Efficacy of Chemotherapy After Immune Checkpoint Inhibitor Discontinuation in Head and Neck Cancer

Abstract

ObjectiveImmune checkpoint inhibitors (ICI) have become widely used becuse of their effectiveness and relatively low rate of severe adverse events. However, active treatment should be continued after discontinuation of ICI as response rates are lower than that of conventional cytotoxic chemotherapy. The purpose of the present study was to determine the efficacy of treatment after ICI discontinuation.MethodsThis was a retrospective study from hospital charts of 99 consecutive cases treated with ICI at our facility since 2017. Of these, 79 cases of squamous cell carcinoma which had already discontinued ICI were enrolled in the present study.ResultsAfter discontinuation of ICI, 40 cases received active treatment with salvage chemotherapy (SCTx; 33 cases) or surgery or radiotherapy (seven patients) and 39 cases received nonactive treatment. SCTx comprising paclitaxel and cetuximab (PTX‐Cmab) was administered to 15 cases and other SCTx regimens to 18 cases. A significant increase in overall survival (OS) was observed with active treatment compared with nonactive treatment. No significant differences in OS or progression‐free survival (PFS) were observed between SCTx regimens; however, there was a trend toward increased survival with PTX‐Cmab. Univariate analysis of overall response rate (ORR) demonstrated significant differences in the site of disease at ICI and SCTx regimens. A significant difference in disease control rate was observed between SCTx regimens. Multivariate analysis of ORR demonstrated a significant correlation with PTX‐Cmab treatment.ConclusionActive treatment after ICI discontinuation and the use of PTX‐Cmab as SCTx may increase OS in head and neck squamous cell carcinoma.Level of EvidenceLevel 4 Laryngoscope, 2023

Ultra‐high combined positive score and high serum albumin are favorable prognostic biomarkers for immune checkpoint inhibitors in head and neck squamous cell carcinoma

“…The current treatment was used only in patients with confirmed recurrence or metastasis and target lesions, and CT scans of the neck and abdomen were performed every 3 months to monitor the growth or shrinkage of the target lesions and determine the effectiveness of the treatment. If tumor growth was observed despite treatment with immune checkpoint inhibitors, cetuximab plus paclitaxel was the main second‐line regimen, 14 and chemotherapy was used for disease control while maintaining ADL. This study was approved by the Ethics Committee for Non‐Interventional Research of the University of Tokyo Hospital (#11456‐6).…”