Salvage Reconstructive Surgery During Nivolumab Therapy for a Patient With Hypopharyngeal Cancer

Potential efficacy of local therapy for progressive lesions after nivolumab in patients with recurrent or metastatic squamous cell carcinoma of the head and neck

BACKGROUND

In recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN), local therapy (LT) such as surgery or radiotherapy can be treatment options for improved survival or quality of life. To date, however, few reports have addressed the efficacy of LT for sites of disease progression after immune checkpoint inhibitors, including other cancers.

METHODS

We conducted a retrospective analysis of patients with R/M SCCHN originating from the oral cavity, oropharynx, hypopharynx, and larynx and treated with nivolumab. We extracted patients undergoing salvage LT or palliative radiotherapy (RT) to the selected progressive lesion at any time after initiation of nivolumab.

RESULTS

Twenty-four patients received LT. Salvage LT was performed in 9 (37.5%) patients, including surgery and definitive RT in 5 and 4 patients, respectively. Palliative RT was performed in 15 (62.5%) patients. LT was provided in 10 (41.7%) patients for oligoprogressive disease. Twelve (50.0%) patients received subsequent systemic therapy immediately after LT. Classification based on patient treatment divided the population into four subgroups with different prognoses (salvage LT followed by subsequent systemic therapy [n = 3], salvage LT alone [n = 6], palliative RT followed by subsequent systemic therapy [n = 9], and palliative RT alone [n = 6]). Median OS in this order was 24.5, 9.0, 7.3, and 2.4 months (p = 0.001). All patients in the salvage LT followed by subsequent systemic therapy group continued nivolumab.

CONCLUSION

In R/M SCCHN patients who have received nivolumab, salvage LT for the selected progressive lesion with continuation of nivolumab potentially provides an excellent survival prognosis.

Retreatment with nivolumab for patients with recurrent and/or metastatic head and neck cancer

BACKGROUND

After treatment with an immune checkpoint inhibitor (ICI) is discontinued, retreatment with an ICI is a potential sequential treatment, but the clinical efficacy/safety data for this treatment of recurrent and/or metastatic head and neck cancer (R/M-HNC) are limited.

AIMS/OBJECTIVES

This study aimed to evaluate the efficacy and safety of retreatment with nivolumab in R/M HNC.

MATERIALS AND METHODS

We divided the 29 eligible R/M-HNC patients who discontinued ICI treatment at our hospital into two cohorts to analyze the clinical characteristics and the efficacy of the salvage therapy: the Niv cohort (nivolumab retreatment) and the no-Niv cohort (no nivolumab retreatment).

RESULTS

The Niv cohort's median overall survival (OS) of 17.5 months (95% confidence interval [CI]: 2.7-32.3) was significantly prolonged compared to that of the no-Niv cohort: 5.8 months (95%CI: 2.4-9.2, p = .034). The Niv cohort achieved objective response rate of 16.7% and a disease control rate of 50.0%. No adverse events > grade 3 occurred in the Niv cohort.

CONCLUSION

Nivolumab retreatment is an option for sequential treatment post-immunotherapy.