European Society for Medical Oncology Congress
European Society for Medical Oncology Congress
Perspective from Ian Chau, MD, FRCP
October 01, 2019
2 min read

Nivolumab extends OS in advanced esophageal squamous cell carcinoma

Perspective from Ian Chau, MD, FRCP
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BARCELONA, Spain — Nivolumab extended survival compared with chemotherapy among patients with advanced or recurrent esophageal squamous cell carcinoma regardless of PD-L1 expression, according to results of the randomized phase 3 ATTRACTION study presented at European Society for Medical Oncology Congress.

Nivolumab (Opdivo, Bristol-Myers Squibb) — a PD-1 immune checkpoint inhibitor — also appeared safe for this population.

“Nivolumab is the first immune checkpoint inhibitor to demonstrate a statistically significant and clinically meaningful improvement in OS vs. chemotherapy in previously treated advanced esophageal squamous cell carcinoma,” Byoung Chul Cho, MD, PhD, clinical oncologist at Yonsei Cancer Center at Yonsei University College of Medicine in South Korea, said during a presentation. “[This] represents a potential new standard second-line treatment option for [these patients].”

Chemotherapy often provides little benefit for patients with advanced esophageal squamous cell carcinoma.

The ATTRACTION study included 419 patients with unresectable, advanced or recurrent disease refractory to or intolerant of one prior treatment of fluoropyrimidine/platinum-based chemotherapy.

Researchers randomly assigned patients to nivolumab dosed at 240 mg every 2 weeks (n = 210) or investigator’s choice of chemotherapy with paclitaxel or docetaxel (n = 209) as second-line treatment.

OS served as the primary endpoint. Minimum follow-up was 17.6 months.

Results showed a statistically significant improvement in median OS for patients who received nivolumab (10.9 months vs. 8.4 months; HR = 0.77; 95% CI, 0.62-0.96).

A higher percentage of nivolumab-treated patients remained alive at 12 months (47% vs. 34%) and 18 months (31% vs. 21%).

Researchers observed the OS benefit with nivolumab among patients with PD-L1 expression of 1% or greater (HR = 0.69; 95% CI, 0.51-0.94), as well as those with expression below 1% (HR = 0.84; 95% CI, 0.62 to 1.14).

Overall response rates were comparable between groups (33% with nivolumab vs. 34% with chemotherapy). However, nivolumab-treated patients also achieved longer median duration of response (6.9 months vs. 3.9 months).

Patients assigned chemotherapy achieved longer median PFS (3.4 months vs. 1.7 months), but nivolumab-treated patients were more likely to be alive and progression free at 6 months (24% vs. 17%) and 12 months (12% vs. 7%).

A higher percentage of patients assigned chemotherapy experienced treatment-related adverse events (95% vs. 66%), grade 3/grade 4 adverse events (63% vs. 18%), or serious adverse events (23% vs. 16%). Nine percent of patients in each treatment group discontinued therapy due to adverse events.

Investigators reported statistically significant improvements in quality of life with nivolumab compared with chemotherapy through week 42, both with the EQ-5D visual analog scale (least square mean, 6.9; 95% CI, 3-10.9) and the EQ-5D utility index (least square mean, 0.076; 95% CI, 0.011-0.142).


“Today is an important day for our patients, who have been eagerly waiting for an effective therapy,” Cho said. “We are very proud to present this good news and hope nivolumab will bring change to these patients.” – by John DeRosier


Cho BC, et al. Abstract LBA11. Presented at: European Society for Medical Oncology; Sept. 27-Oct. 1, 2019; Barcelona, Spain.

Disclosure s : Ono Pharmaceutical Co. and Bristol-Myers Squibb funded this study.

Cho reports honoraria from, consultant roles with or research funding from AstraZeneca, Bayer Champions Oncology, Bristol-Myers Squibb, Dizal Pharma, Dong-A, Eli Lilly, Janssen, Merck Sharpe & Dohme, Mogam Institute, Novartis, Ono Pharmaceutical Co., Pfizer, Roche, Takeda and Yuhan. He also reports stock ownership in Champions Oncology and TheraCanVac. Please see the abstract for all other authors’ relevant financial disclosures.