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Sakai A, Ebisumoto K, Iijima H, Yamauchi M, Teramura T, Yamazaki A, Watanabe T, Inagi T, Maki D, Okami K. Chemotherapy following immune checkpoint inhibitors in recurrent or metastatic head and neck squamous cell carcinoma: clinical effectiveness and influence of inflammatory and nutritional factors. Discov Oncol 2023; 14:158. [PMID: 37642856 PMCID: PMC10465419 DOI: 10.1007/s12672-023-00774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the clinical effectiveness of chemotherapy following immune checkpoint inhibitors (ICI). The association between inflammatory and nutritional factors and prognosis has also been investigated. METHODS We retrospectively reviewed the medical records of recurrent or metastatic head and neck squamous cell carcinoma (RMHNSCC) patients who received chemotherapy following ICI therapy. The response rate and survival after chemotherapy, and nutritional and inflammatory factors, were examined. RESULTS The ICI before chemotherapy was nivolumab in 36 patients (70.6%) and pembrolizumab in 15 patients (29.4%). The chemotherapy regimens consisted of PTX in 32 patients (62.7%), PTX + Cmab in 9 (17.6%), and S1 in 10 (19.6%). The median overall survival (OS) was 20 months (95% CI 12-25), the estimated 12-month OS rate was 63.3%, the median progression-free survival (PFS) was 5 months (CI 4-6), and the 12-month PFS estimate was 8.9%. Univariate analysis significantly correlated Neutrophil-to-Lymphocyte Ratio (NLR), platelet-to-lymphocyte ratio (PLR), controlling nutritional status score (CONUT), and prognostic nutrition index (PNI) with OS and PFS. Additionally, these factors were significantly correlated with OS and PFS in the log-rank tests. CONCLUSIONS Chemotherapy following ICI is highly effective. There were no significant differences in the chemotherapy regimens. Inflammatory and nutritional factors may associate with patient prognosis after chemotherapy.
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Affiliation(s)
- Akihiro Sakai
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Koji Ebisumoto
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Hiroaki Iijima
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Mayu Yamauchi
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Takanobu Teramura
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Aritomo Yamazaki
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Takane Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Toshihide Inagi
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Daisuke Maki
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Kenji Okami
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
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Aguin S, Carral A, Iglesias L, Pena C, Molina A, Costa M, Covela M, Gomez JG, Arroyo RG, Huidobro G, Simo RV, Medina A. Real-world Data of Paclitaxel and Cetuximab in Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck. CANCER DIAGNOSIS & PROGNOSIS 2023; 3:264-271. [PMID: 36875311 PMCID: PMC9949534 DOI: 10.21873/cdp.10211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND/AIM Prior immune-checkpoint inhibitors, weekly paclitaxel-cetuximab was one of the few options for platinum-ineligible patients with recurrent/ metastatic squamous cell carcinoma of the head and neck (R/M-SCCHN). This real-world study analyzed the long-term outcomes of this regimen. PATIENTS AND METHODS A multicenter, retrospective, observational, cross-sectional, chart review study was realized in nine hospitals of the Galician Group of Head and Neck Cancer. Eligible population was adult platinum-ineligible patients with R/M SCCHN (unfit to, or after progressing following EXTREME or other platinum-based regimens) that received weekly paclitaxel plus cetuximab regimen as first- or second-line (1L or 2L) between January 2009 and December 2014. The efficacy was evaluated (1L-2L) in regards to overall survival (OS) and progression-free survival (PFS), and safety was assessed as the incidence of adverse events (AEs). RESULTS Seventy-five R/M-SCCHN patients received the scheme (1L, n=50; 2L: n=25). The mean age of the patients was 59 years (1L, 59.5 years; 2L, 59.2 years), 90% were male (1L, 96%; 2L, 79%), 55% were smokers (1L, 60.4%; 2L, 45.8%), and 61% presented ECOG performance status (PS) 1 (1L, 54%; 2L, 62.5%). Median OS [interquartile range (IQR)] was 8.85 (4.22-40.96) months. Median PFS (IQR) was 8.5 (3.93-12.55) (1L) and 8.8 (5.62-16.91) (2L) months. Disease control rate was 60% (1L) and 85% (2L). Weekly paclitaxel-cetuximab was well tolerated in 1L/2L (cutaneous-toxicity, mucositis, neuropathy; mainly Grade 1-2). No grade 4 AEs were notified in 2L. CONCLUSION Weekly paclitaxel-cetuximab is an active and well tolerated therapeutical option in platinum-ineligible or after platinum regimens in R/M-SCCHN patients.
