Title: Nivolumab in combination with fluoropyrimidine- and platinum-based combination chemotherapy for the first-line treatment of adult patients with unresectable advanced, recurrent, or metastatic oesophageal squamous cell carcinoma with tumour cell PD-L1 expression >1% [ID2712]
Funder: Department of Health and Social Care

Abstract: Oesophageal cancer is a malignant tumour arising from cells lining the oesophagus (gullet), which is the muscular tube through which food passes from the throat to the stomach. The two main types of oesophageal cancer are squamous cell carcinoma and adenocarcinoma. In the upper and middle part of the oesophagus, cancers tend to be squamous cell carcinomas, which develop from cells that make up the inner lining of the oesophagus. Cancers in the lower part tend to adenocarcinomas, which usually develop in gland cells. [1] When the tumour includes both cancer types it is called adenosquamous carcinoma. Adenosquamous carcinoma is a rare type of oesophageal cancer. The most common symptoms are difficulty swallowing, food regurgitation, nausea or vomiting, unexplained weight loss and persistent indigestion or cough.[2]_x000D_ _x000D_ Oesophageal cancer is more common in men than women. In 2017, there were 2,289 new diagnoses in women and 5,280 in men (a total of 7,569 new cases) in England. [3] The risk of developing oesophageal cancer increases with age. Around 40% of all new cases in UK are diagnosed in people aged over 75.[4] Because of the nature of symptoms, oesophageal cancer is often diagnosed at an advanced stage. On average 70-80% are diagnosed at stage 3 (locally advanced) or 4 (metastatic). [5] For adults diagnosed between 2013 and 2017 in England, the 1-year survival rate for people with oesophageal cancer is around 47% and 5-year survival rate is 17%.[6]_x000D_ _x000D_ The aim of treatment in advanced or metastatic oesophageal cancer is primarily palliative. NICE clinical guideline (NG83) recommends chemotherapy combination regimens for people who have a performance status 0 to 2 and no significant comorbidities. Chemotherapy regimens include doublet treatment with fluorouracil or capecitabine in combination with cisplatin or oxaliplatin, or triplet treatment with fluorouracil or capecitabine in combination with cisplatin or oxaliplatin plus epirubicin. NICE technology appraisal 737 recommends pembrolizumab with platinum- and fluoropyrimidine-based as an option for untreated locally advanced unresectable or metastatic carcinoma of the oesophagus or HER-2 negative gastro-oesophageal junction adenocarcinoma in adults whose tumours express PD-L1 with a combined positive score (CPS) of 10 or more._x000D_ _x000D_ References_x000D_ _x000D_ 1. Macmillan cancer support (2020) Signs and symptoms of oesophageal cancer. Accessed April 2020_x000D_ 2. Macmillan cancer support (2020) What is oesophageal cancer? Accessed April 2020._x000D_ 3. Office for National Statistics (2019) Cancer registration statistics, England, 2017. Accessed March 2020._x000D_ 4. Cancer Research UK (2019) Oesophageal cancer incidence statistics. Accessed March 2020._x000D_ 5. NCRAS (2019). Stage breakdown by CCG 2017. Accessed March 2020._x000D_ 6. Office for National Statistics (2019) Cancer survival in England - adults diagnosed Accessed March 2020.

Lay abstract: To appraise the clinical and cost effectiveness of nivolumab in combination with fluoropyrimidine- and platinum-based combination chemotherapy, or ipilimumab within their marketing authorisations for untreated advanced unresectable recurrent or metastatic oesophageal squamous cell carcinoma.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: CANCER AND NEOPLASMS