Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Chemotherapy response following immunotherapy in metastatic head and neck cancer; a single-centre experience (#231)

Anthony Rodrigues 1 , Jia Liu 1 2 3 , Jennifer Lim 1 4 5 , Venessa Chin 1 2 4
  1. The Kinghorn Cancer Centre - St Vincents NSW, Darlinghurst, NSW, Australia
  2. St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia
  3. The University of Sydney, Camperdown, NSW, Australia
  4. The Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
  5. St George Hospital, Kogarah, NSW, Australia

Aim: First-line check point inhibitors alone or in combination with chemotherapy in advanced head and neck squamous cell cancer (HNSCC) improves OS without PFS benefit compared to first line chemotherapy with anti-EGFR therapy1. We hypothesise this may be due to immunotherapy improving responses to later line chemotherapy. The aim of this retrospective study is to compare the sequencing of therapy and impact on disease control rate (DCR) and duration in a cohort of advanced HNSCC patients.

Methodology: This single centre retrospective cohort study utilised an electronic database of advanced head and neck (HN) patients treated with immunotherapy (including on a clinical trial) from January 2017 to December 2021 at The Kinghorn Cancer Centre, St Vincent’s Hospital. Salivary gland and paranasal sinus tumours were excluded. Data captured included age, sex, tumour location, histology, stage, prior curative treatment, subsequent treatment type, duration of treatments, and best responses as per clinician. Survival data was analysed with Kaplan-Meier method and processed with R-software (version 4.2.1)

Results: From a total 197 head and neck cases, 39 patients were eligible for inclusion. 30 patients with advanced HNSCC were treated with immunotherapy in any line. Median age was 63 (range 34-73), 85% were male, with mean 2.7 lines of therapy (range 1-7). Thirteen patients received chemotherapy following immunotherapy with DCR 62%. This is in contrast historical ORR with first-line chemotherapy of 20-50%2-5. There were no significant differences in PFS or OS by type of therapy in the 1st or 2nd line setting due to the small numbers.

Conclusion: Responses to chemotherapy after immunotherapy in advanced HNSCC were higher than expected. The synergism of chemotherapy and immunotherapy, and persistence of immunotherapy treatment effect despite discontinuation may influence this6, and further translational studies are warranted to explore mechanisms now that first-line immunotherapy is standard of care in advanced HNSCC1.

  1. Burtness B, Harrington KJ, Greil R, et al. 2019. "Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study." Lancet. 2019 Nov 23;394(10212):1915-1928.
  2. Vermorken, J. B., R. Mesia, F. Rivera, et al. 2008. "Platinum-based chemotherapy plus cetuximab in head and neck cancer." N Engl J Med 359(11):1116-1127.
  3. Forastiere, A. A., B. Metch, D. E. Schuller, et al. 1992. "Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study." J.Clin Oncol. 10(8):1245-1251.
  4. Ferrari, D., J. Fiore, C. Codeca et al. 2009. "A phase II study of carboplatin and paclitaxel for recurrent or metastatic head and neck cancer." Anticancer Drugs 20(3):185-190.
  5. Moosmann, P., F. Egli, R. A. Stahel et al. 2003. "Weekly paclitaxel and carboplatin combination chemotherapy in patients with advanced squamous cell carcinoma of the head and neck." Onkologie 26(6):568-572.
  6. Kacew AJ, Harris EJ, Lorch JH, et al. 2020. "Chemotherapy after immune checkpoint blockade in patients with recurrent, metastatic squamous cell carcinoma of the head and neck." Oral Oncol. 2020 Jun;105:104676.