派姆单抗联合顺铂和 5-氟尿嘧啶作为晚期食管癌患者的一线治疗显示出比传统化疗更好的客观反应和生存率，并且血液学不良事件也较轻。在T4b食管鳞状细胞癌（ESCC）患者中评估该方案的安全性和有效性。连续8例T4b食管鳞状细胞癌患者按照KEYNOTE-590接受该方案作为诱导，并在1-3个疗程后进行评估。化疗前还评估了程序性死亡配体 1 (PD-L1) 联合阳性评分 (CPS)。原发灶的疗效通过我们原始的肿瘤缩小率公式进行评估。部分缓解（PR）、疾病稳定和疾病进展（PD）的患者数量分别为5、1和2。 PR 患者的肿瘤缩小率为 69% 至 87%，所有 PR 患者的 T4b 症状均得到缓解。两名患者接受了 R0 切除的转换手术。 2 名 PR 患者的 PD-L1 CPS 超过 90，但另外 2 名 PR 患者的 PD-L1 CPS 低于 10。 PD 患者的 PD-L1 CPS 低于 10。一名患者出现超进展，导致食管肺瘘。大于3级的不良事件包括1名患者（12.5%）出血性胃溃疡、3名患者（37.5%）无G-CSF的中性粒细胞减少症和1名患者（12.5%）低钾血症。没有患者出现发热性中性粒细胞减少症。使用派姆单抗加顺铂和 5-氟尿嘧啶治疗的患者中，62.5% 的患者肿瘤明显缩小，且不良事件较少。该方案可作为 T4b ESCC 患者的诱导化疗。© 2024。作者。

Pembrolizumab plus cisplatin and 5-fluorouracil administered as first-line therapy for advanced esophageal cancer patients has shown a better objective response and survival than conventional chemotherapy with less severe hematological adverse events. The safety and efficacy of this regimen were evaluated in patients with T4b esophageal squamous cell carcinoma (ESCC).Eight consecutive patients with T4b ESCC received this regimen according to KEYNOTE-590 as induction, and they were evaluated after 1-3 courses. The programmed death-ligand 1 (PD-L1) combined positive score (CPS) was also evaluated before chemotherapy. Efficacy for the primary lesion was evaluated by our original formula for the tumor reduction rate.The numbers of patients with partial response (PR), stable disease, and progressive disease (PD) were 5, 1, and 2, respectively. The tumor reduction rate ranged from 69 to 87% in PR patients, and all PR patients had relief from T4b. Two patients underwent conversion surgery with R0 resection. PD-L1 CPS was over 90 in 2 PR patients, but under 10 in 2 other PR patients. PD-L1 CPS was under 10 in PD patients. One patient had hyperprogression, resulting in an esophago-pulmonary fistula. Greater than grade 3 adverse events were bleeding gastric ulcer in one patient (12.5%), neutropenia without G-CSF in 3 patients (37.5%), and hypopotassemia in 1 patient (12.5%). No patient had febrile neutropenia.Marked tumor reduction was confirmed in 62.5% of patients with pembrolizumab plus cisplatin and 5-fluorouracil with less adverse events. This regimen could be administered as induction chemotherapy for patients with T4b ESCC.© 2024. The Author(s).