Safety Considerations for Checkpoint Inhibitors in ESCC and Gastric/GEJ Tumors

This discussion reviews the key safety considerations for checkpoint inhibitors used in advanced esophageal squamous cell carcinoma (ESCC) and gastric or gastroesophageal junction (GEJ) cancers. The discussion emphasizes that pembrolizumab, nivolumab, and tislelizumab share a broadly similar immune-related toxicity profile, with most adverse events reflecting well-recognized PD-1 class effects such as dermatitis, colitis, thyroid dysfunction, hepatitis, and pneumonitis. Rates of grade 3 or higher immune-related adverse events are generally low, and the higher overall rates of severe adverse events seen in clinical trials typically reflect the chemotherapy backbone rather than the checkpoint inhibitor itself. Across available studies, no agent has demonstrated unexpected or distinct toxicity patterns in these gastrointestinal cancer settings, and differences between trials are usually attributable to variations in patient populations, treatment regimens, or regional practice. Overall, PD-1 inhibitors have a well-characterized and manageable safety profile, supporting their use as important components of modern first-line treatment approaches in advanced ESCC and gastric/GEJ cancers.