Comparison of neoadjuvant nab‐paclitaxel plus immunotherapy versus paclitaxel plus immunotherapy for esophageal squamous cell carcinoma

BACKGROUND: This study aimed to compare the feasibility of nab‐paclitaxel plus platinum‐based chemotherapy (nabTP) versus paclitaxel plus platinum‐based chemotherapy (TP) with immune checkpoint inhibitors (ICIs) as a neoadjuvant modality for locally resectable esophageal squamous cell carcinoma (ESCC). METHODS: Between April 2019 and March 2022, we identified ESCC patients who received neoadjuvant immunotherapy with both nabTP (n = 213) and TP (n = 98) at our institution and Henan Cancer Hospital. The patients in the ICIs‐nabTP and ICIs‐TP groups were pair‐matched (1:1) for tumor location, sex, smoking, drinking, clinical T and N stage. The primary endpoint was the hazard of 30‐day major postoperative complications. Second, logistic models were applied to estimate the risk factors for pathological complete response (pCR) rate. RESULTS: All patients underwent esophagectomy with R0 resection. A statistically significant increase in the risk of developing major pulmonary (odds ratio [OR], 1.182; 95% confidence interval [CI]: 0.530–2.635; p = 0.683), anastomotic (OR, 1.881; 95% CI: 0.607–5.830; p = 0.267), cardiac (OR, 1.000; 95% CI: 0.426–2.349; p = 1.000) complications after neoadjuvant immunotherapy plus nabTP was not observed. The median interval to surgery was 39 days in the ICIs‐nabTP group versus 44 days in the ICIs‐TP group (p = 0.119). There was no 30‐day mortality in each group. However, there was a slight difference in the 30‐day readmission rate (p = 0.043) and the incidence of hydropneumothorax (p = 0.027) between the two groups. The pCR rates of the ICIs‐nabTP and ICIs‐TP group were 36.7 and 21.4%, respectively (p = 0.018). CONCLUSIONS: It appears to be feasible to add immunotherapy to nabTP regimen for locally advanced ESCC. Compared with TP, nabTP plus ICIs can achieve a better pCR rate in ESCC.