Durable response to first-line nivolumab in a patient with oligometastatic PD-L1 positive nasopharyngeal cancer

Cabezas-Camarero, Santiago; Puebla, F.; Subhi-Issa, A I; Sanz-Ortega, Julián; Pérez‐Segura, Pedro

doi:10.1016/j.oraloncology.2018.10.019

Cited by 5 publications

(5 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, real-world patients included certain HNC subtypes, such as nasopharyngeal carcinoma, salivary gland carcinoma, and unknown primary carcinoma of the head and neck; non-SCC; non-platinum-refractory carcinoma; an ECOG PS score of 2 or 3. Therefore, the applicability of the clinical trial results to patients with RMHNC who do not precisely fit the eligibility criteria of pivotal clinical trials is unclear because the strict eligibility criteria in Checkmate-141 prevented enrollment of a broad patient population, even though real-world clinical data for those subtypes have been reported [9,10]. Various treatment modalities are used in HNC, including surgery, chemotherapy, radiotherapy, molecularly-targeted therapy, and immunotherapy [4,5,6,7,8,11,12,13]; the sequence and combination of HNC treatments vary, and treatment policies differ greatly depending on the primary site [14,15,16,17,18,19,20].…”

Section: Introductionmentioning

confidence: 99%

Real-World Outcomes and Prognostic Factors in Patients Receiving Nivolumab Therapy for Recurrent or Metastatic Head and Neck Carcinoma

Hori

Shinohara

Kojima

et al. 2019

Cancers

View full text Add to dashboard Cite

Recently, a global phase III study demonstrated that nivolumab markedly improved patient outcomes in recurrent or metastatic head and neck carcinoma (RMHNC). However, the efficacy of nivolumab in patients who are ineligible for clinical trials is unknown. We investigated nivolumab efficacy in real-world patients and prognostic factors associated with the response to nivolumab. This study was conducted at 11 institutes associated with Kyoto University and its Affiliated Hospitals-Head and Neck Oncology Group. In total, 93 patients with RMHNC who received nivolumab between May 2017 and May 2018 were retrospectively reviewed. Objective response rate (ORR), overall survival, and progression-free survival (PFS) were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors. The ORRs in patients with squamous cell carcinoma (SCC) and non-SCC were 21.8% and 0%, respectively. In patients with SCC and non-SCC, the 1-year PFS rates were 28.7% and 8.9%, respectively. The hazard ratio (HR) for risk of PFS events (SCC versus non-SCC) was 2.28 (95% confidence interval: 1.21–4.1; log-rank p = 0.007). Univariate and multivariate analyses revealed radiotherapy history, platinum-refractory carcinoma, and treatment-related adverse events (TRAEs) as important prognostic factors associated with PFS in patients with SCC. In a real-world setting, non-SCC and platinum-refractory carcinoma were associated with a poorer prognosis, and a history of radiotherapy to the primary tumor, and the occurrence of TRAEs were associated with a better prognosis. These findings could be useful for clinicians and patients when selecting a treatment strategy.

show abstract

Section: Introductionmentioning

confidence: 99%

Real-World Outcomes and Prognostic Factors in Patients Receiving Nivolumab Therapy for Recurrent or Metastatic Head and Neck Carcinoma

