We speculate that this enhanced activity may be owing to the synergy of anlotinib with ICIs and chemotherapy.17,31–35 Advanced ESCC with low PD-L1 expression usually derive limited PFS benefit (<8 months) from immunochemotherapy.5–8,29 Interestingly, our regimen produced promising outcomes in both PFS (positive vs. negative: 12.9 vs. 14.9 months) and ORR (75% vs. 69.2%) irrespective of PD-L1 status. This evidence concerns the gene CD274 and esophageal squamous cell carcinoma.