Overview

The aim of this study was to investigate the efficacy and safety of pembrolizumab combined with albumin paclitaxel and cisplatin versus albumin paclitaxel and cisplatin or 5-fluorouracil and cisplatin in neoadjuvant therapy for stage II-IVa resectable esophageal squamous cell carcinoma. The study plans to enroll 114 eligible patients who will be randomly assigned in a 1:1:1 ratio to receive 3 cycles of neoadjuvant immunochemotherapy (pembrolizumab plus albumin paclitaxel and cisplatin;Pembrolizumab plus 5-fluorouracil and cisplatin) or chemotherapy alone (5-fluorouracil and cisplatin), followed by surgery 3 weeks later, followed by 16 cycles of adjuvant immunotherapy (pembrolizumab).Patients were followed up for efficacy and safety during treatment.Tumor evaluation will be performed at screening, after neoadjuvant therapy, before surgery, and after adjuvant therapy until objective disease progression is confirmed.

Eligibility

Inclusion Criteria:

        1.Pathological diagnosis: esophageal squamous cell carcinoma. 2.18-75 years old; 3.Clinical
        stage II-IVa; 4.no prior antitumor therapy, such as immunotherapy or chemoradiotherapy;
        5.ECOG PS score 0-1. 6.Organs function well:Hemoglobin ≥100g/L, white blood cell count
        ≥410^9/L or neutrophil count ≥2.510^9/L, platelet count ≥100*10^9/L, serum total
        bilirubin level ≤1.5 times the upper limit of normal, aspartate aminotransferase (AST) ≤2.5
        times the upper limit of normal,Alanine aminotransferase (ALT) ≤2.5 times the upper limit
        of normal, serum creatinine level below the upper limit of normal or creatinine clearance
        rate ≥60ml/min, urea nitrogen ≤200mg/L, urinary protein <+, if urinary protein +, 24-hour
        total protein must be <500mg, blood glucose:In patients with normal-range and/or diabetes
        under treatment but stable glycemic control, pulmonary function: baseline FEV1 of at least
        2L;If the baseline FEV1 was <2L, the predicted FEV1 after surgery was >800ml, and the
        cardiac function was: no myocardial infarction within 1 year;Unstable angina
        pectoris;Asymptomatic severe arrhythmias;The centerless function is incomplete;
        7.Non-surgically sterilized women, or women of reproductive age, need to use a medically
        approved contraceptive method (such as an intrauterine device, birth control pill, or
        condom) during and for 3 months after the end of the study treatment period.Women of
        childbearing age who were not surgically sterilized had to have a negative serum or urine
        HCG test within 72 hours before study enrollment.And must be non-lactation period;For male
        patients with partners of women of childbearing age, effective methods of contraception
        should be used during the trial period and within 3 months after the last dose of
        treatment; 8.Sign an informed consent form.
        Exclusion Criteria:
          1. Pathological findings suggest compound squamous cell carcinoma, including squamous
             adenocarcinoma, squamous cell carcinoma, carcinosarcoma, sarcomatoid carcinoma, etc.
          2. History of subtotal gastrectomy;
          3. accompanied by a second primary cancer;
          4. Tumor metabolic imaging prior to treatment suggested distant metastasis.
          5. people who have previously received chemoradiotherapy;
          6. preesophageal perforation signs
          7. pregnant women of reproductive age;
          8. Any active autoimmune disease or a history of autoimmune disease (such as autoimmune
             hepatitis, interstitial pneumonia, uveitis, enteritis, hypophysitis, vasculitis,
             myocarditis, nephritis, hyperthyroidism, hypothyroidism, etc.);
          9. People with the following active infectious diseases, including active tuberculosis,
             hepatitis, and known human immunodeficiency virus (HIV) infection;
         10. Someone who has a known or concomitant hemorrhagic disease or other uncontrollable
             disease that cannot be treated surgically;
         11. Physical examination or clinical trial findings that researchers believe could
             interfere with the outcome or put the patient at increased risk of treatment
             complications;
         12. A previous history of interstitial lung disease, drug-induced interstitial disease,
             radiation pneumonitis requiring hormone therapy, or any clinically documented active
             interstitial lung disease, and the presence of idiopathic pulmonary fibrosis on CT
             scan at baseline;Uncontrolled massive pleural or pericardial effusion;
         13. unstable systemic diseases (active infection, moderately severe chronic obstructive
             pulmonary disease (copd), poorly controlled hypertension, unstable angina and
             congestive heart failure, 6 months occurrence of myocardial infarction, drug control
             severe mental disorders, liver, kidney or other metabolic disease, nerve mental
             disease such as Alzheimer 's disease);
         14. Gastrointestinal dysfunction, malabsorption syndrome, active gastrointestinal ulcers;
         15. Previously treated with anti-PD-1 or anti-PD-L1 antibodies;
         16. Receiving any investigational drug within 4 weeks before the first use of the
             investigational drug;
         17. Enroll in another clinical study at the same time, unless it's an observational
             (non-intervention) clinical study or an intervention clinical study follow-up;
         18. Subjects who require systematic treatment with corticosteroids (equivalent dose of
             prednisone > 10 mg per day) or other immunosuppressive agents within 2 weeks prior to
             the first use of the study drug, except for the use of corticosteroids for local
             esophageal inflammation and prevention of allergy, nausea, and vomiting.Other special
             circumstances, need to communicate with the sponsor.In the absence of active
             autoimmune disease, inhaled or topical steroids and adrenocorticosteroid replacement
             at doses > 10mg/ day in response to prednisone are permitted;
         19. People who have been vaccinated with anti-tumor vaccine or who have been vaccinated
             with live vaccine within 4 weeks prior to the first administration of the study drug;
         20. Major surgery or severe trauma within 4 weeks before the first use of the study drug;
         21. Congenital or acquired immunodeficiency disease or a history of organ
             transplantation;A history of allergies to monoclonal antibodies, albumin paclitaxel,
             5-fluorouracil, cisplatin, and other platinum-based drugs