Data support the use of first and second line immune checkpoint inhibitors in HNSCC

Data support the use of first and second line immune checkpoint inhibitors in HNSCC

Findings from a retrospective cohort study found that immune checkpoint inhibitors induced promising responses in the first- and second-line treatment of head and neck squamous cell carcinoma.

Immune Checkpoint Inhibitors (ICIs) Show Promising Results for Patients With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC), Study Finds A recent retrospective cohort study published in JAMA Otorhinolaryngology, whose data support the modality in the first and second line treatment of the disease.

The ICIs resulted in an overall response rate of 30.1%. The investigator reported an estimated 1-year overall survival (OS) rate of 51.8% (95% CI, 44.5%-58.8%) and an estimated 1-year progression-free survival (PFS) rate. year of 9.4% (95% CI, 5.0%-15.5%) in this study population. In addition, the median OS was 12.9 months ([Interquartile range [IQR], 4.1-36.5) and the median PFS was 3.9 months (IQR, 1.9-17.8 months). Oral cavity cancer patients fared worse on ICIs than HNSCC patients from other subsites, experiencing worse OS.

“In this large cohort study of patients with recurrent or metastatic mucosal HNSCC from the general population who were treated with [ICIs], the observed survival and response rates were similar to those seen in previous clinical trials, despite 31.1% of patients having an ECOG performance status of 2 or higher,” the researchers wrote. “Our findings support the use of [ICI] therapies for the first or second line treatment of recurrent or metastatic HNSCC”.

This study evaluated 212 patients with HNSCC treated with ICI, the majority of whom (50.9%) had distant metastatic disease at the time of treatment initiation. Additionally, 58.0% of those with distant metastases had oligometastases. The majority of patients in the cohort were male (77.8%) and the majority were current or former smokers (69.8%). The median age at diagnosis was 63.2 years (IQR, 57.2-71.2 years). The most common primary tumor sites included the oropharynx (46.7%)—75.8% of which had human papillomavirus (HPV)-associated disease), the oral cavity (28.8%), and the larynx or larynx. hypopharynx (24.5%). PD-L1 status was not included in the multivariable models as only 43.9% of the patient population had PD-L1 test results available.

Patients in the study cohort underwent ICI therapy for a median of 2.9 months (IQR, 1.4-7.5) and completed a median of 5 doses (IQR, 3-10). In total, 167 patients discontinued treatment during the study period, most commonly due to disease progression (72.5%) and toxic effects (12.6%). However, 6 patients (3.6%) discontinued treatment after achieving a durable response of 12 months or more.

Results with ICI therapy in combination with chemotherapy did not differ from those who did not receive chemotherapy. Additionally, among the 183 patients with available post-treatment imaging data, 8.2% demonstrated a complete response, 21.9% demonstrated a partial response, 9.3% demonstrated a mixed response, 20.2% demonstrated stable disease and 40.4% demonstrated disease progression. Patients with HPV-positive oropharyngeal cancer (odds ratio [OR], 2032; 95% CI, 0.758-5.452) and those with other primary tumor sites (OR, 1.948; 95% CI, 0.751-5.053) experienced numerically higher response rates than patients with the oral cavity as the primary site; however, the differences were not found to be statistically significant.

Treatment-associated adverse events occurred in 50 patients, the most common being thyroid function abnormalities (44%), rash (30%), and colitis (18%).

Reference

Hobday SB, Brody RM, Kriegsman B, et al. Outcomes among patients with mucosal squamous cell carcinoma of the head and neck treated with checkpoint inhibitors. JAMA Otolaryngol Head Neck Surg. 2022;148(10):918-926. doi:10.1001/jamaoto.2022.2284

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