Impact of tumor burden on survival in patients with recurrent or metastatic head and neck cancer treated with immune checkpoint inhibitors

Abstract

Immune checkpoint inhibitors (ICIs) have become the standard treatment for recurrent or metastatic head and neck cancer (RM-HNC). However, many patients fail to benefit from the treatment. Previous studies have revealed that tumor burden predicts the efficacy of ICIs, but this association remains unclear for RM-HNC. We retrospectively analyzed 94 patients with RM-HNC treated with ICI monotherapy. We estimated the tumor burden using the baseline number of metastatic lesions (BNML) and the baseline sum of the longest diameters of the target lesions (BSLD), and evaluated the association between BNML, BSLD, and standardized uptake value (SUV) and clinical outcomes. The median progression-free survival (PFS) was 7.1 and 3.1 months in the low-BNML and high-BNML groups, respectively (p = 0.010). The median PFS was 9.1 and 3.5 months in the low-BSLD and high-BSLD groups, respectively (p = 0.004). Moreover, patients with high SUVmax levels had worse overall survival (OS) and PFS. BNML, BSLD, and SUVmax are useful prognostic factors in patients with RM-HNC treated with ICIs. Imaging examinations before ICI treatment are recommended to predict the efficacy of ICIs. If the tumor burden is high, cytotoxic anticancer agents may be administered concomitantly with or prior to ICI monotherapy.

Survival impact of sequential chemotherapy following pembrolizumab for recurrent or metastatic head and neck squamous cell carcinoma

“…Decision-making factors for selecting monotherapy or combination therapy include patient preference, biological age, tumor burden, speed of disease progression, and PD-L1 expression status [15]. PD-L1 expression and tumor burden, including the sum of the longest diameters of the target lesions and the number of metastatic lesions, are associated with prognosis in patients treated with ICIs [16,17]. In our cohort, treatment selection was based on these factors, and patients with higher CPS scores, smaller tumor volumes, and fewer metastatic lesions tended to be treated with pembrolizumab monotherapy.…”

Programmed Death Ligand-1 and Tumor Burden Score Dictate Treatment Responses in Patients with Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

“…Tumor burden simply indicates the total amount of tumor in the body. Accumulating studies have demonstrated that tumor burden is an independent prognostic factor with a negative impact on survival in several types of malignancies, including melanoma [14], lung cancer [15][16][17][18], head and neck cancer [19,20], thyroid cancer [21] and lymphoma [22]. Kim et al conducted a systematic review and identified the negative impact of tumor burden on baseline immunity and treatment-induced immune responses [7].…”

“…Based on these reasons, Gr and SumTLs are not widely used in clinical practice. Matoba et al also conducted another retrospective analysis of 94 patients with R/M HNSCC treated with immunotherapy [20]. They estimated the tumor burden using the number of tumor lesions and the size of the largest tumor lesions.…”