Hori

Shinohara

Kojima

et al. 2019

Cancers

View full text Add to dashboard Cite

show abstract

“…To our knowledge, this is the first report of a head and neck cancer patient treated with neoadjuvant nivolumab followed by local therapies in the R/M setting outside a clinical trial. Radical local treatments (surgery or radiotherapy) are currently recommended for treating oligometastatic or oligoprogressive disease in certain disease entities, including selected patients with head and neck cancers, particularly since the advent of immunotherapy, given the better systemic disease control and longer survival achieved, as well as potential synergies with conventional local therapies [5][6][7][8]. Indeed, increased responses with chemotherapy or radiotherapy have been reported after progression under immune checkpoint inhibitors [6,7,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Radical local treatments (surgery or radiotherapy) are currently recommended for treating oligometastatic or oligoprogressive disease in certain disease entities, including selected patients with head and neck cancers, particularly since the advent of immunotherapy, given the better systemic disease control and longer survival achieved, as well as potential synergies with conventional local therapies [5][6][7][8]. Indeed, increased responses with chemotherapy or radiotherapy have been reported after progression under immune checkpoint inhibitors [6,7,10,11]. More than 15 phases I-II trials with neoadjuvant immunotherapy have been conducted in patients with SCCHN, most of them in the locally advanced setting [12].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with slowly progressive disease, maintaining treatment beyond progression is an accepted and widely used option [4]. In patients with oligometastatic or oligoprogressive disease under immune checkpoint inhibitor therapy, local therapies constitute powerful allies that may improve outcomes [5][6][7]. These two strategies allow for longer chemo-free periods thereby preserving quality of life and may achieve durable responses and OS [4,5,8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Durable complete remission with local therapies after neoadjuvant and adjuvant nivolumab in recurrent/metastatic head and neck cancer

et al. 2022

Self Cite

View full text Add to dashboard Cite

Up to 10–15% of patients with first-line recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) present with platinum-refractory disease. The anti-PD1 nivolumab is the first therapeutic option in this setting achieving a 19.2% objective response rate and a 7.7-month median overall survival (OS). Given the poor prognosis of platinum-refractory patients, those showing slow progressive disease with no functional status deterioration should maintain nivolumab beyond progression in the absence of severe or unmanageable toxicities. Another strategy is to use local therapies such as radiotherapy and surgical tumor resection in cases of oligometastatic or oligoprogressive disease. Both strategies may significantly improve disease control and OS in these populations. We present the case of a patient with platinum-refractory disease treated with first-line nivolumab beyond progression who achieved a durable complete response after palliative radiation and surgical resection of five tumor lesions. To our knowledge, this is the first reported case of an R/M HNSCC treated with such a strategy outside a clinical trial and contributes to the evidence for combining anti-PD1 agents and local therapies in selected patients with R/M HNSCC.

show abstract

“…Early clinical evidence, currently based on case reports in recurrent metastatic nasopharyngeal cancer, showed durable response even in case of distant failure in heavily pre-treated nasopharyngeal cancer. Two cases, one with pembrolizumab and the other with nivolumab, underwent sequential combination of immunotherapy with radiotherapy showed complete response after all other conventional treatment has failed [46, 47]. Radiotherapy was sandwiched between immunotherapy in those cases.…”

Section: Current Work In Progress For Potential Immune-related Targementioning

confidence: 99%

Current Immune-Related Molecular Approach in Combating Nasopharyngeal Cancer

et al. 2019

View full text Add to dashboard Cite

Nasopharyngeal cancer is a cancer closely related to Epstein-Barr virus (EBV) infection. EBV protein has been shown to be related to various oncogenic development. Suppression of tumor suppressor genes, upregulating molecules to prevent immune attack, downregulating pro-apoptotic proteins, and stimulating local immune suppressive environment are among some roles that EBV proteins can exert on host cells. All those factors combined together with underlying genetic susceptibility of host cells further increase the chance of nasopharyngeal cancer development. Approach targeting those carcinogenesis pathways has been tested with marginal benefit. A newer approach boosting immune cells to increase recognition of tumor antigen and promoting cytotoxic T cell attack has shown promising clinical benefit. Further combination of those immunotherapies with other modality, in particular radiotherapy, has resulted in amplification of cancer killing.

show abstract

Durable response to first-line nivolumab in a patient with oligometastatic PD-L1 positive nasopharyngeal cancer

Cited by 5 publications

References 8 publications

Real-World Outcomes and Prognostic Factors in Patients Receiving Nivolumab Therapy for Recurrent or Metastatic Head and Neck Carcinoma

Real-World Outcomes and Prognostic Factors in Patients Receiving Nivolumab Therapy for Recurrent or Metastatic Head and Neck Carcinoma

Durable complete remission with local therapies after neoadjuvant and adjuvant nivolumab in recurrent/metastatic head and neck cancer

Current Immune-Related Molecular Approach in Combating Nasopharyngeal Cancer

Contact Info

Product

Resources

About