| Sumario: | What is known and objective: First‐line and second‐line immunotherapy with programmed death‐1 (PD‐1) inhibitors both improve overall survival in patients with advanced oesophageal squamous cell cancer (ESCC). This study explored survival differences between first‐line and second‐line PD‐1 inhibition in advanced ESCC. Methods: This registry study included 167 patients with advanced ESCC who were exposed to PD‐1 inhibitors in either a first‐line or a second‐line setting between 15 January 2019 and 31 October 2020. The primary endpoint was overall survival, and secondary endpoints included overall tumour response, progression‐free survival (PFS) and PFS2. A propensity score‐matching (PSM) analysis was performed using the nearest‐neighbour method. Results and discussion: Sixty‐one patients started first‐line treatment with chemotherapy and a PD‐1 inhibitor (Group 1), while 106 started chemotherapy as the first‐line choice and received a PD‐1 inhibitor as the second‐line choice (Group 2). The median PFS was 7.1 months in Group 1 and 4.1 months in Group 2 (log‐rank p = 0.001). The median PFS2 was 7.1 months in Group 1 and 7.4 months in Group 2 (log‐rank p = 0.4). Before PSM, the median overall survival was 13.5 months in Group 1 and 14.1 months in Group 2 (log‐rank p = 0.9), and the sensitivity analysis showed consistent results (14.0 vs. 14.1 months). After PSM, the median overall survival rates for Group 1 (n = 61) and Group 2 (n = 61) were 13.5 and 13.1 months (log‐rank p = 0.7) respectively. What is new and conclusion: In this study, patients with advanced ESCC who received first‐line or second‐line PD‐1 inhibitors seemed to have comparable overall survival.
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