P1.078. Long-Term Follow-Up of Tislelizumab Combined With Chemotherapy or Radiotherapy as Neoadjuvant Therapy for Resectable Esophageal Squamous Cell Carcinoma (TINES)

Abstract

Abstract Topic Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Background Esophageal squamous cell carcinoma (ESCC) is a prevalent and aggressive malignancy with limited treatment options. Neoadjuvant therapy has shown promise in improving surgical outcomes and overall survival. This study focuses on long-term follow-up results of tislelizumab combined with chemotherapy or radiotherapy as neoadjuvant treatment for resectable ESCC. Methods Patients with resectable ESCC (T2-4aNanyM0) were randomized into two arms for neoadjuvant therapy. Arm A received tislelizumab (200 mg on day 1), paclitaxel (150 mg/m2 on day 1), and cisplatin (75 mg/m2 on day 1) once every three weeks for three cycles; arm B received radiotherapy with 41.4 Gy in 23 fractions combined with tislelizumab for three cycles. Surgery was planned within four to six weeks post-neoadjuvant therapy. The TINES study enrolled 44 patients between October 2022 and December 2024. The median age was 66 years (37 to 75 years). Most patients were at stage III (75%), cT3 (65.91%), and cN2 (47.73%). Results Among the patients who underwent surgery, the pCR rate was higher in the radiotherapy group compared to the chemotherapy group [60% vs. 31.58%, respectively]. The overall pCR rate was observed to be 41.38%, while the R0 resection rate stood at an impressive figure of 86.21%. The median follow-up time was 23 months (13 months to 40 months). During this period, the median disease-free survival time was 18 months (4 months to 36 months). Although initial observations showed higher postoperative pathological efficacy in the radiotherapy group, further follow-up revealed instances of disease recurrence between 4-7 months post-treatment in this cohort. Specifically, there were 4 cases from radiotherapy group (arm B) with clinical stages ranging from II-IIIB that experienced recurrence, raising questions about optimal selection criteria and management protocols for patients undergoing immuno-radiation therapy regimens. Survival follow-up remains ongoing. Conclusion Combining tislelizumab with either chemotherapy or radiotherapy shows promising efficacy as neoadjuvant treatments for resectable ESCC, particularly highlighting enhanced pCR rates in radiation arm. However, these findings need to be further validated to identify the most appropriate patient population to receive immunotherapy combined with radiotherapy and to optimize treatment regimens to improve long-term survival.