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Affiliation(s)
- Santiago Aguin
- Medical Oncology Department, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS), A Coruña, Spain
| | - Alberto Carral
- Medical Oncology Department, Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Leticia Iglesias
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense (CHOU), Ourense, Spain
| | - Carolina Pena
- Medical Oncology Department, Fundación Centro Oncológico de Galicia (COG), A Coruña, Spain
| | - Aurea Molina
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Marinha Costa
- Medical Oncology Department, Hospital Ribera POVISA, Pontevedra, Spain
| | - Marta Covela
- Medical Oncology Department, Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Jesus Garcia Gomez
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense (CHOU), Ourense, Spain
| | - Ramón Garcia Arroyo
- Medical Oncology Department, Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | - Gerardo Huidobro
- Medical Oncology Department, Complejo Hospitalario de Vigo (CHUVI), Pontevedra, Spain
| | - Rocío Vilches Simo
- Medical Oncology Department, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Ana Medina
- Medical Oncology Department, Fundación Centro Oncológico de Galicia (COG), A Coruña, Spain
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Forman R, Deshpande H, Burtness B, Bhatia AK. Efficacy and toxicity of weekly paclitaxel, carboplatin, and cetuximab as induction chemotherapy or in cases of metastases or relapse for head and neck cancer with a focus on elderly or frail patients. Head Neck 2022; 44:1777-1786. [PMID: 35488876 DOI: 10.1002/hed.27077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/26/2022] [Accepted: 04/22/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Paclitaxel, carboplatin, and cetuximab (PCC) has shown promise as induction chemotherapy and in patients with metastatic/recurrent head and neck cancer (HNC). Given its tolerability, the regimen is used in frail and elderly patients. METHODS Software generated the cohort of adult patients with HNC treated with PCC in 2014-2019. Modified RECIST response rate (RR), progression-free survival (PFS), and overall survival (OS) were calculated for the metastatic/recurrent group, and successful induction rate and RR for the induction group. These were also calculated in the elderly/frail subset (EF): age ≥75, performance status ≥2, albumin <3.5. RESULTS Fifty-two percent of patients experienced ≥grade 3 toxicities. For metastatic/recurrent disease (N = 58), RR was 22%, mean PFS was 7.1 months. Mean OS was 15.2 months. In the induction cohort (N = 22), 86% reached their endpoint. The RR was 64%. There were no significant differences for EF. CONCLUSIONS PCC is well-tolerated with good induction success rate and reasonable PFS/OS in metastatic/recurrent disease.
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Affiliation(s)
- Rebecca Forman
- Department of Internal Medicine, Section of Medical Oncology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Hari Deshpande
- Department of Internal Medicine, Section of Medical Oncology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Barbara Burtness
- Department of Internal Medicine, Section of Medical Oncology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Aarti K Bhatia
- Department of Internal Medicine, Section of Medical Oncology, Yale New Haven Hospital, New Haven, Connecticut, USA
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Clinical Outcomes of Cetuximab and Paclitaxel after Progression on Immune Checkpoint Inhibitors in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111151. [PMID: 34833369 PMCID: PMC8621992 DOI: 10.3390/medicina57111151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/23/2022]
Abstract
Background and Objectives: In recent years, the effectiveness of chemotherapy after immune checkpoint inhibitor administration has attracted attention in various cancers, including head and neck cancers. However, individual assessments of the administered chemotherapy regimens are insufficient. This study aimed to evaluate the efficacy and safety of chemotherapy after immune checkpoint inhibitor administration in recurrent metastatic head and neck cancer by focusing on a single regimen. Materials and Methods: We retrospectively reviewed clinical and radiological data from the medical records of 18 patients with recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) who received systemic chemotherapy with weekly cetuximab and paclitaxel (Cmab + PTX) after progression following immune checkpoint inhibitor (ICI) therapy. The objective response rate (ORR) and disease control rate (DCR) were assessed using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Adverse events (AEs) were recorded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Results: In all patients, the ORR, DCR, median PFS, and median OS were 44.4%, 72.2%, 3.8 months, and 9.6 months, respectively. Regarding AEs, three patients developed grade 3 neutropenia. Grade 3 anemia, paronychia, asthenia, and peripheral neuropathy were observed in one patient each. There were no treatment-related deaths. Conclusions: Cmab + PTX was shown to maintain high efficacy and acceptable safety for R/M HNSCC that progressed after ICI therapy. Further research is needed to establish optimal treatment sequences and drug combinations for recurrent R/M HNSCC.
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Zhang Z, Yang L, Hou J, Tian S, Liu Y. Molecular mechanisms underlying the anticancer activities of licorice flavonoids. JOURNAL OF ETHNOPHARMACOLOGY 2021; 267:113635. [PMID: 33246112 DOI: 10.1016/j.jep.2020.113635] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/25/2020] [Accepted: 11/23/2020] [Indexed: 05/20/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Licorice has been commonly used in traditional Chinese medicine for treatment of gastric, liver, and respiratory disease conditions for more than two thousand years. It is a major component of several Chinese patent medicines certificated by National Medical Products Administration that possess great anticancer activities. AIM OF THE STUDY To comprehensively summarize the anticancer activities of licorice flavonoids, explain the underlying molecular mechanisms, and assess their therapeutic potentials and side-effects. METHODS PubMed, Research Gate, Web of Science, Google Scholar, academic journals, and Science Direct were used as information sources, with the key words of "anticancer", "licorice", "flavonoids", and their combinations, mainly from 2000 to 2019. RESULTS Sixteen licorice flavonoids are found to possess anticancer activities. These flavonoids inhibit cancer cells through blocking cell cycle and regulating multiple signaling pathways. The major pathways targeted by licorice flavonoids include: the MAPK pathway, PI3K/AKT pathway, NF-κB pathway, death receptor - dependent extrinsic signaling pathway, and mitochondrial apoptotic pathway. CONCLUSION Licorice flavonoids are a group of versatile molecules that have pleiotropic effects on cell growth, survival and cell signaling. Many of the flavonoids possess inhibitory activities toward cancer cell growth and hence have a great therapeutic potential in cancer treatment. However, additional preclinical studies are still needed to assess their in vivo efficacy and possible toxicities. It is also imperative to evaluate the effects of licorice flavonoids on the metabolism of other drugs and explore the potential synergistic mechanism.
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Affiliation(s)
- Zhixin Zhang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Lin Yang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Jiaming Hou
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Shaokai Tian
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Ying Liu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China.
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