Effectiveness comparison of pembrolizumab versus other immune checkpoint inhibitors in neoadjuvant chemoimmunotherapy for esophageal squamous cell carcinoma

Background and purpose: Neoadjuvant chemoimmunotherapy (nICT) has emerged as a promising strategy for esophageal squamous cell carcinoma (ESCC). However, the efficacy and safety comparison of imported and domestic immune drugs remain unclear. This study aimed to compare short- and long-term efficacy between domestic and imported immunotherapeutic agents. Method: A total of 128 ESCC patients were retrospectively analyzed. Domestic immune drugs included sintilimab, tislelizumab, camrelizumab, and toripalimab, while the imported drug was pembrolizumab. Propensity score matching (PSM) was applied to balance baseline characteristics. Cox analysis, Kaplan-Meier survival and landmark analysis were used for survival analysis. Study outcomes included recurrence-free survival (RFS), locoregional recurrence-free survival (L-RFS), distant metastasis-free survival (D-MFS), pathological response, and postoperative complications. Result: 97 patients received domestic drugs and 31 received imported drugs. No significant differences were observed in RFS (p = 0.351), L-RFS (p = 0.075) and D-MFS (p = 0.772) before PSM. After PSM, survival outcomes remained comparable. 12th-month landmark analysis also showed no significant differences between two categories. Although imported drug was associated with a higher MPR rate before matching (p = 0.005), this difference was not significant after PSM (p = 0.128). Complication rates were similar except for fewer pleural effusions (p = 0.026) and more electrolyte disturbances (p = 0.030) in the imported group after PSM. Conclusion: Domestic and imported immune drugs demonstrated comparable long-term survival and safety in ESCC patients receiving nICT. Although imported agents may offer a modest advantage in pathological response, both categories remain effective options for clinical use.