BACKGROUND: Patients with advanced or metastatic oesophageal squamous cell 
carcinoma have poor prognosis and few treatment options after first-line 
therapy. We aimed to assess efficacy and safety of the anti-PD-1 antibody 
camrelizumab versus investigator's choice of chemotherapy in previously treated 
patients.
METHODS: ESCORT is a randomised, open-label, phase 3 study of patients aged 18 
to 75 years with a histological or cytological diagnosis of advanced or 
metastatic oesophageal squamous cell carcinoma done at 43 hospitals in China. 
Eligible patients had an Eastern Cooperative Oncology Group (ECOG) performance 
status of 0 or 1, and had progressed on, or were intolerant to, first-line 
standard therapy. Patients were randomly assigned (1:1) to camrelizumab (200 mg 
every 2 weeks) or chemotherapy with docetaxel (75 mg/m2 every 3 weeks) or 
irinotecan (180 mg/m2 every 2 weeks), all given intravenously. Central 
randomisation was done using the Randomization and Trial Supply Management 
system with block size randomly generated as four or six and stratified by 
disease and ECOG performance status. The primary endpoint was overall survival, 
assessed in randomised patients who had received at least one dose of treatment. 
Safety was assessed in all treated patients. The trial is registered with 
ClinicalTrials.gov, NCT03099382, and is closed to new participants.
FINDINGS: From May 10, 2017, to July 24, 2018, 457 (75%) of 607 screened 
patients were randomly assigned to treatment, of whom 228 received camrelizumab 
treatment and 220 received chemotherapy. As of data cutoff on May 6, 2019, with 
a median follow-up time of 8·3 months (IQR 4·1-12·8) in the camrelizumab group 
and 6·2 months (3·6-10·1) in the chemotherapy group, median overall survival was 
8·3 months (95% CI 6·8-9·7) in the camrelizumab group and 6·2 months (5·7-6·9) 
in the chemotherapy group (hazard ratio 0·71 [95% CI 0·57-0·87]; two-sided 
p=0·0010). The most common treatment-related adverse events of grade 3 or worse 
were anaemia (camrelizumab vs chemotherapy: six [3%] vs 11 [5%]), abnormal 
hepatic function (four [2%] vs one [<1%]), and diarrhoea (three [1%] vs nine 
[4%]). Serious treatment-related adverse events occurred in 37 (16%) of 228 
patients in the camrelizumab group, and in 32 (15%) of 220 patients in the 
chemotherapy group. Ten treatment-related deaths occurred, seven (3%) in the 
camrelizumab group (three deaths from unknown causes, one enterocolitis, one 
hepatic function abnormal, one pneumonitis, and one myocarditis) and three (1%) 
in the chemotherapy group (two deaths from unknown causes, and one 
gastrointestinal haemorrhage).
INTERPRETATION: Second-line camrelizumab significantly improved overall survival 
in patients with advanced or metastatic oesophageal squamous cell carcinoma 
compared with chemotherapy, with a manageable safety profile. It might represent 
a potential option of standard second-line treatment for patients with 
oesophageal squamous cell carcinoma in China.
FUNDING: Jiangsu Hengrui Medicine.