EFFICACY AND SAFETY OF CHEMO-IMMUNOTHERAPY IN RECURRENT/METASTATIC HNSCC: A RETROSPECTIVE ANALYSIS
Purpose/Objective
After KEYNOTE 048, PDL1 CPS score has become essential in treatment choice for patients with squamous cell carcinoma of the head and neck (HNSCC) not eligible for curative treatment. This report aims to analyze efficacy and safety outcomes in a cohort of patients treated in our center with first line systemic therapy (FLST) from 2021.
Material/Methods
We collected retrospectively data about stadiation and treatment from patients with recurrent/metastatic HNSCC treated in our center with FLST according to CPS. The primary endpoints were overall survival (OS) and progression-free survival (PFS) (considered from the start of FLST). Toxicity data were reported according to CTCAEv4.0.
Results
Thirty-nine patients who underwent FLST in our center between Jan 2021 and May 2023 were included in this retrospective study, with a median follow-up of 9 months [95%CI 1.2-16.8]. Median age was 63 years and PS ECOG mostly 0-1 (90%); CPS resulted negative in 8 (21%), >1 in 9 (23%) and >20 in 22 (56%) patients. 16 patients (41%) had distant metastases, the others locoregional disease not eligible for radical treatment. EXTREME schedule was chosen in the 8 CPS-negative patients; 20 of the CPS-positive cohort received Platinum+5FU+Pembrolizumab (PFP) and 11 Pembrolizumab alone. Considering all patients, median OS was 9 months [95%CI 3.1-14.8], 1-year OS 46%, 2-year OS 20%; median PFS was 5 months [95%CI 3.4-6.5] (Figure 1). One-year PFS 21%. Pembrolizumab group had a median OS of 9 months [95%CI 3.5-14.5] and 1-year OS of 38%; PFP group had median OS of 10 months [95%CI 0-23.9], 1-year OS 45% and 2-year OS 30%. At univariate analysis, younger age was associated with longer survival with a median OS of 17 months [95%CI 4.2-29.7] and 5 months [95%CI 1.7-8.3] for patients aged <70y and >70y respectively (p=0.01). Regarding toxicity, we reported 15 events > G3; the most frequent were mucositis (4) and neutropenia (4) in chemotherapy groups; only 3 occurred with Pembrolizumab alone.
Conclusion
In our cohort, patients with recurrent/metastatic HNSCC had efficacy and safety outcomes in line with published chemo-immunotherapy data (KN048). Younger age was significantly associated with longer survival.
