Survival impact of induction chemotherapy in advanced head and neck cancer: A National Cancer Database analysis

Stokes, William A.; Amini, Arya; Jones, Bernard L.; McDermott, Jessica D.; Raben, David; Ghosh, Debashis; Goddard, Julie; Bowles, Daniel W.; Karam, Sana D.

doi:10.1002/hed.24739

Cited by 11 publications

(9 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the therapeutic efficacy of systemic therapy is limited. The 5 years overall survival (OS) rate of HNSC patients receiving concurrent chemoradiotherapy is approximately 50% (Lin et al, 2016), and the median OS time is 66.3 months (Stokes et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Age and Mutations as Predictors of the Response to Immunotherapy in Head and Neck Squamous Cell Cancer

Zhang

Lin

et al. 2020

Front. Cell Dev. Biol.

View full text Add to dashboard Cite

The immunosuppressive tumor microenvironment plays an essential role in the treatment of head and neck squamous cell carcinoma (HNSC). Compared to traditional chemoradiotherapy, immune checkpoint inhibitors (ICIs) have become increasingly important in HNSC therapy. Prior studies linked the efficacy of ICIs to PD-L1, microsatellite instability (MSI), HPV infection, tumor mutation burden (TMB), and tumor lymphocyte infiltration in patients with HNSC, but further verification is needed. Additional predictors are needed to recognize HNSC patients with a good response to ICIs. We collected the clinical information and mutation data of HNSC patients from Memorial Sloan Kettering Cancer Center (MSKCC) and The Cancer Genome Atlas (TCGA) databases to generate two clinical cohorts. The MSKCC cohort was used to recognize predictors related to the efficacy of ICIs, and the TCGA cohort was used to further examine the immune microenvironment features and signaling pathways that are significantly enriched in the subgroups of predictors. Multivariate Cox regression analysis indicated that age (HR = 0.50, p = 0.014) and ARID1A (HR = 0.13, p = 0.048), PIK3CA (HR = 0.45, p = 0.021), and TP53 (HR = 1.82, p = 0.035) mutations were potential predictors for ICI efficacy in HNSC patients. Age > 65 years and ARID1A or PIK3CA mutations correlated with good overall survival (OS). TP53 mutant-type (MT) patients experienced a worse prognosis than TP53 wild-type (WT) patients. The subgroups associated with a good prognosis (age > 65 years, ARID1A-MT, and PIK3CA-MT) universally had a high TMB and increased expression of immune checkpoint molecules. Although TP53-MT was associated with a high TMB, the expression of most immune checkpoint molecules and immune-related genes was lower in TP53-MT patients than TP53-WT patients, which may reflect low immunogenicity. Pathways related to the immunosuppressive tumor microenvironment were mostly enriched in the subgroups associated with a poor prognosis (age ≤ 65 years, low TMB, ARID1A-WT, PIK3CA-WT, and TP53-MT). In conclusion, the factors age > 65 years, PIK3CA-MT, and ARID1A-MT predicted favorable efficacy for ICI treatment in HNSC patients, and TP53 mutation was a negative predictor.

show abstract

Section: Introductionmentioning

confidence: 99%

Age and Mutations as Predictors of the Response to Immunotherapy in Head and Neck Squamous Cell Cancer

Zhang

Lin

et al. 2020

Front. Cell Dev. Biol.

View full text Add to dashboard Cite

show abstract

“…The authors concluded that their algorithm for dose de‐escalation in RT or CRT based on response to IC and risk‐stratification was associated with favorable survival outcomes and reduced acute and chronic toxicity 19 . A National Cancer Data Base review of IC did not show a survival impact but patients were more likely to receive a reduced RT dose, <66 Gy, if they received RT; presumably resulting in reduced radiation‐associated acute and chronic toxicities 20 . The findings of these three studies suggest a role for a reduced radiation dose in HPV positive patients that demonstrate effective cytoreduction from IC to minimize radiation related toxicities.…”

Section: Discussionmentioning

confidence: 99%

Subjective functional outcomes in oropharyngeal cancer treated with induction chemotherapy using the MD Anderson Symptom Inventory (MDASI)

