Choosing Chemotherapy With or Without Immunotherapy and the Use of PD-1 Inhibitors in ESCC

This discussion examines the key considerations oncologists weigh when choosing between chemotherapy alone or chemotherapy combined with a PD-1 inhibitor for patients with advanced esophageal squamous cell carcinoma (ESCC). The discussion focuses on how clinical judgment, practice patterns, and regional treatment norms influence decision-making, alongside the growing survival evidence supporting chemo-immunotherapy approaches. PD-L1 testing plays an increasingly important role in guiding these choices, with a CPS ≥1 threshold frequently used in clinical trials and real-world practice to help identify patients more likely to benefit from immunotherapy. Patient and tumor specific factors, such as disease burden, performance status, and comorbidities, are highlighted as central to personalizing treatment. The segment also emphasizes how guideline recommendations, including NCCN designations such as Category 1 for select regimens, shape standard practice and support treatment authorization. Together, these insights illustrate how clinicians integrate biomarkers, evidence, and guidelines to determine the most appropriate first-line approach for ESCC.