Camrelizumab plus chemotherapy as neoadjuvant therapy in resectable esophageal squamous cell carcinoma

The REVO phase 2 trial, recently published on Nature Communications, shows that camrelizumab added to chemotherapy is a safe and effective neoadjuvant strategy for resectable esophageal squamous cell carcinoma with a more favorable safety profile versus chemoradiotherapy.

The REVO trial is a multicenter, randomized, open-label phase 2 non-inferiority trial that assessed efficacy and safety of the PD-1 inhibitor camrelizumab added to neoadjuvant chemotherapy (with nab-paclitaxel and cisplatin) versus chemoradiotherapy in 104 patients with resectable esophageal squamous cell carcinoma. Neoadjuvant camrelizumab plus chemotherapy showed non inferiority in pathological complete response, the primary endpoint of this trial: major pathological complete response was observed in 42.3% of camrelizumab plus chemotherapy versus 57.7% of chemoradiotherapy.  1-year disease-free survival was 89.1% versus 78.2%, and 1-year overall survival was 100% versus 92.3% for camrelizumab plus chemotherapy and chemoradiotherapy, respectively. Grade 3> treatment-related adverse events were more frequent in the chemoradiotherapy group. As authors conclude, «The study’s findings indicate that camrelizumab plus chemotherapy achieved pathological complete response rates similar to those of chemoradiotherapy while demonstrating a better safety profile. This similarity in pathological response rates, along with the enhanced safety of camrelizumab plus chemotherapy, supports its non-inferiority to chemoradiotherapy as a treatment option for patients with locally advanced esophageal squamous cell carcinoma. The preliminary survival data are promising and emphasize the need for further investigation; additional survival data are eagerly anticipated to confirm these encouraging trends».