Maximizing survival benefit with precision therapy based on progressive patterns after immunochemotherapy in metastatic esophageal cancer.

This study aimed to define optimal treatment strategies for metastatic esophageal cancer with different progressive patterns after first-line immunotherapy (IO) resistance. Patients were stratified into oligoprogression and polyprogression, with further subclassifications (repeat oligoprogression [REO]/induced oligoprogression [INO]/de-novo polyprogression [DNP]/repeat polyprogression [REP]). Oligoprogression patients receiving radiotherapy (RT) had longer progression-free survival (PFS) (9.4 vs. 5.8 months, p = 0.018, q = 0.036) and overall survival (OS) (21.9 vs. 9.2 months, p = 0.012, q = 0.024), especially in the REO subgroup (PFS: 9.4 vs. 5.7 months, p = 0.0249, q = 0.0498; OS: 21.9 vs. 8.7 months, p = 0.018, q = 0.036). Polyprogression patients on IO rechallenge showed improved PFS (4.7 vs. 2.8 months, p = 0.006, q = 0.024) and OS (8.5 vs. 4.8 months, p = 0.001, q = 0.004), particularly in the REP subgroup (PFS: 5.6 vs. 2.8 months, p = 0.008, q = 0.016; OS: 5.6 vs. 2.8 months, p < 0.001, q < 0.002). Overall, RT is more important for patients with REO, while IO rechallenge could play a more dominant role for REP.