NCCN Guidelines® Insights: Esophageal and Esophagogastric Junction Cancers, Version 4.2026
- Study type
- Clinical guideline
- Study name
- NCCN Esophageal v4.2026
- Design
- Excerpt of the clinical guideline of the US National Comprehensive Cancer Network (NCCN Guidelines Insights)
- Source
- J Natl Compr Canc Netw · 2026
In plain words
The NCCN guidelines are a major US reference for cancer treatment. This version stresses that oesophageal cancer has two different types (squamous and adenocarcinoma) that are treated differently, and that in advanced disease, tumour tests and immunotherapy have come to play an important role in choosing treatment.
Key guideline recommendations
In locally advanced or metastatic disease, systemic therapy is used to palliate symptoms and improve survival and/or quality of life.
Biomarker testing and immunotherapy are an important part of treating advanced disease; details of the first-line immunotherapy recommendations in squamous cell carcinoma are in the full text.
- Category 1, preferred
First line, oesophageal squamous cell carcinoma with PD-L1 CPS ≥1: fluoropyrimidine (fluorouracil or capecitabine) + oxaliplatin or cisplatin + nivolumab, preferred option.
- Category 1, preferred
First line, oesophageal squamous cell carcinoma with PD-L1 CPS ≥1: fluoropyrimidine- and platinum-based chemotherapy + pembrolizumab, preferred option.
- Category 1, preferred (platinum + paclitaxel + tislelizumab: category 2A, preferred)
First line, oesophageal squamous cell carcinoma with PD-L1 CPS ≥1: fluoropyrimidine- and platinum-based chemotherapy + tislelizumab, preferred option; platinum + paclitaxel + tislelizumab is also a preferred option.
- 2A
Nivolumab + ipilimumab in the first line, restricted to tumours with PD-L1 CPS ≥1.
- 2A (NCCN default)
MSI-H/dMMR testing is recommended for all newly diagnosed patients; in MSI-H/dMMR tumours, single-agent immunotherapy (pembrolizumab or dostarlimab) is a first-line option regardless of PD-L1.
- 2A, preferred
If the patient is not a candidate for immunotherapy, chemotherapy alone: fluoropyrimidine (fluorouracil or capecitabine) with oxaliplatin or cisplatin is the preferred first-line option.
Study population
Patients with cancer of the oesophagus and oesophagogastric junction; this excerpt focuses on the treatment of advanced oesophageal squamous cell carcinoma, particularly first-line immunotherapy.
Endpoints
This document is a guideline and has no trial endpoints.
Safety and side effects
The abstract does not address treatment toxicities.
Clinical significance and place in guidelines
This excerpt supersedes version 2.2023 published in JNCCN and focuses on the choice of first-line immunotherapy in advanced oesophageal squamous cell carcinoma. The full current guideline is updated at NCCN.org.
Limitations
The abstract does not give the details of the recommendations, evidence categories or PD-L1 thresholds; these are in the full text of the excerpt.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.