Pembrolizumab versus cetuximab concurrent with radiotherapy in patients with locally advanced squamous cell carcinoma of head and neck unfit for cisplatin (GORTEC 2015-01 PembroRad): a multicenter, randomized, phase II trial

BACKGROUND

To evaluate potential synergistic effect of pembrolizumab with radiotherapy (RT) compared with a standard-of-care (SOC) cetuximab-RT in patients with locally advanced-squamous cell carcinoma of head and neck (LA-SCCHN).

PATIENTS AND METHODS

Patients with nonoperated stage III-IV SCC of oral cavity, oropharynx, hypopharynx, and larynx and unfit for receiving high-dose cisplatin were enrolled. Patients received once-daily RT up to 69.96 Gy in 33 fractions with weekly cetuximab (cetuximab-RT arm) or 200 mg Q3W pembrolizumab during RT (pembrolizumab-RT arm). The primary endpoint was locoregional control (LRC) rate 15 months after RT. To detect a difference between arms of 60%-80% in 15-month LRC, inclusion of 66 patients per arm was required to achieve a power of at least 0.85 at two-sided significance level of 0.20.

RESULTS

Between May 2016 and October 2017, 133 patients were randomized to cetuximab-RT (n = 66) and pembrolizumab-RT (n = 67). Two patients (one in each arm) were not included in the analysis (a consent withdrawal and a progression before treatment start). The median age was 65 years (interquartile range 60-70 years), 92% were smokers, 60% were oropharynx (46% of oropharynx with p16+) and 75% were stage IV. Median follow-up was 25 months in both arms. The 15-month LRC rate was 59% with cetuximab-RT and 60% with pembrolizumab-RT ]odds ratio 1.05, 95% confidence interval (CI) 0.43-2.59; P = 0.91]. There was no significant difference between arms for progression-free survival (hazard ratio 0.85, 95% CI 0.55-1.32; P = 0.47) and for overall survival (hazard ratio 0.83, 95% CI 0.49-1.40; P = 0.49). Toxicity was lower in the pembrolizumab-RT arm than in the cetuximab-RT arm: 74% versus 92% patients with at least one grade ≥3 adverse events (P = 0.006), mainly due to mucositis, radiodermatitis, and rash.

CONCLUSION

Compared with the SOC cetuximab-RT, pembrolizumab concomitant with RT did not improve the tumor control and survival but appeared less toxic in unfit patients with LA-SCCHN.

OS7.7 Educational program for caregivers of patients with brain tumors: AGAPE

BACKGROUND

Patients with brain tumors suffer from physical, neurocognitive, and psychological decline. Among the potential evolutions of the disease, patients become dependent on caregivers. Nearly half suffer from anxiety or depression, which can significatively impact their quality of life. Better medical information and more effective integration of the caregivers are positively received. Patients and caregivers need more information on supportive care and the specificities of brain tumors. Educational programs may help them better support this new caregiving role and give them more information on the disease.

MATERIALS AND METHODS

At the Comprehensive Cancer Centre in Rennes, we have created an educational program for caregivers of patients with brain tumor, called AGAPE. The aim of AGAPE is to explain more precisely the medical aspects of brain tumors, describe resources that are available to caregivers, and allow a moment of exchange between caregivers. A medical oncologist and a nurse specialized in neuro-oncology organize the program divided into three workshops. During the first workshop, neurocognitive symptoms that may be presented by the patients as well as therapeutics are discussed. The second workshop aims to provide information on instrumental and human resources available, as well as on psychometrics, nutrition, and palliative care units. The last workshop gives each caregiver the opportunity to share their difficulties. In order to objectively evaluate the impact of AGAPE, caregivers are asked to complete a quality of life questionnaire after each workshop: CargoQoL (Caregiver Oncology Quality of Life). We retrospectively analyzed CargoQoL scores for each caregiver during their participation in AGAPE in order to evaluate the impact of AGAPE on the caregiver’s quality of life.

