Paclitaxel Plus Cetuximab as 1st Line Chemotherapy in Platinum-Based Chemoradiotherapy-Refractory Patients With Squamous Cell Carcinoma of the Head and Neck

Enokida, Tomohiro; Okano, Susumu; Fujisawa, Takao; Ueda, Yoshio; Uozumi, Shinya; Tahara, Makoto

doi:10.3389/fonc.2018.00339

Cited by 19 publications

(30 citation statements)

References 21 publications

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“…Despite the few existing data regarding the depth of responses with chemotherapy in SCCHN both in patients pretreated and non-pretreated with IO, responses to SCAI in our series showed a median PCTL of -57.5% (range: -30 to -100), which are deeper than the median PCTL of -40% reported by Enokida et al [31], in a Japanese series of 23 platinum-refractory patients receiving first-line ERBITAX -the most frequently used SCAI in our series. While only 30.4% of the patients in our series were platinum-refractory, all, per definition, were more pre-treated since they received SCAI as second or further line.…”

Section: Discussioncontrasting

confidence: 92%

Safety and Efficacy of Cetuximab-Based Salvage Chemotherapy After Checkpoint Inhibitors in Head and Neck Cancer

et al. 2021

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Background. There are still few data on the activity and safety of cetuximab-based salvage chemotherapy after immunotherapy (SCAI) in patients with squamous cell cancer of the head and neck (SCCHN). Materials and Methods. Retrospective study of patients with SCCHN who received cetuximab-based SCAI after PD1 or PDL1 (PD(L)1) inhibitors. Overall response rate (ORR) and disease control rate (DCR) with SCAI and with last chemotherapy before immunotherapy (LCBI) by RECIST 1.1, percentage change from baseline in target lesions (PCTL), progression-free survival (PFS), overall survival (OS), treatment compliance and toxicity were evaluated. Results. Between March 2016 and November 2019, 23 patients were identified. SCAI consisted of cetuximabbased combinations (3wkCDDP-5FU-Cetuximab (n=2), wkPaclitaxel-Cetuximab (n=17), wkCDDP-Cetuximab (n=2), wkCBDCA-Paclitaxel-Cetuximab (n=2)). ORR was 56.5% (11 partial response (PR), 2 complete response (CR)). DCR was 78.3%. Among 13 objective responders, median best PCTL was-53.5% (range:-30% to-100%). Median OS and PFS were 12m and 6m, respectively. In 10 patients receiving LCBI, ORR to LCBI was 40%, while ORR to SCAI achieved 60%. In LCBI-treated patients median PFS with LCBI was 8m and median PFS and OS with SCAI were 7m and 12m, respectively. Reduced dose intensity of the chemotherapy and cetuximab components occurred in 82.6% and 52.2% of the patients. Grade 1 or 2 AEs occurred in all patients. Grade 3 or 4 AEs developed in 65%, being grade 3 in all of them except in one patient (grade 4 neutropenia). There were no treatment-related deaths. Conclusion. Cetuximab-based salvage chemotherapy after PD(L)1 inhibitors associated with high response rates and deep tumor reductions with a manageable safety profile. Subsequent lines of therapy may explain the long survival achieved in our series. These results invite to design studies to elucidate the best therapeutic sequence in patients with SCCHN in the immunotherapy era. The Oncologist 2021;9999:• • Implications for Practice: Cetuximab-based salvage chemotherapy (SCAI) achieved high response rates in patients with R/M SCCHN after progression to PD1/PDL1 inhibitors. Objective response rate was higher and progression-free survival was comparable to that of chemotherapy administered before immunotherapy (IO). In most patients, SCAI consisted of weekly, welltolerated regimens. These observations have implications for current practice due to the limited evidence to date in SCCHN and the scant therapeutic options in this disease, and invite to elucidate which may be the best treatment sequence for head and neck cancer patients in the IO era.

