LAUSR

Key Points Question Does immunotherapy confer a survival benefit for patients with advanced esophageal squamous cell carcinoma and low expression of programmed death ligand 1? Findings In this meta-analysis of 4752 patients with esophageal squamous cell carcinoma, immune checkpoint inhibitors were investigated in 9 first- and second-line trials. In the pooled analysis of first-line trials that used the tumor proportion score, no significant benefit in overall survival was observed with immunochemotherapy vs chemotherapy for the subgroup with a score lower than 1%; in the pooled analysis of first-line trials using the combined positive score, overall survival benefit with immunochemotherapy vs chemotherapy was modest but significant in the subgroup with a score lower than 10. Meaning Findings suggest that novel strategies should be investigated in the subgroup of patients with a tumor proportion score lower than 1% as there is a lack of overall survival benefit of immune checkpoint inhibitor–based regimens in the first-line setting vs chemotherapy alone.