RESULTS

From February 2015 to February 2018, 9 three-month sessions were organized, allowing 45 caregivers to participate. Data for the years 2018 and 2019 are currently being updated. Each group of 3 to 4 caregivers met once a month for a period of 3 months. Final analysis of CargoQoL was based on 21 caregivers (responses with excessive missing data and the experience of caregivers who assisted to only one of the workshops organized every 3 months were not taken into account). For the 9 items of CargoQoL, there was no decrease in quality of life between the first and the last workshop. Even though these findings are not significant, caregivers seem to have a better relationship with healthcare providers and better self-esteem after attending the AGAPE workshops.

CONCLUSION

Diagnosis of brain tumors impacts the quality of life of both patients and caregivers. The assessment of the caregivers’ needs is essential in order to support them in caring for their loved ones and to include them in the healthcare process. AGAPE educational programs help caregivers maintain their quality of life.

P14.04 10 years of weekly web conference for brain tumor of Adolescent/Young Adult (AYA) on behalf of ANOCEF, GO-AJA and SFCE societies

BACKGROUND

The skills of adult versus pediatric neuro-oncologists are not completely similar though additive. Because the tumors and their protocols are different and the tolerance and expected sequelae are specific. Multidisciplinary meetings including adult and pediatric neuro oncologists are warranted to share expertise.

MATERIAL AND METHODS

Since 2008, on behalf of ANOCEF, GO-AJA and SFCE societies, a weekly national web based conference was held in France. Any patient with the following criteria could be discussed: Adolescent and Young Adults aged between 15 and 25 years, and any adult with a pediatric type pathology, including medulloblastoma, germ cell tumors, embryonic tumors, ependymoma, pilocytic astrocytoma.

RESULTS

Number of cases discussed increased from 8 to 202/year, with a mean number of 3 cases (1 to 7) discussed at each meeting. In 2018, 36 meetings were held, with a mean of 8 participants (2 to 14) issued from various French centers. 168 cases were discussed in 2018. Mean age was 30 years old (7 to 67). 45% were discussed at diagnosis; The patients had mostly medulloblastomas (n=47), ependymomas (n=24), low (n=21) or high grade gliomas (n=11), pineal tumors (n=20), germ cell tumors (n=9) and embryonal tumors (n=6). The rate of inclusion in protocols was increased since the opening of this web conference, especially for the germ cell tumor GCT SIOP protocol that is opened without age restriction, and in RSMA standard risk or MEVITEM relapse adult medulloblastoma protocols.

CONCLUSION

Multidisciplinary Web conference for AYAs is feasible and fruitful. It shares knowledge and increases the inclusion rate in protocols. It should be developped further.

P14.76 Characteristics of anaplastic oligodendrogliomas short-term survivors: a POLA network study

BACKGROUND

Although patients with 1p/19q codeleted anaplastic oligodendrogliomas (AO) usually have a prolonged survival, some patients have a poorer outcome. The aim of the present study was to analyze their characteristics.

MATERIAL AND METHODS

The characteristics of AO patients with a survival < 5 years included in the POLA network were analyzed and compared to those of AO patients with a survival > 5 years.

RESULTS

In January 2019, among the 519 patients AO patients included in the POLA network, 55 patients were short-term survivors and 146 patients had a survival > 5 years. Among the 55 AO short-term survivors, 44 patients (80%) died from tumor progression and 11 patients (20%) from another cause (suicide n=2, toxicity n=2, intercurrent disease n=6, other n=1). Compared to > 5 years survivors, short-term survivors were older (57 years vs 48 years, p<0.001) and less frequently presented with isolated seizures (9% vs 33%, p=0.0017). They presented with tumors that more frequently involved multiple lobes (66% vs 47%, p=0.03), had a higher rate of nuclear atypia (80% vs 48%, p<0.001), a higher proliferative index (Ki67, 26% vs 18%, p<0.001), a higher level of p53 expression (10.8% vs 3.9% p<0.001), and had a higher rate of chromosomal abnormalities (91% vs 71% p=0.008). Compared to > 5 years survivors, short-term survivors less frequently underwent a surgical resection (64% vs 89% p<0.001) and their initial treatment more frequently consisted in temozolomide chemotherapy alone (41% vs 20% p=0.008).

CONCLUSION

AO short-term survivors are associated with distinct clinical, radiological, histological and molecular characteristics at diagnosis.