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Section: Discussioncontrasting

confidence: 92%

Safety and Efficacy of Cetuximab-Based Salvage Chemotherapy After Checkpoint Inhibitors in Head and Neck Cancer

et al. 2021

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“…The Knoedler et al study evaluated cetuximab plus docetaxel in patients who failed a platinum-based therapy, achieving an overall disease control rate of 51% (85). Recently, a retrospective study showed that the combination of paclitaxel and cetuximab could be a suitable treatment option in HNSCC patients with platinum-based CRT-refractory disease (86).…”

Section: Recurrent or Metastatic Head And Neck Squamous Cell Carcinomamentioning

confidence: 99%

Cetuximab-Containing Combinations in Locally Advanced and Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

2019

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Cetuximab remains to date the only targeted therapy approved for the treatment of head and neck squamous cell carcinoma (HNSCC). The EGFR pathway plays a key role in the tumorigenesis and progression of this disease as well as in the resistance to radiotherapy (RT). While several anti-EGFR agents have been tested in HNSCC, cetuximab, an IgG1 subclass monoclonal antibody against EGFR, is the only drug with proven efficacy for the treatment of both locoregionally-advanced (LA) and recurrent/metastatic (R/M) disease. The addition of cetuximab to radiotherapy is a validated treatment option in LA-HNSCC. However, its use has been limited to patients who are considered unfit for standard of care chemoradiotherapy (CRT) with single agent cisplatin given the lack of direct comparison of these two regimens in randomized phase III trials and the inferiority suggested by metanalysis and phase II studies. The current use of cetuximab in HNSCC is about to change given the recent results from randomized prospective clinical trials in both the LA and R/M setting. Two phase III studies evaluating RT-cetuximab vs. CRT in Human Papillomavirus (HPV)-positive LA oropharyngeal squamous cell carcinoma (De-ESCALaTE and RTOG 1016) showed inferior overall survival and progression-free survival for RT-cetuximab combination, and therefore CRT with cisplatin remains the standard of care in this disease. In the R/M HNSCC, the EXTREME regimen has been the standard of care as first-line treatment for the past 10 years. However, the results from the KEYNOTE-048 study will likely position the anti-PD-1 agent pembrolizumab as the new first line treatment either alone or in combination with chemotherapy in this setting based on PD-L1 status. Interestingly, cetuximab-mediated immunogenicity through antibody dependent cell cytotoxicity (ADCC) has encouraged the evaluation of combined approaches with immune-checkpoint inhibitors in both LA and R/M-HNSCC settings. This article reviews the accumulated evidence on the role of cetuximab in HNSCC in the past decade, offering an overview of its current impact in the treatment of LA and R/M-HNSCC disease and its potential use in the era of immunotherapy.

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“…Median PFS, OS, and response rates were significantly lower than in studies that have already studied this association. [8][9][10][11] However, in the publications of Enokida et al and Hitt et al, all patients were treated in a first-line setting and no patient had already been exposed to cetuximab, 8,9 which could explain the difference. In the two retrospective studies published by Péron and Fayette, patients could have been treated either in first or second line.…”

Section: Discussionmentioning

confidence: 99%

“…They showed a 52%-54% response rate and 4.2-7.0 median PFS and 8.1-16.3 median OS. 8,9 In retrospective studies, PC showed high activity with a 48%-55% response rate, and a median OS of 7.6-9.2 months. However, in these retrospective studies, a significant proportion of patients were treated in a first-line setting because of their ineligibility for platinum chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Cetuximab combined with paclitaxel or paclitaxel alone for patients with recurrent or metastatic head and neck squamous cell carcinoma progressing after EXTREME

Chevalier¹,

Daste

Saada-Bouzid

et al. 2021

Cancer Medicine

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Paclitaxel Plus Cetuximab as 1st Line Chemotherapy in Platinum-Based Chemoradiotherapy-Refractory Patients With Squamous Cell Carcinoma of the Head and Neck

Cited by 19 publications

References 21 publications

Safety and Efficacy of Cetuximab-Based Salvage Chemotherapy After Checkpoint Inhibitors in Head and Neck Cancer

Safety and Efficacy of Cetuximab-Based Salvage Chemotherapy After Checkpoint Inhibitors in Head and Neck Cancer

Cetuximab-Containing Combinations in Locally Advanced and Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

Cetuximab combined with paclitaxel or paclitaxel alone for patients with recurrent or metastatic head and neck squamous cell carcinoma progressing after EXTREME

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