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Akyildiz A, Guven DC, Koksal B, Karaoglan BB, Kivrak D, Ismayilov R, Aslan F, Sutcuoglu O, Yazici O, Kadioglu A, Alan O, Majidova N, Erciyestepe M, Ozcan E, Akdag G, Taban H, Kaya AO, Guliyev M, Yildirim N, Sakalar T, Yazilitas D, Unal C, On S, Biter S, Demirci NS, Senler FC, Kemal Y, Halil OD, Gullu I, Aksoy S. Real-world evaluation of nivolumab in patients with non-nasopharyngeal recurrent or metastatic head and neck cancer: a retrospective multi-center study by the Turkish Oncology Group (TOG). Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08744-4. [PMID: 38795147 DOI: 10.1007/s00405-024-08744-4] [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: 11/13/2023] [Accepted: 05/16/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES Head and neck cancers (HNCs) represent a significant global health concern due to high morbidity and mortality rates. Despite therapeutic advances, the prognosis for advanced or recurrent cases remains challenging. Nivolumab obtained approval for recurrent or metastatic HNC based on the Phase III CheckMate 141 trial. This study aimed to evaluate the real-world outcomes of nivolumab in patients with non-nasopharyngeal HNC. DESIGN In this multicenter retrospective study, we analyzed 124 patients with recurrent or metastatic non-nasopharyngeal HNC who received nivolumab in the second-line setting and beyond. Data were collected from 20 different cancer centers across Turkey. The effectiveness and safety of the treatment and survival outcomes were evaluated. RESULTS Nivolumab exhibited favorable clinical responses, yielding an objective response rate of 29.9% and a disease control rate of 55.7%. Safety assessments revealed a generally well-tolerated profile, with no instances of treatment discontinuation or mortality due to side effects. Survival analysis disclosed a median overall survival (OS) of 11.8 (95% CI 8.4-15.2) months. Multivariate analysis revealed that ECOG-PS ≥ 1 (HR: 1.64, p = 0.045), laryngeal location (HR: 0.531, p = 0.024), and neutrophil-to-lymphocyte ratio > 3.5 (HR: 1.97, p = 0.007) were independent predictors of OS. CONCLUSIONS Nivolumab is an effective and safe treatment option for patients with recurrent or metastatic non-nasopharyngeal HNC in real-world settings. Further studies are needed on factors affecting response to treatment and survival outcomes.
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Affiliation(s)
- Arif Akyildiz
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Baris Koksal
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Beliz Bahar Karaoglan
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Derya Kivrak
- Department of Medical Oncology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Rashad Ismayilov
- Department of Internal Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Firat Aslan
- Department of Medical Oncology, Ankara Medical Park Hospital, Ankara, Turkey
| | - Osman Sutcuoglu
- Department of Medical Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ozan Yazici
- Department of Medical Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Kadioglu
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ozkan Alan
- Department of Medical Oncology, Koç University, Istanbul, Turkey
| | - Nargiz Majidova
- Department of Medical Oncology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Mert Erciyestepe
- Department of Medical Oncology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Erkan Ozcan
- Department of Medical Oncology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Goncagul Akdag
- Department of Medical Oncology, University of Health Science, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Hakan Taban
- Department of Medical Oncology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ali Osman Kaya
- Department of Medical Oncology, Biruni University Faculty of Medicine, Istanbul, Turkey
| | - Murad Guliyev
- Department of Medical Oncology, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Nilgun Yildirim
- Department of Medical Oncology, Firat University Faculty of Medicine, Elazig, Turkey
| | - Teoman Sakalar
- Department of Medical Oncology, Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Dogan Yazilitas
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Caglar Unal
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Sercan On
- Department of Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Sedat Biter
- Department of Medical Oncology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Nebi Serkan Demirci
- Department of Medical Oncology, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Filiz Cay Senler
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Kemal
- Department of Medical Oncology, Altinbas University Faculty of Medicine, Samsun, Turkey
| | - Omer Diker Halil
- Department of Medical Oncology, Near East University Hospital, Nicosia, Cyprus
| | - Ibrahim Gullu
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Treatment Sequences in Patients with Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: Cetuximab Followed by Immunotherapy or Vice Versa. Cancers (Basel) 2022; 14:cancers14102351. [PMID: 35625956 PMCID: PMC9139601 DOI: 10.3390/cancers14102351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prognosis was poor when patients had recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC). Herein, we conducted an observational study of cetuximab followed by immunotherapy (Cet-IO) versus immunotherapy followed by cetuximab (IO-Cet) in patients with R/M HNSCC. METHODS Patients who were diagnosed with R/M HNSCC and treated with a sequential cetuximab-containing regimen and immunotherapy-containing regimen were enrolled in our study. Kaplan-Meier curves were estimated for progression-free survival (PFS) and overall survival (OS). RESULTS A total of 75 patients were enrolled in our study for oncologic outcomes evaluation, with 40 patients in Cet-IO and 35 patients in IO-Cet. The median PFS1 was 5.1 months in Cet-IO and 4.5 months in IO-Cet (p = 0.777) and the median PFS2 was 16.5 months in Cet-IO and 11.4 months in IO-Cet (p = 0.566). The median OS was 23.7 months versus 22.8 months in Cet-IO and IO-Cet, respectively (p = 0.484). The overall response rate (ORR) were 73% in Cet-IO versus 37% in IO-Cet (p = 0.002). Multivariate analysis demonstrated that the treatment sequences, Cet-IO or IO-Cet, were insignificantly different with survival. CONCLUSION Both Cet-IO and IO-Cet are effective in R/M HNSCC patients with insignificant survival differences. The higher ORR of Cet-IO might render it to be considered in patients with large tumor burdens and urgent needs for treatment responses. Further prospective studies are merited to validate our conclusions.
