Current evidence and therapeutic strategies in immunotherapy for esophageal cancer: a narrative review
- Author:
Kabsoo SHIN
1
Author Information
- Publication Type:Focused Issue of This Month
- From:Journal of the Korean Medical Association 2025;68(12):790-801
- CountryRepublic of Korea
- Language:Korean
- Abstract: This review summarizes the latest evidence on immunotherapy in esophageal cancer, with emphasis on histologic and molecular subtype differences, advances in immune checkpoint inhibitor (ICI)-based strategies, and future directions for optimizing therapy.Current Concepts: Histologic subtypes display distinct geographic patterns: esophageal squamous cell carcinoma (ESCC) predominates in East Asia, whereas adenocarcinoma is more common in Western countries. These subtypes differ in etiology, molecular characteristics, and the tumor immune microenvironment. Chronic carcinogen exposure confers high immunogenicity, characterized by increased tumor mutational burden and immune infiltration, which provides a strong rationale for immunotherapy. Programmed cell death-1–based chemo-immunotherapy is now established as the standard first-line treatment in advanced ESCC, demonstrating survival benefits in multiple phase III trials. ICIs are also being evaluated in perioperative settings and in combination with chemoradiotherapy, targeted agents, anti-angiogenic therapies, dual-checkpoint blockade, and bispecific antibodies. In the neoadjuvant setting, ICI combinations may yield favorable pathological complete response rates, and adjuvant nivolumab after chemoradiotherapy has improved disease-free survival in patients with residual disease.Discussion and Conclusion: The incorporation of ICIs across disease stages is rapidly transforming the management of esophageal cancer. Precision strategies, including active surveillance after a clinical complete response and detection of minimal residual disease using circulating tumor DNA, are emerging to guide treatment intensity. Priorities for future work include standardized predictive biomarkers, dynamic monitoring using liquid biopsy, and strengthened multidisciplinary collaboration to individualize care. Broad participation in clinical trials will be essential to further improve survival and quality of life for patients with esophageal cancer.
