Oesophageal cancer and cancer of the gastro-oesophageal junction (GOJ) have a poor prognosis in the advanced setting. The addition of pembrolizumab to standard treatment has improved outcomes for eligible patients in both the first-line and second-line settings, establishing immunotherapy as an important component of care for this disease.
KEYNOTE-590: First-line oesophageal cancer
KEYNOTE-590 evaluated pembrolizumab in combination with platinum and fluoropyrimidine chemotherapy versus chemotherapy alone as first-line treatment for advanced oesophageal cancer or GOJ cancer. In patients with squamous cell carcinoma and a CPS of 10 or higher, pembrolizumab plus chemotherapy produced a median overall survival of 13.9 months versus 8.8 months with chemotherapy alone. Across the broader population (both squamous cell carcinoma and adenocarcinoma), adding pembrolizumab to chemotherapy produced a statistically significant survival benefit. KEYNOTE-590 established pembrolizumab as a standard first-line component for eligible patients.
KEYNOTE-181: Second-line squamous cell carcinoma
In patients with previously treated oesophageal squamous cell carcinoma and CPS 10 or higher, KEYNOTE-181 demonstrated that pembrolizumab produced a significantly better overall survival than standard chemotherapy (10.3 months vs 6.7 months). This made pembrolizumab the preferred second-line option for PD-L1 positive squamous oesophageal cancer.
CPS scoring in oesophageal cancer
The Combined Positive Score is the relevant PD-L1 measure for oesophageal cancer. A CPS of 10 or higher identifies the population most likely to benefit from pembrolizumab, though lower CPS patients may still qualify in some settings depending on the specific indication and clinical context. Your oncologist will advise on how your result affects treatment options.
Practical considerations
Oesophageal cancer can significantly affect nutrition and swallowing, and patients often have other treatment-related challenges including the aftermath of surgery or chemoradiotherapy. For patients on maintenance or continuing pembrolizumab after initial combination chemotherapy, home administration removes the need for ongoing hospital visits and can meaningfully reduce the physical demands of the treatment phase.
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