The combination of immunotherapy plus chemotherapy and dual immunotherapy may change clinical practice in the frontline treatment of patients with advanced esophageal cancer. The turning point comes from the CheckMate-648 study, presented today at the Congress of the American Society of Clinical Oncology (ASCO), which represents “a milestone in the fight against this neoplasm thanks to results never achieved so far”, the experts highlight. 970 patients were involved, affected by advanced or metastatic squamous cell cancer of the esophagus and never treated before. Both patients with Pd-L1 biomarker expression (greater than or equal to 1%) and the entire randomized population were considered. “In the former, the combination of nivolumab plus chemotherapy – says Stefano Cascinu, head of the oncological medicine unit at Irccs San Raffaele hospital in Milan and professor of medical oncology at Vita-Salute San Raffaele University – showed a truly impressive advantage in terms of survival overall median in comparison with chemotherapy alone, equal to 15.4 months compared to 9.1 months. The result achieved by the combination of the two immuno-oncological molecules, nivolumab and ipilimumab, was also excellent, equal to 13.7 months compared to 9, 1 month of chemotherapy alone “. The results were substantially overlapping in all randomized patients, regardless of Pd-L1 expression. “In this group, the median overall survival was 13.2 months with the combination of nivolumab plus chemotherapy and 12.8 months with nivolumab and ipilimumab compared to 10.7 months with chemotherapy alone. The objective response rate, too,” he explains. – is better with combinations “. In 2020, in Italy, 2,400 new cases of esophageal cancer were estimated, constantly increasing. “About half have the disease already in an advanced stage at the time of diagnosis – continues Cascinu – Today chemotherapy is the standard treatment for these patients, but the prognosis remains unfavorable because survival does not exceed 10 months. Hence the importance of identify new options. The significant clinical improvement in survival of these two treatment regimens highlights the impact of immunotherapy on cancer management and may bring new treatment options for patients with advanced disease. Furthermore, dual immunotherapy is the first chemo-free treatment to show a survival benefit in these patients, who are often very frail and also affected by other pathologies. It can therefore represent an effective therapeutic alternative in people who cannot tolerate chemotherapy due to compromised general health conditions “, he concludes by underlining the importance of “promoting prevention campaigns to increase early diagnosis and defeat the disease “.