patient's condition.
Can you comment on the significance of the approval of nivolumab for ESCC?
Dr. Kato: The advantage of nivolumab over taxanes is that nivolumab is associated with a more durable efficacy and less toxicity than taxanes.
What are the next steps for this research?
Dr. Kato: The real-world data will provide a more strict indication for the patients more at risk for immune-related adverse events. We need a biomarker for the patients who relapse early after nivolumab administration.
How do you see the treatment landscape evolving in the coming years?
Dr. Kato: We are waiting for the results of a first-line pembrolizumab study, KEYNOTE-590, and CheckMate-648 (nivolumab plus either ipilimumab or chemotherapy); these results will be coming out within a year.
Do you have any advice for community oncologists who treat this patient population?
Dr. Kato: The post treatment is important for the patients who have failed on nivolumab. Don't miss the timing to change the treatment sequence.
About Dr. Kato
Ken Kato, MD, PhD, conducts research on gastrointestinal oncology at the National Cancer Center in Japan. His research interests also include translational research on gastrointestinal cancer, especially in esophageal squamous cell carcinoma.
For More Information
Kato K, Cho BC, Takahashi M, et al (2019). Nivolumab versus chemotherapy in patients with advanced esophageal squamous cell carcinoma refractory or intolerant to previous chemotherapy (ATTRACTION-3): a multicenter, randomized, open-label, phase 3 trial. Lancet Oncol. [Epub ahead of print] DOI:10.1016/S1470-2045(19)30626-6
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily represent the views of i3 Health.