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

Abstract

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.

Novel Prognostic Score for recurrent or metastatic head and neck cancer patients treated with Nivolumab

“…Regarding salvage chemotherapy following nivolumab therapy, we mainly performed paclitaxel and cetuximab therapy, and our clinical outcomes, including 41% ORR, were comparable to those of previous studies [29][30][31] . As mentioned above, since the efficacy of cetuximab and other chemotherapies following ICI has been reported, relatively early changes in treatment modalities might be acceptable.…”

Novel Prognostic Score for Recurrent or Metastatic Head and Neck Cancer Patients treated with Nivolumab: Japanese Multi-Institutional Cohort Study

“…Regarding salvage chemotherapy following nivolumab therapy, we mainly performed paclitaxel and cetuximab therapy, and our clinical outcomes, including 41% ORR, were comparable to those of previous studies [25][26][27] . As mentioned above, since the e cacy of cetuximab and other chemotherapies following ICI has been reported, relatively early changes in treatment modalities might be acceptable.…”

Clinical Outcomes of Cetuximab and Paclitaxel after Progression on Immune Checkpoint Inhibitors in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

“…The combination of ICI therapy and chemotherapy has a synergistic effect, and recent studies have confirmed its efficacy [17]. Chemotherapy has also been shown to be more effective in R/M HNSCC after progression following ICI therapy [8,9,18]. This emphasizes the importance of not only the use of ICI and chemotherapy in combination but also the treatment sequence of ICI and chemotherapy.…”

“…The efficacy of cetuximab-containing regimens after the use of ICIs in R/M HNSCC has been recently reported, and this may be the result of a synergistic effect of ICIs and cetuximab, as described above. However, multiple regimens including cetuximab have been evaluated in these reports, and individual regimens were not considered [18,23]. This is the first report to describe the efficacy and safety of a regimen limited to Cmab + PTX after progression following ICI therapy, which has important implications for the optimization of the treatment sequence for R/M HNSCC.…”