Safety and efficacy of cetuximab-containing chemotherapy after immune checkpoint inhibitors for patients with squamous cell carcinoma of the head and neck: a single-center retrospective study

Abstract

Immunotherapy has been shown to prolong survival in recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) in front-line use; however, subsequent systemic therapy has not been optimized. This study aimed to evaluate the safety and efficacy of cetuximab-containing chemotherapy after immunotherapy. We retrospectively analyzed patients with recurrent or metastatic SCCHN who underwent cetuximab-containing regimens after progression on immunotherapy. Of the 22 patients who met the inclusion criteria, 21 received paclitaxel and cetuximab, and 1 carboplatin and fluorouracil and cetuximab after immunotherapy. Nine patients achieved a partial response, 10 patients had stable disease as their best response on cetuximab-containing chemotherapy, yielding an overall response rate and disease control rate of 40.9 and 86.4%, respectively. The median progression-free survival was 5.2 months, and the median overall survival was 14.5 months. Ten patients developed grade 3–4 adverse events, including neutropenia (31.8%), acneiform rash (9.1%), anemia (4.5%), hypertransaminasemia (4.5%) and stomatitis (4.5%). The most frequent cetuximab-related toxicities across all grades were skin reactions (77.3%), hypomagnesemia (40.9%), stomatitis (27.3%), paronychia (13.6%) and keratitis (4.5%). There was no treatment-related death. Taken together, cetuximab-containing chemotherapy was effective and feasible even after immunotherapy.

Outcomes of long-term nivolumab and subsequent chemotherapy in Japanese patients with head and neck cancer: 2-year follow-up from a multicenter real-world study

“…In the present study, despite 72.7% of patients receiving nivolumab as second-or later-line treatment [5], paclitaxel ± cetuximab as subsequent chemotherapy demonstrated favorable effectiveness, which was consistent with the findings of a previous study that investigated a combination of paclitaxel and cetuximab as first-line treatment [19]. Several small retrospective studies in Japanese patients with R/M SCCHN have also reported the effectiveness of chemotherapy following treatment with immune checkpoint inhibitors [7][8][9].…”

“…Several recent studies have demonstrated the efficacy of subsequent chemotherapy following immunotherapy in patients with HNC [6][7][8][9]. A previous study reported a significantly longer OS (7.8 months, P = 0.0028, n = 25) in Japanese R/M SCCHN patients who received salvage chemotherapy following nivolumab treatment than that in patients who received best supportive care (3.5 months, n = 31) [7].…”

“…Recently, several studies have demonstrated the efficacy of subsequent chemotherapy in HNC following immunotherapy [6][7][8][9]. Saleh et al reported an objective response rate (ORR) of 30% in patients who received chemotherapy after disease progression on immunotherapy, which was three to five times higher than that in those who had received chemotherapy as a second-line treatment in clinical trials [6].…”

“…Saleh et al reported an objective response rate (ORR) of 30% in patients who received chemotherapy after disease progression on immunotherapy, which was three to five times higher than that in those who had received chemotherapy as a second-line treatment in clinical trials [6]. Similar studies in Japan have demonstrated the efficacy of subsequent chemotherapy following immunotherapy in patients with HNC; however, these studies included only a small number of Japanese patients [7][8][9]. Furthermore, in patients with R/M HNC in whom disease progresses following first-line therapy, treatment options remain heterogeneous, and treatment patterns and outcomes show substantial variations across countries [10].…”

Clinical Outcomes of Cetuximab and Paclitaxel after Progression on Immune Checkpoint Inhibitors in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

“…The efficacy of cetuximab-containing regimens after the use of ICIs in R/M HNSCC has been recently reported, and this may be the result of a synergistic effect of ICIs and cetuximab, as described above. However, multiple regimens including cetuximab have been evaluated in these reports, and individual regimens were not considered [18,23]. This is the first report to describe the efficacy and safety of a regimen limited to Cmab + PTX after progression following ICI therapy, which has important implications for the optimization of the treatment sequence for R/M HNSCC.…”