Effect of preoperative programmed death‐1 or programmed death ligand‐1 immune check point inhibition on complications after surgery for primary head and neck cancer

Abstract

BackgroundThere is sparse literature on the effect of preoperative immunotherapy on complications after surgery for primary head and neck squamous cell carcinoma (HNSCC). The objectives are to compare complication rates in patients receiving surgery with and without neoadjuvant immune checkpoint inhibitors (nICI) for primary HNSCC and to evaluate factors associated with increased odds of surgical complications.MethodsA retrospective review of patients who underwent ablation and free flap reconstruction or transoral robotic surgery (TORS) for primary HNSCC between 2017–2021 was conducted. Complications were compared between patients who underwent surgery with or without nICI before and after propensity score matching. Regression analysis to estimate odds ratios was performed.ResultsA total of 463 patients met inclusion criteria. Free flap reconstruction constituted 28.9% of patients and TORS constituted 71.1% of patients. nICI was administered in 83 of 463 (17.9%) patients. There was no statistically significant difference in surgical, medical, or overall complications between patients receiving surgery with or without nICI. In the unmatched cohort, multivariable model identified non‐White race, former/current smoking history, free flap surgery, and perineural invasion as factors significantly associated with increased complications. In the matched cohort, multivariable model identified advanced age and free flap surgery as factors significantly associated with increased complications.Plain Language Summary It is safe to give immunotherapy before major surgery in patients who have head and neck cancer. Advanced age, non‐White race, current/former smoking, free flap surgery, and perineural invasion may be associated with increased the odds of surgical complications.

Neoadjuvant immunotherapy is safe before surgery in head and neck squamous cell carcinoma. Is it time to challenge the standard‐of‐care?

“…1 For resectable head and neck squamous cell carcinoma (HNSCC), neoadjuvant immunotherapy has been tested in the phase 2 setting for both human papillomavirus (HPV)-negative [9][10][11] and HPV-positive disease 12 and is currently under investigation in a randomized phase 3 trial. 13 In this context, Philips et al 14 present their experience with anti-programmed death-1 or programmed death ligand-1 immune checkpoint inhibition in patients with previously untreated HNSCC undergoing definitive transoral robotic surgery or free tissue transfer reconstruction. Using Propensity score matching, the authors compared 83 patients treated using neoadjuvant immunotherapy on-trial to 83 of 380 patients treated contemporaneously without neoadjuvant immunotherapy off-trial.…”

“…In this context, Philips et al. 14 present their experience with anti‐programmed death‐1 or programmed death ligand‐1 immune checkpoint inhibition in patients with previously untreated HNSCC undergoing definitive transoral robotic surgery or free tissue transfer reconstruction. Using Propensity score matching, the authors compared 83 patients treated using neoadjuvant immunotherapy on‐trial to 83 of 380 patients treated contemporaneously without neoadjuvant immunotherapy off‐trial.…”