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Tuesday Poster Session

Category: Esophagus

P4890 - Platinum-Based Chemo + Anti-PD-1 Cuts Death Risk by One-Third in Esophageal Squamous Cell Carcinoma—A Sex-Disaggregated Meta-Analysis of Five Randomized Controlled Trials

Tuesday, October 28, 2025
10:30 AM - 4:00 PM PDT
Location: Exhibit Hall

    Presenting Author(s)

  • Ashesh Das, MBBS

    KPC Medical College and Hospital , Kolkata, India
    Kolkata, West Bengal, India

Anushka Anand. Hanchate, MBBS1, Ritvik Baweja, MBBS2, Muthuramalingam Kamala Parthiban, MBBS3, Shayan Mahapatra, MD4, Aurpy Das, MBBS5, Jashanpreet Kaur, 6, Jana Al Jnainati, MD7, Ashesh Das, MBBS8, Smit C. Desai, MBBS9, M. Rafiqul Islam, 10, Sushmitha Rameshbabu, MBBS11
1Mgm Medical College and Hopsital , Kamothe ,Navi mumbai, Mumbai, Maharashtra, India; 2Maulana Azad Medical College, Delhi, Delhi, India; 3Stanley Medical College, Chennai, Tamil Nadu, India; 4Aiken Regional Medical Center, Graniteville, SC; 5Chittagong Medical College, Rahway, NJ; 6Sri guru ram das institute of medical sciences & research, Moga, Punjab, India; 7University of Milan–Bicocca: Universita degli Studi di Milano-Bicocca, Bergamo, Lombardia, Italy; 8KPC Medical College and Hospital , Kolkata, India, Kolkata, West Bengal, India; 9GMERS Medical College, Gandhinagar, Milpitas, CA; 10Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh, Dhaka, Dhaka, Bangladesh; 11Madras Medical College, Neyveli, Tamil Nadu, India

Introduction: Immune-checkpoint blockade combined with platinum-based chemotherapy has transformed first-line care for advanced oesophageal squamous-cell carcinoma (ESCC), yet the extent to which biological sex modulates this survival gain is uncertain. Women remain under-represented in pivotal immunotherapy trials, raising concern that efficacy signals may be driven by male-predominant cohorts. To address this knowledge gap, we conducted a subgroup-level meta-analysis to quantify sex-specific overall-survival (OS) benefit with chemo-immunotherapy.

Methods: A systematic literature search of PubMed, Embase, Scopus, Cochrane Library databases was done to collect Randomized Controlled Trials (RCTs) comparing platinum-based chemotherapy with anti-PD-1 antibody versus chemotherapy alone for overall survival (OS) in esophageal cancer, stratified by gender. Statistics was done by R (v4.4.3), with the REML estimator for between-study variance and Hartung-Knapp adjustment with random-effects/common effects model . Hazard ratios (HRs) and 95% confidence intervals (CIs) for male and female subgroups were extracted and log HRs and standard errors were derived from reported CIs.. Gender subgroup analysis and interaction testing were conducted & Heterogeneity assessed using the I² statistic.

Results: Across five first-line phase-III RCTs, the addition of a PD-1 inhibitor to standard chemotherapy significantly improved overall survival compared with chemotherapy alone (random-effects HR 0.64, 95 % CI 0.55–0.74; I² = 38 %). The survival advantage was evident in both men (HR 0.63, 95 % CI 0.52–0.75; I² = 37 %) and women (HR 0.67, 95 % CI 0.38–1.19; I² = 49 %), with no statistically significant interaction between sex and treatment effect (test for subgroup differences p = 0.73). A pooled ratio-of-hazard-ratios (female / male) of 1.07 (95 % CI 0.56–2.08; I² = 52 %) confirmed that the magnitude of benefit was comparable across.

Discussion:









Chemo-immunotherapy slashes first-line ESCC mortality by ~36 % versus chemotherapy alone; the gain is near-identical in men (HR 0.63) and women (HR 0.67), with no sex-treatment interaction (p = 0.73).Our results show sex should no longer sway regimen choice—every eligible patient deserves PD-1 plus platinum-fluoropyrimidine. While moderate heterogeneity and wide female CIs reflect < 20 % female enrolment, the uniformly favourable direction across five global RCTs supports an immediate guideline upgrade and demands future trials recruit women equitably and report sex-specific outcomes.



















Figure: Forest Plot Overall and Subgroup Analysis

Figure: Forest Plot of Hazard Ratio


Disclosures:
Anushka Hanchate indicated no relevant financial relationships.
Ritvik Baweja indicated no relevant financial relationships.
Muthuramalingam Kamala Parthiban indicated no relevant financial relationships.
Shayan Mahapatra indicated no relevant financial relationships.
Aurpy Das indicated no relevant financial relationships.
Jashanpreet Kaur indicated no relevant financial relationships.
Jana Al Jnainati indicated no relevant financial relationships.
Ashesh Das indicated no relevant financial relationships.
Smit Desai indicated no relevant financial relationships.
M. Rafiqul Islam indicated no relevant financial relationships.
Sushmitha Rameshbabu indicated no relevant financial relationships.


Anushka Anand. Hanchate, MBBS1, Ritvik Baweja, MBBS2, Muthuramalingam Kamala Parthiban, MBBS3, Shayan Mahapatra, MD4, Aurpy Das, MBBS5, Jashanpreet Kaur, 6, Jana Al Jnainati, MD7, Ashesh Das, MBBS8, Smit C. Desai, MBBS9, M. Rafiqul Islam, 10, Sushmitha Rameshbabu, MBBS11. P4890 - Platinum-Based Chemo + Anti-PD-1 Cuts Death Risk by One-Third in Esophageal Squamous Cell Carcinoma—A Sex-Disaggregated Meta-Analysis of Five Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.