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Harrington KJ, Soulières D, Le Tourneau C, Dinis J, Licitra LF, Ahn MJ, Soria A, Machiels JPH, Mach N, Mehra R, Burtness B, Ellison MC, Cheng JD, Chirovsky DR, Swaby RF, Cohen EEW. Quality of Life With Pembrolizumab for Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma: KEYNOTE-040. J Natl Cancer Inst 2021; 113:171-181. [PMID: 32407532 PMCID: PMC7850527 DOI: 10.1093/jnci/djaa063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) affects health-related quality of life (HRQoL); few treatments have demonstrated clinically meaningful HRQoL benefit. KEYNOTE-040 evaluated pembrolizumab vs standard of care (SOC) in patients with recurrent and/or metastatic HNSCC whose disease recurred or progressed after platinum-containing regimen. METHODS Patients received pembrolizumab 200 mg or SOC (methotrexate, docetaxel, or cetuximab). Exploratory HRQoL analyses used European Organisation for Research and Treatment of Cancer (EORTC) 30 quality-of-life, EORTC 35-question quality-of-life head and neck cancer-specific module, and EuroQoL 5-dimensions questionnaires. RESULTS The HRQoL population comprised 469 patients (pembrolizumab = 241, SOC = 228). HRQoL compliance for patients in the study at week 15 was 75.3% (116 of 154) for pembrolizumab and 74.6% (85 of 114) for SOC. The median time to deterioration in global health status (GHS) and QoL scores were 4.8 months with pembrolizumab and 2.8 months with SOC (hazard ratio = 0.79, 95% confidence interval [CI] = 0.59 to 1.05). At week 15, GHS / QoL scores were stable for pembrolizumab (least squares mean [LSM] = 0.39, 95% CI = -3.00 to 3.78) but worsened for SOC (LSM = -5.86, 95% CI = -9.68 to -2.04); the LSM between-group difference was 6.25 points (95% CI = 1.32 to 11.18; nominal 2-sided P = .01). A greater difference in the LSM for GHS / QoL score occurred with pembrolizumab vs docetaxel (10.23, 95% CI = 3.15 to 17.30) compared with pembrolizumab vs methotrexate (6.21, 95% CI = -4.57 to 16.99) or pembrolizumab vs cetuximab (-1.44, 95% CI = -11.43 to 8.56). Pembrolizumab-treated patients had stable functioning and symptoms at week 15, with no notable differences from SOC. CONCLUSIONS GHS / QoL scores were stable with pembrolizumab but declined with SOC in patients at week 15, supporting the clinically meaningful benefit of pembrolizumab in recurrent and/or metastatic HNSCC.
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Affiliation(s)
- Kevin J Harrington
- The Institute of Cancer Research/The Royal Marsden National Institute for Health Research Biomedical Research Centre, London, UK
| | | | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, France
- INSERM U900 Research Unit, Saint-Cloud, France
- Paris-Saclay University, Paris, France
| | - Jose Dinis
- Instituto Português Oncologia, Porto, Portugal
| | - Lisa F Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ainara Soria
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Nicolas Mach
- HUG - Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Ranee Mehra
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | - Ezra E W Cohen
- Moores Cancer Center at UC San Diego Health, University of California San Diego, La Jolla, CA, USA
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Morkramer L, Geitner M, Boeger D, Buentzel J, Kaftan H, Mueller AH, Ernst T, Guntinas-Lichius O. Systemic therapy for recurrent and/or metastatic head and neck cancer: a population-based healthcare research study in Thuringia, Germany. J Cancer Res Clin Oncol 2021; 147:2625-2635. [PMID: 33517469 PMCID: PMC8310840 DOI: 10.1007/s00432-021-03535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/12/2021] [Indexed: 11/27/2022]
Abstract
Purpose Systemic therapy choice for patients with recurrent and/or metastatic head and neck cancer (R/M HNC) is a challenge. Not much is known about systemic therapies used in daily clinical routine and their outcome. Methods Data of all 283 patients with R/M HNC (89.4% male, median age: 60 years) registered for first-line systemic therapy between 2015 and 2018 in the cancer registries of Thuringia, a federal state in Germany, were included. Patient characteristics and treatment patterns were summarized. Exploratory univariate and multivariate analyses were conducted on select of systemic therapy and prognostic factors for overall survival. Results The most frequent first-line regimens were platinum-based combinations (71.4%), mainly cetuximab + platinum + 5-fluorouracil (32.5%). 32.5, 13.1, 4.9, and 1.1%, respectively, received, a second, third, fourth, and fifth line of systemic therapy. Median follow-up was 5.5 months. Median real-world overall survival was 16.8 months [95% confidence interval (CI) 11.1–22.6]. Alcohol drinking [hazard ratio (HR) 2.375, CI 1.471–3.831; p < 0.001], no second-line therapy (HR 3.425, CI 2.082–5.635, p < 0.001), and application of three agents compared to one agent in first-line therapy (HR 2.798, CI 1.374–5.697; p = 0.005) were associated to decreased overall survival after start of first-line systemic therapy. Termination of second-line treatment because of deterioration of the general condition was the only independent negative prognostic factor (HR 4.202, CI 1.091–16.129; p = 0.037) after start of second-line systemic therapy. Conclusions This study offers useful information, mainly prior to the availability of immunotherapy, on patient characteristics, treatment patterns, and survival in a German real-world population. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03535-4.