Mott

Sacks

Johnson

et al. 2020

Laryngoscope Investig Oto

View full text Add to dashboard Cite

Objectives: Evaluate the use of induction chemotherapy (IC) in oropharyngeal cancer (OPC) and its impact on subjective functional outcomes using a validated MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) survey tool. Methods: A single institution retrospective review of OPC patients who received IC, including reasons given for using IC, regimens employed, responses, and patientreported outcomes (PRO). The latter included pain, distress, dysphagia, xerostomia, and feeding tube placement and dependency. PRO's were assessed using the validated MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) conducted at baseline, during treatment, and at six-month follow up. Results: One hundred and twenty-five patients were evaluable. They were more likely to have large primary and/or bulky or low neck nodal disease as a reason for IC. A taxane-containing regimen was most common. Primary tumor response was seen in 83.2% and the nodal response in 81.6%. Pain and xerostomia improved with IC, dysphagia was not adversely affected with IC. These symptoms all increased with consolidation chemoradiotherapy (CRT) but returned to baseline by 6 months post treatment. Feeding tube placement did not increase with IC but did with CRT, most patients were no longer feeding tube dependent at 6 months. Conclusion: This retrospective review of subjective functional outcomes, especially swallowing and feeding tube dependency, using the MDASI survey tool in 125 oropharyngeal cancer patients with large primary tumors and/or bulky adenopathy treated predominantly with platinum-taxane based induction chemotherapy showed This study was conducted entirely at

show abstract

“…[ 5 , 7 , 11 – 13 ] Despite this, there is controversy as to whether this translates to an improved overall survival outcome. [ 14 , 15 ] It has been suggested, however, that as well as several problems with poor methodology undermining the applicability of trials comparing ICT to CRT alone; trials have included patients that are unlikely to benefit from the potential advantages of ICT such as those with a low risk of distant metastases, hence diluting any positive effects. [ 14 ] Tumour heterogeneity also affects response to treatment.…”

Section: Introductionmentioning

confidence: 99%

“…[ 14 , 15 ] It has been suggested, however, that as well as several problems with poor methodology undermining the applicability of trials comparing ICT to CRT alone; trials have included patients that are unlikely to benefit from the potential advantages of ICT such as those with a low risk of distant metastases, hence diluting any positive effects. [ 14 ] Tumour heterogeneity also affects response to treatment. [ 16 ] The key to extracting the benefits of ICT may be meticulous patient and tumour selection.…”

Section: Introductionmentioning

confidence: 99%

Pre-treatment tumour perfusion parameters and initial RECIST response do not predict long-term survival outcomes for patients with head and neck squamous cell carcinoma treated with induction chemotherapy

et al. 2018

View full text Add to dashboard Cite

ObjectivesPreviously, we showed that pre-treatment tumour plasma perfusion (Fp) predicts RECIST response to induction chemotherapy (ICT) in locoregionally advanced head and neck squamous cell carcinoma (HNSCC). The aim here was to determine whether the pre-treatment tumour Fp estimate, changes in tumour Fp or RECIST response post 2 cycles of ICT were prognostic for long-term survival outcomes.MethodsA prospective study enrolled patients with high stage HNSCC treated with docetaxel (T), cisplatin (P) and 5-fluorouracil (F) (ICT) followed by synchronous cisplatin and intensity modulated radiotherapy. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) before and after two cycles of ICT was used to measure Fp and RECIST response.ResultsForty-two patients were recruited and 37 underwent two scans. The median follow-up was 36 (range 23–49) months. Pre-treatment tumour Fp (stratified by median) was not prognostic for overall survival (p = 0.42), disease specific survival (p = 0.20) and locoregional control (p = 0.64). Neither change in tumour Fp nor RECIST response post two cycles of ICT was prognostic for any outcome (p>0.21).ConclusionDCE-MRI parameters do not predict long-term survival outcomes following ICT and RECIST response to ICT may not be an appropriate endpoint to determine early efficacy of a treatment in HNSCC patients.

show abstract

Survival impact of induction chemotherapy in advanced head and neck cancer: A National Cancer Database analysis

Abstract: Induction chemotherapy subjects experienced no survival advantage over concurrent chemotherapy subjects but were more likely to receive lower RT doses. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1113-1121, 2017.

Cited by 11 publications

References 28 publications

Age and Mutations as Predictors of the Response to Immunotherapy in Head and Neck Squamous Cell Cancer

Age and Mutations as Predictors of the Response to Immunotherapy in Head and Neck Squamous Cell Cancer

Subjective functional outcomes in oropharyngeal cancer treated with induction chemotherapy using the MD Anderson Symptom Inventory (MDASI)

Pre-treatment tumour perfusion parameters and initial RECIST response do not predict long-term survival outcomes for patients with head and neck squamous cell carcinoma treated with induction chemotherapy

Contact Info

Product

Resources

About