Immune checkpoint inhibitor-based chemotherapy for granulocyte-colony stimulating factor-producing advanced esophageal squamous cell carcinoma: a report of three cases.
Kohei Suto, Akiharu Kimura, Etsuko Hisanaga et al.
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Case in brief
Three men with advanced granulocyte-colony stimulating factor (G-CSF)-producing esophageal squamous cell carcinoma received fluorouracil, cisplatin, and pembrolizumab. One had regression of multiple nodal and lung metastases with normalization of inflammatory markers; after treatment was de-escalated to fluorouracil and pembrolizumab, disease remained stable. In a second patient, initial tumor reduction was followed by progression after four cycles, prompting a switch to weekly paclitaxel. The third had a partial response in the primary tumor but progression of bone metastasis, requiring radiation and a switch to paclitaxel.
What made this case unusual
The cases illustrate discordant responses: primary-tumor or overall regression did not ensure control of metastatic disease, with bone metastasis progressing despite a partial response in the primary tumor.
Diagnostic / clinical pearl
In G-CSF-producing esophageal squamous cell carcinoma treated with immune checkpoint inhibitor combination chemotherapy, assess metastatic sites separately; response at the primary tumor may not reflect control of distant disease.
Why it matters
These cases show varied outcomes and treatment resistance, underscoring the authors’ call for further research and additional case accumulation to clarify efficacy and optimize strategies.