This discussion examines how clinicians decide between chemotherapy alone or chemotherapy combined with a PD-1 inhibitor in the first-line treatment of advanced esophageal squamous cell carcinoma (ESCC). The discussion emphasizes the relevance of PD-L1 expression in informing these choices, while noting that different clinical trials have used different PD-L1 assessment methods and thresholds, such as tumor-cell PD-L1 ≥1% or combined positive score (CPS)–based approaches, to help identify patients most likely to benefit from chemo-immunotherapy. Experts also review guideline-supported first-line options that incorporate PD-1 inhibitors such as nivolumab, pembrolizumab, or tislelizumab alongside platinum-based chemotherapy. Decisions about whether to add immunotherapy often depend on disease extent, PD-L1 expression level, patient comorbidities, and individual suitability for immunotherapy. Practical considerations, including institutional pathways and insurance requirements, may also influence regimen selection. Overall, the segment provides a realistic view of how clinicians integrate biomarkers, clinical evidence, and guidelines when personalizing first-line therapy for ESCC.
