Update of a prognostic survival model in head and neck squamous cell carcinoma patients treated with immune checkpoint inhibitors using an expansion cohort

Abstract

Background Immune checkpoint inhibitors (ICI) treatment in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) offers new therapeutic venues. We have previously developed a predictive survival model in this patient population based on clinical parameters, and the purpose of this study was to expand the study cohort and internally validate the model. Methods A single institutional retrospective analysis of R/M HNSCC patients treated with ICI. Clinical parameters collected included p-16 status, hemoglobin (Hb), albumin (Alb), lactate dehydrogenase (LDH), neutrophil, lymphocyte and platelet counts. Cox proportional hazard regression was used to assess the impact of patient characteristics and clinical variables on survival. A nomogram was created using the rms package to generate individualized survival prediction. Results 201 patients were included, 47 females (23%), 154 males (77%). Median age was 61 years (IQR: 55-68). P-16 negative (66%). Median OS was 12 months (95% CI: 9.4, 14.9). Updated OS model included age, sex, absolute neutrophil count, absolute lymphocyte count, albumin, hemoglobin, LDH, and p-16 status. We stratified patients into three risk groups based on this model at the 0.33 and 0.66 quantiles. Median OS in the optimal risk group reached 23.7 months (CI: 18.5, NR), 13.8 months (CI: 11.1, 20.3) in the average risk group, and 2.3 months (CI: 1.7, 4.4) in the high-risk group. Following internal validation, the discriminatory power of the model reached a c-index of 0.72 and calibration slope of 0.79. Conclusions Our updated nomogram could assist in the precise selection of patients for which ICI could be beneficial and cost-effective.

Impact of Tobacco, Marijuana, and Alcohol use on Overall Survival in Recurrent Metastatic head and neck Cancer Patients Treated with Immune Checkpoint Inhibitors

“…Approximately 13 to 20 percent of patients will experience clinical bene t, while the majority will progress within the rst two years of commencing ICI (22)(23)(24). Hence, numerous studies were conducted in order to better identify candidates who are more likely to bene t from treatment with ICI, and researchers have explored clinical characteristics, in ammatory markers and prognostic survival models (25,26). Besides, identifying the effect of modi able lifestyle habits and metabolic disorders on ICI results is crucial to maximizing the outcomes (27).…”

Impact of Tobacco, Marijuana and Alcohol Use on Overall Survival in Recurrent Metastatic Head and Neck Cancer Patients Treated with Immune Checkpoint Inhibitors

“…Approximately 13 to 20 percent of patients will experience clinical bene t, while the majority will progress within the rst two years of commencing ICI (22)(23)(24). Hence, numerous studies were conducted in order to better identify candidates who are more likely to bene t from treatment with ICI, and researchers have explored clinical characteristics, in ammatory markers and prognostic survival models (25,26). Besides, identifying the effect of modi able lifestyle habits and metabolic disorders on ICI results is crucial to maximizing the outcomes (27).…”