Results from a phase 3 trial show that nivolumab significantly improves overall survival compared with chemotherapy in patients who have been previously treated for advanced esophageal squamous cell carcinoma (ESCC). In this interview with i3 Health, Ken Kato, MD, PhD, explains the results from this study, as well as rationale for using nivolumab in ESCC, safety considerations, and the study's implications for oncology practice.
What is the most challenging aspect of treating patients with advanced ESCC who have been previously treated?
Ken Kato, MD, PhD: The patients with ESCC who fail previous treatments have poor nutrition status and performance status. As there are only a few chances to receive an effective treatment option, best supportive care or taxanes are recommended in the guidelines of ESMO or Japanese Esophageal Society without any pivotal evidence.
Why is nivolumab more effective than chemotherapy for patients with advanced ESCC?
Dr. Kato: First, nivolumab showed effective activity against ESCC, as it did in the previous study, ATTRACTION-1. Second, most of the patients could receive subsequent therapy if nivolumab failed, including paclitaxel or radiotherapy due to consistent condition and better quality of life during nivolumab administration.
Are there any serious safety considerations that oncologists should know about?
Dr. Kato: Of course the oncologist should monitor for general adverse events associated with immune checkpoint inhibitors, but there were no new specific adverse events when administering nivolumab. Although 70% of the patients received prior radiotherapy, there was no significance in the rate of pneumonitis compared to other clinical trials.
What advice would you give to oncologists who administer nivolumab to their patients with advanced esophageal squamous cell carcinoma?
Dr. Kato: Immune checkpoint inhibitors work more effectively in patients with better performance status. From the survival curve of progression-free survival (PFS) and overall survival (OS) in ATTRACTION-3 which was crossed, it seemed that some patients experienced cancer progression before the immune system was activated. Additionally, the discrepancy of PFS and OS indicate that subsequent therapy may prolong the survival of ESCC patients. We should wait for the details of ATTRACTION-3, including the spider plot and other results. I recommend earlier administration of nivolumab and switching to an active agent when disease progression occurs.
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.