Treatment response lowers tumor symptom burden in recurrent and/or metastatic head and neck cancer

Abstract

Background Head and neck squamous cell cancer (HNSCC) frequently causes severe symptoms that may be reduced, when the tumor is successfully treated. The SOCCER trial studied the association of treatment response with patient reported tumor symptom burden in first line treatment of recurrent and/or metastatic HNSCC. Methods In this prospective, multi-center, non-interventional trial patients were treated either with platinum-based chemotherapy and cetuximab or radiotherapy and cetuximab. Tumor symptom burden was assessed every four weeks with a questionnaire containing ten visual analogue scales (VAS, range 0–100), which were summarized to the overall VAS score. Results Fourhundred seventy patients were registered in 97 German centers. A total of 315 patients with at least the baseline and one subsequent questionnaire were available for analysis. Changes in the VAS score were rated as absolute differences from baseline. Negative values indicate improvement of symptoms. The overall VAS score improved significantly at the first post-baseline assessment in responders (− 2.13 vs. non-responders + 1.15, p = 0.048), and even more for the best post-baseline assessment (− 7.82 vs. non-responders − 1.97, p = 0.0005). The VAS for pain (− 16.37 vs. non-responders − 8.89, p = 0.001) and swallowing of solid food (− 16.67 vs. non-responders − 5.06, p = 0.002) improved significantly more in responders (best post-baseline assessment). In the multivariable Cox regression analysis, worse overall VAS scores were associated with worse overall survival (hazard ratio for death 1.12 per 10 points increment on the overall VAS scale, 95% CI 1.05–1.20, p = 0.0009). Conclusion In unselected patients beyond randomized controlled trials, treatment response lowers tumor symptom burden in recurrent and/or metastatic HNSCC. Trial registration ClinicalTrials.gov, NCT00122460. Registered 22 Juli 2005,

Kinase Inhibitors of DNA-PK, ATM and ATR in Combination with Ionizing Radiation Can Increase Tumor Cell Death in HNSCC Cells While Sparing Normal Tissue Cells

“…Patients with distant metastasis generally have a poor prognosis and suffer from relevant tumor symptom burden [ 52 , 53 , 54 , 55 ]. Cell migration is a requirement for the formation of distant metastases and can be observed with a wound healing assay or scratch assay [ 55 , 56 , 57 , 58 ].…”

Treatment Stratification in First-Line Recurrent or Metastatic Head and Neck Cancer, on Behalf of the EORTC Young Investigator Head and Neck Cancer Group

“…Due to the limited overall response rate achieved with immunotherapy alone (less than 20% in the unselected population) (2, 10), the majority of physicians participating in this survey voted for the combination with chemotherapy when a situation of high tumor burden exists. It should be underlined that obtaining response to treatment is crucial in particular when facing disease with high tumor burden and corresponding symptoms (15). The survey was complemented by a clinical case discussion, which took most factors guiding treatment decisions into account.…”

A Prospective Real-World Multi-Center Study to Evaluate Progression-Free and Overall Survival of Radiotherapy with Cetuximab and Platinum-Based Chemotherapy with Cetuximab in Locally Recurrent Head and Neck Cancer

“…The current analysis included only patients with loco-regional recurrence without distant metastases. The primary endpoint of the study was the evaluation of tumor symptom burden in responders and non-responders and was previously reported [ 10 ]. The patients’ tumor symptom burden was assessed using a questionnaire with visual analogue scales (VAS) for pain, breathing, swallowing, speech, smelling, taste, physical activity, and overall health state, which is summarized to the overall VAS score [ 10 ].…”