Neoadjuvant Chemoimmunotherapy for the Treatment of Locally Advanced Head and Neck Squamous Cell Carcinoma: A Single-Arm Phase 2 Clinical Trial

Abstract

Purpose: This study aimed to assess the antitumor activity and safety of neoadjuvant chemotherapy combined with PD-1 inhibitor camrelizumab in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Patients and Methods: In this single-center, single-arm, phase 2 trial, patients with resectable stage III–IVB HNSCC received chemotherapy [albumin-bound paclitaxel 260 mg/m2 (or docetaxel 75 mg/m2) plus cisplatin 75 mg/m2] and camrelizumab 200 mg on day 1 of each 21-day cycle for three cycles, followed by surgery, and adjuvant radiotherapy. Co-primary end points were pathological complete response (pCR) rate and safety. Results: Thirty patients were enrolled and completed the neoadjuvant therapy, with an objective response rate (ORR) of 96.7% (29/30). Twenty-seven patients underwent surgery without delay, with an R0 resection rate of 92.6% (25/27). The clinical to pathological downstaging rate was 100% (27/27). The pCR rate was 37.0% [95% confidence interval (CI), 19.4%–57.6%], and the major pathological response (MPR) rate was 74.1% (95% CI, 53.7%–88.9%). The median follow-up duration was 16.1 months (range, 8.3–28.5), and the disease-free survival rate at 12 months was 95.8% (95% CI, 73.9%–99.4%). Grade 3 neoadjuvant therapy–related adverse events included rash (1; 3.3%), pruritis (1; 3.3%), and thrombocytopenia (1; 3.3%), and no grade 4 or 5 treatment-related events occurred. The most common surgical complication was delayed wound healing (5; 18.5%). Conclusions: Neoadjuvant chemotherapy plus camrelizumab for locally advanced HNSCC showed high ORR, pCR, and MPR rates, with an acceptable safety profile. These data support further evaluation of neoadjuvant chemoimmunotherapy for the treatment of locally advanced HNSCC.

Neoadjuvant toripalimab combined with gemcitabine and cisplatin in resectable locally advanced head and neck squamous cell carcinoma (NeoTGP01): An open label, single-arm, phase Ib clinical trial

“…Kunyu Yang et al recently published the results of a phase 2 trial involving patients with resectable stage III-IVB HNSCC who received chemotherapy [albumin-bound paclitaxel (or docetaxel) plus cisplatin] and camrelizumab for three cycles. In their study, 27 patients underwent surgery, with an R0 resection rate of 92.6% [ 25 ]. The pCR rate was 37.0%, and the MPR rate was 74.1%, with tolerable safety profile.…”

Pretreatment radiomics power in evaluating neoadjuvant chemotherapy response and outcome for patients with head and neck squamous cell carcinoma: a systematic review and meta-analysis

“…Therefore, clinicians should determine whether patients can be treated with IC in order to allow for a larynx-preserving surgery while minimizing toxic side effects which are associated with chemotherapy. For the patients with laryngeal or hypopharyngeal malignancies which require the preservation of laryngeal function, the ability in predicting their response to induction chemotherapy and selecting the optimal treatment strategy greatly improves the chances of preserving laryngeal function and extending patient survival [55]. Moreover, the response of tumor cells to induction chemotherapy is an independent contributor to patient prognosis [53,56].…”

Pretreatment radiomics power in evaluating neoadjuvant chemotherapy response and outcome for patients with head and neck squamous cell carcinoma: a systematic review and meta-analysis

“…Therefore, clinicians should determine whether patients can be treated with IC in order to allow for a larynx-preserving surgery while minimizing toxic side effects which are associated with chemotherapy. For the patients with laryngeal or hypopharyngeal malignancies which require the preservation of laryngeal function, the ability in predicting their response to induction chemotherapy and selecting the optimal treatment strategy greatly improves the chances of preserving laryngeal function and extending patient survival [54]. Moreover, the response of tumor cells to induction chemotherapy is an independent contributor to patient prognosis [52; 55].…”