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Ho AL. Immunotherapy, Chemotherapy, or Both: Options for First-Line Therapy for Patients With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma. J Clin Oncol 2023; 41:736-741. [PMID: 36223554 PMCID: PMC9901972 DOI: 10.1200/jco.22.01408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/07/2022] [Accepted: 07/28/2022] [Indexed: 02/03/2023] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in the Journal of Clinical Oncology, to patients seen in their own clinical practice.The development of immune checkpoint inhibitors has revolutionized the management of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC). The landmark KEYNOTE-048 clinical trial established the programmed death-1 inhibitor pembrolizumab with and without chemotherapy as a new standard first-line treatment for patients with platinum-sensitive R/M HNSCC. Nonetheless, clinical decision making can be challenging when considering the significant morbidity associated with rapidly progressive disease in high-risk locations, patient fitness, and programmed death-ligand 1 expression. Both planned and unplanned subgroup analyses from KEYNOTE-048 provide valuable insights into how therapy for untreated R/M HNSCC may be optimized for individual patients. Given differences in the toxicity profile of pembrolizumab alone versus in combination with chemotherapy, prioritizing patient preference is paramount in this palliative treatment setting. Here, the case of a patient presenting with de novo metastatic HNSCC is discussed to highlight the practical application of KEYNOTE-048 data in clinical practice.
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Affiliation(s)
- Alan L. Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY
- Department of Medicine Weill Cornell Medical College, New York City, NY
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Le Roy C, Vernerey D, Evin C, Richard S, Crespel C, Samaille T, Le Tourneau C, Huguet F. Efficacy and Tolerance of Carboplatin plus Cetuximab (Simplified EXTREME Regimen) in Patients with Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma. Clin Oncol (R Coll Radiol) 2022; 34:e473-e481. [PMID: 36207237 DOI: 10.1016/j.clon.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/13/2022] [Accepted: 09/14/2022] [Indexed: 01/31/2023]
Abstract
AIMS The EXTREME regimen is the standard for recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC). However, many patients have a poor performance status and/or comorbidities, making them unfit for this regimen. We have treated them with carboplatin and cetuximab (simplified EXTREME regimen) since 2007. Our aim was to assess the efficacy and tolerance of this regimen in this frail population. MATERIALS AND METHODS A retrospective chart review of all patients treated with the simplified EXTREME regimen for recurrent and/or metastatic HNSCC in three academic hospitals between 2007 and 2017 was carried out. The primary end point was overall survival. Secondary end points were progression-free survival (PFS), overall response rate (ORR) and toxicity. RESULTS One hundred and three patients were included. The median age was 63 years, 40% had performance status 2-3. The median follow-up was 30.2 months. The median overall survival and PFS were 7.2 and 3.7 months, respectively. The median overall survival was 10.1 months in patients with performance status 0-1 versus 4.6 months in patients with performance status 2-3 (P = 0.01). ORR was 39%. Acute grade 3-4 haematological and non-haematological toxicity rates were 25.2% and 27.2%, respectively. Patients with grade 1 or more skin toxicity had a higher ORR (hazard ratio = 3.44; P = 0.03), a prolonged overall survival (hazard ratio = 0.37; P < 0.0001) and PFS (hazard ratio = 0.29; P < 0.0001). During treatment, 29% of patients had pain reduction, 13.5% had weight gain and 17.2% had an improvement in performance status. CONCLUSIONS This is the largest cohort of patients treated with simplified EXTREME for HNSCC. It was well tolerated, with a high ORR. Interestingly, skin toxicity correlated with treatment efficacy.
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Affiliation(s)
- C Le Roy
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - D Vernerey
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, INSERM UMR 1098, Besançon, France
| | - C Evin
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Department of Medical Oncology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université de Paris, Paris, France
| | - S Richard
- Department of Medical Oncology, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - C Crespel
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université de Paris, Paris, France
| | - T Samaille
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Institut Curie, Department of Drug Development and Innovation (D3i), Paris & Saint-Cloud, France
| | - C Le Tourneau
- Institut Curie, INSERM U900 Research Unit, Saint-Cloud, France; Paris-Saclay University, Paris, France
| | - F Huguet
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Centre de Recherche Saint-Antoine, INSERM UMR_S 938, Saint-Antoine Hospital, Paris, France; Institut Universitaire de Cancérologie, Sorbonne Université, Paris, France.
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