What is your second line therapy for PDL1 negative metastatic squamous esophageal cancer who did not receive a checkpoint inhibitor in first line setting?

I would not personally consider immunotherapy in any context for such a patient. For the purpose of answering this question, I assume that a "PD-L1 negative" tumor refers to a PD-L1 TPS 0% and CPS 0 tumor.

As a quick reminder, the 2 relevant studies in the US for 1st-line immunotherapy in ESCC patien...

Short Answer: Nivolumab.

Let's first discuss the ATTRACTION-3 trial in detail. This was a multicenter randomized open-label trial in Denmark, Germany, Italy, Japan, South Korea, Taiwan, the UK, and the USA but 96% are identified as Asian in the demographics. Patients who were refractory or intoleran...

A meta-analysis, involving five randomized controlled trials with a total of 1,970 patients with advanced ESCC patients, compared second line conventional chemotherapy to second-line PD-1 inhibitors (987 patients on PD-1 inhibitors and 983 on chemotherapy). (Zhu et al., PMID 34758782) The OS (hazard...