Chemotherapy postimmunotherapy for recurrent metastatic head and neck squamous cell carcinoma

Abstract

Purpose of reviewClinical data on salvage chemotherapy used after checkpoints inhibitors in oncology are reviewed, with a special focus on recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). Recent findingsConverging evidence is emerging about high response and/or disease control rates associated with salvage chemotherapy after immunotherapy failure in advanced solid tumours. This phenomenon is mainly reported in retrospective studies for ''hot tumours'' such as R/M HNSCC, melanoma, lung, urothelial or gastric cancers, but also in haematological malignancies. Some physiopathological hypotheses have been raised. SummarySeveral independent series show increased response rates associated with postimmuno chemotherapy when compared with retrospective series in similar settings. Several mechanisms could be involved such as a ''carry-over'' allowed by a persistence of the checkpoint inhibitor, a modulation of tumour microenvironment components but also an intrinsic immunomodulatory effect of chemotherapy, increased by a specific immunologic state induced by the therapeutic pressure of checkpoint inhibitors. These data establish a rationale for prospectively evaluating the features of postimmunotherapy salvage chemotherapy.

Carboplatin and paclitaxel after anti‐PD‐1 or anti‐PD‐L1 antibody therapy in recurrent and/or metastatic squamous cell carcinoma of head and neck

“…Immune checkpoint inhibitors are known to improve overall survival in patients who were treated with first‐line cytotoxic chemotherapy, but there is limited data on patients treated with chemotherapy after immune checkpoint inhibitors in HNSCC. In other solid tumors including NSCLC, melanoma, and more, data has shown improvement of response to salvage chemotherapy after immunotherapy 4,5 . In HNSCC, several small case series 6–8 and some larger retrospective studies 9,10 have described clinical outcomes in patients treated with chemotherapy after immunotherapy, but these have often included patients treated with a variety of cytotoxic regimens such that comparison to historical controls is difficult.…”

“…In other solid tumors including NSCLC, melanoma, and more, data has shown improvement of response to salvage chemotherapy after immunotherapy. 4,5 In HNSCC, several small case series [6][7][8] and some larger retrospective studies 9,10 have described clinical outcomes in patients treated with chemotherapy after immunotherapy, but these have often included patients treated with a variety of cytotoxic regimens such that comparison to historical controls is difficult. Here we present clinical outcomes in a series of patients treated with combination carboplatin and paclitaxel immediately following disease progression on anti-PD-1 or anti-PD-L1 antibodies.…”