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Affiliation(s)
- Lisa Morkramer
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07740, Jena, Germany
| | - Maren Geitner
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07740, Jena, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, Zentralklinikum, Suhl, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum, Erfurt, Germany
| | | | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07740, Jena, Germany.
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Grünwald V, Chirovsky D, Cheung WY, Bertolini F, Ahn MJ, Yang MH, Castro G, Berrocal A, Sjoquist K, Kuyas H, Auclair V, Guillaume X, Joo S, Shah R, Harrington K. Global treatment patterns and outcomes among patients with recurrent and/or metastatic head and neck squamous cell carcinoma: Results of the GLANCE H&N study. Oral Oncol 2020; 102:104526. [PMID: 31978755 DOI: 10.1016/j.oraloncology.2019.104526] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Given a lack of universally-accepted standard-of-care treatment for patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC), study objectives were to assess treatment utilization and survival outcomes for R/M HNSCC in the real-world setting. MATERIALS AND METHODS A multi-site retrospective chart review was conducted in Europe (Germany, United Kingdom, Italy, Spain), Asia Pacific (Australia, South Korea, Taiwan), and Latin/North America (Brazil and Canada) to identify patients who initiated first-line systemic therapy for R/M HNSCC between January 2011 and December 2013. Patients were followed through December 2015 to collect clinical characteristics, treatment and survival data. RESULTS Among 733 R/M HNSCC patients across 71 sites, median age was 60 years (inter-quartile range 54-67), 84% male, and 70% Eastern Cooperative Oncology Group performance status 0-1; 32% had oral cavity and 30% oropharyngeal cancers. The most common first-line regimen across all countries consisted of platinum-based combinations (73%), including platinum + 5-fluorouracil (5-FU) (26%), cetuximab + platinum ± 5-FU (22%), or taxane + platinum ± 5-FU (16%). However, use of different platinum-based combinations varied substantially; administration of cetuximab + platinum ± 5-FU was frequent in Italy (81%), Germany (46%) and Spain (38%), whereas use in other countries was limited. Median follow-up was 22.6 months (95% confidence interval [CI]: 21.5-24.6 months). Median real-world overall survival was only 8.0 months (95% CI: 7.0-8.0), with one-year survival reaching only 30.9% (95% CI: 27.5-34.3). CONCLUSION Systemic therapies used in clinical practice for patients with R/M HNSCC vary substantially across countries. Prognosis remains poor in this patient population, highlighting the need for newer, more efficacious treatments.
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Affiliation(s)
- Viktor Grünwald
- Clinic for Internal Medicine (Tumour Research) and Clinic for Urology, University Hospital Essen, Hufelandtsr. 55, 45147 Essen, Germany; Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - Diana Chirovsky
- Merck & Co., Inc., Center for Observational and Real World Evidence, 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| | - Winson Y Cheung
- University of Calgary, Tom Baker Cancer Centre, Department of Oncology, 2500 University Dr. NW, Calgary, Alberta T2N 1N4, Canada; Cross Cancer Institute, Medical Oncology, Alberta Cancer Foundation, 11560 University Avenue, Edmonton, Alberta T6G 1Z2, Canada.
| | - Federica Bertolini
- AOU Policlinico di Modena, Day Hospital Oncologico, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo, 71, 41124 Modena, Italy.
| | - Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine Section of Hematology-Oncology, Department of Medicine, 135-710 Seoul, South Korea.
| | - Muh-Hwa Yang
- Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, Republic of China.
| | - Gilberto Castro
- Instituto de Cancer do Estado de São Paulo, Faculdade de Medicina da USP - Disciplina de Oncologia, Av Dr Arnaldo 251 - 5o andar, São Paulo, SP 01246-000, Brazil.
| | - Alfonso Berrocal
- Hospital General Universitario de Valencia, Servicio de Oncologia Medica, Avda Tres Cruces S, N, 46006 Valencia, Spain.
| | - Katrin Sjoquist
- St George Hospital, Cancer Care Centre, 1 Short Street, Kogarah, NSW 2217, Australia; NHMRC Clinical Trials Centre, University of Sydney, ABN 15 211 513 464, Locked Bag 77, Camperdown, NSW 1450, Australia.
| | - Hélène Kuyas
- Kantar Health, 3 Avenue Pierre Masse, 75014 Paris, France.
| | | | | | - Seongjung Joo
- Merck & Co., Inc., Center for Observational and Real World Evidence, 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| | - Roshani Shah
- Merck & Co., Inc., Center for Observational and Real World Evidence, 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| | - Kevin Harrington
- The Royal Marsden/Institute of Cancer Research NIHR Biomedical Research Centre, 237 Fulham Road, London SW3 6JB, United Kingdom.
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Theodoraki M, Lorenz K, Lotfi R, Fürst D, Tsamadou C, Jaekle S, Mytilineos J, Brunner C, Theodorakis J, Hoffmann T, Laban S, Schuler P. Influence of photodynamic therapy on peripheral immune cell populations and cytokine concentrations in head and neck cancer. Photodiagnosis Photodyn Ther 2017; 19:194-201. [DOI: 10.1016/j.pdpdt.2017.05.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/02/2017] [Accepted: 05/18/2017] [Indexed: 12/23/2022]
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