P120. Adjuvant Immunotherapy for Esophageal Cancer in the CheckMate 577 Era: A National Cohort Analysis of Uptake and Overall Survival

Saturday, March 7, 2026

9:28 AM - 9:35 AM MST

Location: 101A-C

Co-Author(s)

OB

Omar Bushara, MD, MPH

Department of Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Russell A. Simons, MD, MPH

Resident
Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Gracia M. Vargas, MD

Resident
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
AJ

Anish Jona, BA

Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
IF

Ian W. Folkert, MD, PhD

Assistant Professor of Surgery
Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
ME

Mark S. Etherington, MD

Assistant Professor of Surgery
Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
John T. Miura, MD

Assistant Professor of Surgery
Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
JK

John C. Kucharczuk, MD

Division of Thoracic Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
GK

Giorgos C. Karakousis, MD (he/him/his)

Professor of Surgery
Department of Surgery, University of Pennsylvania Health System, United States
RR

Robert E. Roses, MD (he/him/his)

Professor of Surgery
Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Primary Presenter(s)

M. Saad Farooq, MD, MSTR

General Surgery Resident
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Slides

Introduction: The CheckMate 577 trial demonstrated improved disease-free survival in patients with esophageal cancer who received adjuvant nivolumab after completing neoadjuvant chemoradiotherapy. Notably, no significant overall survival (OS) benefit was demonstrated in the initial and follow-up trial reports. We therefore aimed to characterize uptake of adjuvant immunotherapy (Adj-IO) and assess OS in this patient population using a large national cohort.

Methods: We used the National Cancer Database to identify patients with esophageal adenocarcinoma/squamous cell carcinoma who received preoperative chemoradiotherapy and underwent R0 resection from 2018-2022. We categorized patients recommended for consideration of Adj-IO per current National Comprehensive Cancer Network guidelines (ypT+/ypN+) for analysis. Proportion receiving Adj-IO, factors associated with receipt of Adj-IO, and 3-yr OS were analyzed using univariable and multivariable analyses.

Results: Of 8796 eligible patients, 1431 (16%) received Adj-IO. This proportion increased significantly after 2020, coinciding with the publication of CheckMate 577 in 2021 (6% from 2018-2020 vs. 34% from 2021-2022, p< 0.001). Among patients with ypT+/ypN+ disease (6657, 75%), 45% received Adj-IO in 2022.
Factors associated with receipt of Adj-IO included ypT+N+ (adjusted odds ratio[aOR]: 2.20, p< 0.001), adenocarcinoma histology (aOR: 1.37, p=0.006) and minimally invasive surgery (aOR: 1.23, p=0.006). Length of stay >10 days (aOR: 0.78, p< 0.001) and increasing age (per yr aOR: 0.99, p=0.044) were negatively associated with receiving Adj-IO.
On unadjusted Kaplan-Meier analysis with a median follow-up time of 24.1 months (IQR 12.6–38.9) after surgery, Adj-IO was associated with improved 3-yr OS in ypN+ (51 vs 41%, p< 0.001) and ypT+ (58 vs 54%, p=0.003) patients vs. no Adj-IO. On multivariable Cox proportional hazards analysis, Adj-IO was associated with improved 3-yr OS in ypN+ (aHR: 0.71, p< 0.001) and ypT+ (aHR: 0.83, p=0.007) patients.

Conclusions: In this large real-world national cohort analysis, receipt of Adj-IO after preoperative chemoradiotherapy and R0 resection of esophageal cancer was associated with improved 3-yr OS. These results support the findings of CheckMate 577 and can potentially translate to other perioperative systemic/immunotherapy regimens currently under investigation. Importantly, despite OS benefit in ypT+/ypN+ patients, only 45% of this subset received Adj-IO in the most recent year of data, suggesting an area for improvement in uptake and guideline concordance.

Learning Objectives:

Assess uptake of adjuvant immunotherapy for patients with esophageal cancer that have undergone neoadjuvant chemoradiotherapy, specifically in relation to publication of the CheckMate 577 trial.
Understand the potential overall survival benefit of adjuvant immunotherapy in this patient population.
Understand patient/tumor characteristics associated with likelihood of receiving adjuvant immunotherapy.