Effectiveness of cetuximab as preemptive postsurgical therapy for oral squamous cell carcinoma patients with major risk: a single‐center retrospective cohort study

Abstract

SummaryA retrospective cohort study was performed to investigate the effectiveness of preemptive postsurgical therapy with cetuximab for patients with a major risk of recurrence or metastasis after clinical complete resection of primary oral squamous cell carcinoma (OSCC). The study period was from 2007 to 2019 for patients treated at the Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine. OSCC patients with major risk (n = 88) in the follow-up period were divided into groups with no postsurgical treatment (NP group), with standard postsurgical treatment (SP group), and with postsurgical treatment including cetuximab (CP group), and prognosis were compared among those groups. The 5-year overall survival rate was significantly higher in patients who received postsurgical treatment with cetuximab (CP) compared to that in the other two groups ((CP vs. NP, p = 0.028; CP vs. SP, p = 0.042). Furthermore, we performed multivariate analysis to evaluate the effects of the main components of the treatment. Among CDDP, radiotherapy, and cetuximab, only cetuximab significantly contributed to improved survival by univariate analysis (crude HR:0.228, 95%CI:0.05–0.968, p = 0.045). cetuximab also showed the same tendency in multivariate analysis, although p value did not reach significant level (Adjusted HR: 0.233, 95%CI: 0.053–1.028, p = 0.054). The results suggest that the postsurgical treatment with cetuximab as a preemptive postsurgical therapy after complete surgical resection of a visible tumor is considerably effective for OSCC patients with major risk, in other words, invisible dormant metastasis.

Surveillance for Patients with Oral Squamous Cell Carcinoma after Complete Surgical Resection as Primary Treatment: A Single-Center Retrospective Cohort Study

“…Since the study was performed over the course of 14 years, treatment strategies varied over time, but general clinical factors were examined for the patients who were at major risk for a poor outcome and in cases where postsurgical treatment was considered. In the early part of the study period, this treatment was mainly platinum-based chemotherapy alone or combined with RT, as described in the NCCN guidelines, but after the introduction of cetuximab, postsurgical treatment including cetuximab became common as a preemptive therapy for dormant cancer cells [ 4 ]. After the completion of postsurgical treatment, the oral administration of S-1 was recommended for all patients as adjuvant therapy at 1 year after surgery [ 11 ].…”

“…The guidelines for head and neck cancer by the National Comprehensive Cancer Network (NCCN) indicate extranodal extension, positive margins, close margins, pT3 or pT4 primary, pN2 or pN3 nodal disease, nodal disease in levels IV or V, and perineural, vascular, and lymphatic invasion as adverse features (AFs) for a poor postsurgical outcome [ 1 ]. We extracted extranodal extension, positive margins, close margins, pN2 or pN3 nodal disease, and nodal disease in levels IV or V among the AFs and defined them with the addition of the Yamamoto–Kohama (YK) mode of invasion [ 2 , 3 ], with YK-4C and YK-4D as the major risk factors for recurrence or metastasis [ 4 ]. We have used these risk factors since 2014, and we have found that patients with these factors have significantly poorer outcomes and that these outcomes are significantly improved using combination therapy with cetuximab and paclitaxel [ 4 , 5 ].…”

“…We extracted extranodal extension, positive margins, close margins, pN2 or pN3 nodal disease, and nodal disease in levels IV or V among the AFs and defined them with the addition of the Yamamoto–Kohama (YK) mode of invasion [ 2 , 3 ], with YK-4C and YK-4D as the major risk factors for recurrence or metastasis [ 4 ]. We have used these risk factors since 2014, and we have found that patients with these factors have significantly poorer outcomes and that these outcomes are significantly improved using combination therapy with cetuximab and paclitaxel [ 4 , 5 ]. This postsurgical therapy with cetuximab is a preemptive therapy for dormant tumors that cannot be visualized, meaning that it might not deviate from the NCCN guidelines.…”

“…The detection of local recurrence, cervical lymph node metastasis, distant metastasis, and second primary cancers as early as possible post-surgery is important for selecting the salvage therapy and for improving the outcome. In OSCC cases with postsurgical events, we hypothesized that latent/dormant cancer cells that were undetectable before or during the initial treatment might grow and become visible tumors after the primary treatment [ 4 , 5 ].…”

Identification of Binding Proteins for TSC22D1 Family Proteins Using Mass Spectrometry

“…Many cancers including head and neck cancer have been treated by molecular-targeted drugs in addition to surgery, chemotherapy, and radiotherapy [1,2]. Acute promyelocytic leukemia can be treated by all-trans retinoic acid (ATRA), which is a molecular-targeted drug and has a differentiation-inducing activity [3,4].…”