Efficacy and Safety of Camrelizumab Plus Apatinib for Esophageal Squamous Cell Carcinoma: A Systematic Review and Meta-analysis.

Abstract

Esophageal squamous cell carcinoma (ESCC) is a major global health burden with limited treatment options. Combining immunotherapy with antiangiogenic agents has shown promise. Camrelizumab, a PD-1 inhibitor, and apatinib, a VEGFR-2 inhibitor, offer synergistic effects, improving outcomes in patients with advanced or metastatic ESCC. A literature search was conducted across PubMed, Cochrane, Embase, Scopus, and clinicaltrials.gov from inception till May 2025. Nine studies evaluating the safety and efficacy of camrelizumab plus apatinib were included. Analysis was conducted on R Studio v4.5.0. Pooled estimates were reported as proportions and 95% CI using a random effect model. Statistical heterogeneity was assessed using I². Subgroup analysis was based on treatment exposure. The pooled 1-year overall survival (OS) rate was 71%, with treatment-naive patients exhibiting a statistically higher 1-year OS of 95% compared with 55% in pretreated patients. One-year progression-free survival was 25%. The overall response rate was significantly higher in the treatment-naive group than in the previously treated group (87% vs. 28%). Previously treated patients showed a modest complete response rate (CRR) of 1%, while treatment-naive patients showed a significantly higher CRR of 22%. Partial response rate was significantly higher in the treatment-naive subgroup (64% vs. 26%). Hemangioma was the significant adverse event in the treatment-naive subgroup (47% vs. 12%). Rates of leukopenia, neutropenia, anemia, and thrombocytopenia were comparable between the 2 subgroups. Camrelizumab plus apatinib has shown promising efficacy with improved OS, PFS, and response rates. Large-scale trials are warranted to validate these findings and optimize treatment strategies.