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Yasumatsu R, Shimizu Y, Hanai N, Kariya S, Yokota T, Fujii T, Tsukahara K, Ando M, Hanyu K, Ueda T, Hirakawa H, Takahashi S, Ono T, Sano D, Yamauchi M, Watanabe A, Omori K, Yamazaki T, Monden N, Kudo N, Arai M, Yonekura S, Asakage T, Nekado T, Yamada T, Homma A. Outcomes of long-term nivolumab and subsequent chemotherapy in Japanese patients with head and neck cancer: 2-year follow-up from a multicenter real-world study. Int J Clin Oncol 2021; 27:95-104. [PMID: 34773525 PMCID: PMC8732924 DOI: 10.1007/s10147-021-02047-y] [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: 04/13/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Abstract
Background We have previously reported the effectiveness and safety of nivolumab in patients with head and neck cancer (HNC) in real-world clinical practice in Japan. Here, we report long-term outcomes from this study in the overall population and subgroups stratified by subsequent chemotherapy. Methods In this multicenter, retrospective observational study, Japanese patients with recurrent or metastatic (R/M) HNC receiving nivolumab were followed up for 2 years. Effectiveness endpoints included overall survival (OS), OS rate, progression-free survival (PFS), and PFS rate. Safety endpoints included the incidence of immune-related adverse events (irAEs). Results Overall, 256 patients received a median of 6.0 doses (range: 1–52) of nivolumab over a median duration of 72.5 days (range: 1–736). Median OS was 9.5 months [95% confidence interval (CI) 8.2–12.0] and median PFS was 2.1 months (95% CI 1.8–2.7). A significant difference between 2-year survivors (n = 62) and non-2-year survivors was observed by median age (P = 0.0227) and ECOG PS (P = 0.0001). Of 95 patients who received subsequent chemotherapy, 54.7% received paclitaxel ± cetuximab. The median OS and PFS from the start of paclitaxel ± cetuximab were 6.9 months (95% CI 5.9–11.9) and 3.5 months (95% CI 2.3–5.5), respectively. IrAEs were reported in 17.2% of patients. Endocrine (7.0%) and lung (4.3%) disorders were the most common irAEs; kidney disorder (n = 1) was newly identified in this follow-up analysis. Conclusions Results demonstrated the long-term effectiveness of nivolumab and potential effectiveness of subsequent chemotherapy in patients with R/M HNC in the real-world setting. Safety was consistent with that over the 1-year follow-up. Supplementary Information The online version contains supplementary material available at 10.1007/s10147-021-02047-y.
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Affiliation(s)
- Ryuji Yasumatsu
- Department of Otolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasushi Shimizu
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shin Kariya
- Department of Otolaryngology, Head and Neck Surgery, Okayama University Hospital, Okayama, Japan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Mizuo Ando
- Otorhinolaryngology and Head and Neck Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Kenji Hanyu
- Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Tsutomu Ueda
- Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Hitoshi Hirakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of the Ryukyus Hospital, Okinawa, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeharu Ono
- Department of Otolaryngology, Head and Neck Surgery, Kurume University Hospital, Kurume, Japan
| | - Daisuke Sano
- Otolaryngology, Head and Neck Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Moriyasu Yamauchi
- Department of Otolaryngology, Head and Neck Surgery, Saga University Hospital, Saga, Japan
| | - Akihito Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Koichi Omori
- Department of Otolaryngology, Head and Neck Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Tomoko Yamazaki
- Division of Head and Neck Cancer Oncology, Miyagi Cancer Center, Sendai, Japan
| | - Nobuya Monden
- Department of Head and Neck Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Naomi Kudo
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Makoto Arai
- Department of Medical Oncology, Chiba University Hospital, Chiba, Japan
| | - Syuji Yonekura
- Department of Otorhinolaryngology, Head and Neck Surgery, Chiba University Hospital, Chiba, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University Medical Hospital, Tokyo, Japan
| | | | - Takayuki Yamada
- Japan Medical and Development, Bristol-Myers Squibb K.K, Tokyo, Japan
| | - Akihiro Homma
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita15 Nishi7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
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