NCCN Flash Update: Guideline Update for Esophageal and Esophagogastric Junction Cancers in Version 3.2025

Author(s):

Key Takeaways

The updated guidelines highlight the growing role of immunotherapy in esophageal cancer, particularly with the inclusion of tislelizumab-jsgr in preferred regimens.
New first-line treatment options for SCC with PD-L1 CPS of 1 or greater include combinations of oxaliplatin, paclitaxel, and tislelizumab.
Revised recommendations for nivolumab and ipilimumab reinforce their significance in the immunotherapy landscape for SCC.
Two new dosing schedules for tislelizumab-based regimens reflect the integration of immune checkpoint inhibitors in frontline treatment for PD-L1–expressing esophageal SCC.

The Version 3.2025 update adds tislelizumab-based regimens as preferred first-line treatments and introduces new dosing schedules for PD-L1–positive esophageal squamous cell carcinoma.

The National Comprehensive Cancer Network (NCCN) has published updates on April 22, 2025 to Version 3.2025 of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) and NCCN Drugs & Biologics Compendium (NCCN Compendium) for Esophageal and Esophagogastric Junction Cancers, incorporating significant updates that reflect the evolving landscape of therapeutic options, particularly for patients with squamous cell carcinoma (SCC).

Updated guidelines for squamous cell carcinoma. Image generated with AI

These updates underscore the growing role of immunotherapy in the management of esophageal cancer, highlighting new preferred regimens that integrate the PD-1 inhibitor tislelizumab-jsgr (Tevimbra; BeiGene).

Key Guideline Updates for SCC

First-Line Therapy: Preferred Regimens (ESOPH-F 5 of 24)

For patients with PD-L1 combined positive score (CPS) of 1 or greater, the following combinations have been added as preferred first-line treatment options:

Oxaliplatin, paclitaxel, and tislelizumab
Cisplatin, paclitaxel, and tislelizumab

Additionally, the guideline revises the recommendation for nivolumab (Opdivo;Bristol Myers Squibb) and ipilimumab (Yervoy, Bristol Myers Squibb) use in patients with PD-L1 CPS of 1 or greater, reinforcing their role in the immunotherapy landscape for SCC.

Dosing Schedules for Tislelizumab-Based Regimens (ESOPH-F 14 of 24)

Two new dosing schedules were added for tislelizumab-based combination therapies in SCC:

Oxaliplatin, paclitaxel, and tislelizumab-jsgr

Oxaliplatin: 130 mg/m² IV on day 1 (up to 6 doses)
Paclitaxel: 175 mg/m² IV on day 1
Tislelizumab-jsgr: 200 mg IV on day 1
Cycle: Every 21 days

Cisplatin, paclitaxel, and tislelizumab-jsgr

Cisplatin: 60 to 80 mg/m² IV on day 1 (up to 6 doses)
Paclitaxel: 175 mg/m² IV on day 1
Tislelizumab-jsgr: 200 mg IV on day 1
Cycle: Every 21 days

These additions reflect growing clinical evidence supporting the integration of immune checkpoint inhibitors in frontline treatment for PD-L1–expressing esophageal SCC.

REFERENCE

Esophageal and Esophagogastric Junction Cancers, Version 3.2025. National Comprehensive Cancer Network. April 22, 2025. Accessed April 23, 2025. https://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf