1
|
Dzienis M, Cundom J, Fuentes CS, Spreafico A, Nordlinger M, Pastor AV, Alesi E, Neki A, Fung AS, Figueiredo Lima IP, Oppelt P, da Cunha Junior GF, Burtness B, Franke FA, Tseng JE, Joshi A, McCarthy J, Swaby R, Sidi Y, Gumuscu B, Naicker N, de Castro G. Pembrolizumab Plus Carboplatin and Paclitaxel as First-Line Therapy for Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (KEYNOTE-B10): A Single-Arm Phase IV Trial. J Clin Oncol 2024; 42:2989-2999. [PMID: 39038265 PMCID: PMC11361359 DOI: 10.1200/jco.23.02625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/29/2024] [Accepted: 04/23/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE Standard-of-care first-line treatment for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) is pembrolizumab plus platinum and fluorouracil (FU). However, FU is associated with potential challenges (continuous 4-day infusion, high administration costs, and cardiovascular and gastrointestinal toxicities), creating a clinical need for alternative chemotherapy combinations. We evaluated the efficacy and safety of first-line pembrolizumab plus carboplatin and paclitaxel for R/M HNSCC in the open-label, single-arm, phase IV KEYNOTE-B10 study (ClinicalTrials.gov identifier: NCT04489888). METHODS Eligible adults had previously untreated, histologically or cytologically confirmed R/M HNSCC regardless of PD-L1 status, measurable disease per RECIST v1.1 by blinded independent central review (BICR), and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients received pembrolizumab 200 mg intravenously once every 3 weeks for ≤35 cycles and carboplatin AUC 5 mg/mL/min intravenously once every 3 weeks for ≤6 cycles and investigator's choice of paclitaxel 100 mg/m2 on days 1 and 8 or 175 mg/m2 on day 1, intravenously once every 3 weeks. The primary end point was objective response rate per RECIST v1.1 by BICR. RESULTS Between October 27, 2020, and April 29, 2022, 149 patients were screened and 101 received treatment. As of February 20, 2023, the median follow-up was 18.9 months (range, 9.1-27.0). At this final analysis, 49 (49%) of 101 patients had an objective response (95% CI, 38.4 to 58.7), including seven patients (7%) with a confirmed complete response. Of the 101 treated patients, grade 3-5 and serious treatment-related adverse events occurred in 76 (75%) and 27 (27%), respectively. There were no new safety signals. CONCLUSION Pembrolizumab plus carboplatin and paclitaxel showed promising antitumor activity and a manageable safety profile in first-line R/M HNSCC, suggesting this combination may be an alternative option for this patient population.
Collapse
Affiliation(s)
- Marcin Dzienis
- Cancer Department, Gold Coast University Hospital, Southport, QLD, Australia
| | - Juan Cundom
- Department of Oncology, IDIM Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina
| | | | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Melanie Nordlinger
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Jefferson-Abington Hospital, Philadelphia, PA
| | | | - Erin Alesi
- Department of Hematology/Oncology and Palliative Medicine, VCU Massey Cancer Center, Richmond, VA
| | - Anterpreet Neki
- Department of Hematology/Oncology, UC Davis Medical Center, Sacramento, CA
| | - Andrea S. Fung
- Department of Oncology, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON, Canada
| | | | - Peter Oppelt
- Department of Oncology, Washington University School of Medicine, St Louis, MO
| | | | - Barbara Burtness
- Yale University School of Medicine and Yale Cancer Center, New Haven, CT
| | - Fabio Andre Franke
- Department of Oncology, Oncosite Centro de Pesquisa Clínica em Oncologia, Ijuí, Brazil
| | - Jennifer E. Tseng
- Department of Hematology and Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - Abhishek Joshi
- Department of Medical Oncology, The Townsville University Hospital, Douglas, QLD, Australia
| | - Joy McCarthy
- Dr. H. Bliss Murphy Cancer Centre, St John's, NL, Canada
| | | | | | | | - Niroshini Naicker
- Oncology European Clinical Development, MSD (UK) Limited, London, United Kingdom
| | - Gilberto de Castro
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo—ICESP, São Paulo, Brazil
| |
Collapse
|
2
|
Diniz CHDP, Henrique T, Stefanini ACB, De Castro TB, Tajara EH. Cetuximab chemotherapy resistance: Insight into the homeostatic evolution of head and neck cancer (Review). Oncol Rep 2024; 51:80. [PMID: 38639184 PMCID: PMC11056821 DOI: 10.3892/or.2024.8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/03/2024] [Indexed: 04/20/2024] Open
Abstract
The complex evolution of genetic alterations in cancer that occurs in vivo is a selective process involving numerous factors and mechanisms. Chemotherapeutic agents that prevent the growth and spread of cancer cells induce selective pressure, leading to rapid artificial selection of resistant subclones. This rapid evolution is possible because antineoplastic drugs promote alterations in tumor‑cell metabolism, thus creating a bottleneck event. The few resistant cells that survive in this new environment obtain differential reproductive success that enables them to pass down the newly selected resistant gene pool. The present review aims to summarize key findings of tumor evolution, epithelial‑mesenchymal transition and resistance to cetuximab therapy in head and neck squamous cell carcinoma.
Collapse
Affiliation(s)
- Carlos Henrique De Paula Diniz
- Department of Molecular Biology, School of Medicine of São José do Rio Preto-FAMERP, São José do Rio Preto, São Paulo, SP 15090-000, Brazil
| | - Tiago Henrique
- Department of Molecular Biology, School of Medicine of São José do Rio Preto-FAMERP, São José do Rio Preto, São Paulo, SP 15090-000, Brazil
| | - Ana Carolina B. Stefanini
- Department of Molecular Biology, School of Medicine of São José do Rio Preto-FAMERP, São José do Rio Preto, São Paulo, SP 15090-000, Brazil
- Department of Experimental Research, Albert Einstein Education and Research Israeli Institute, IIEPAE, São Paulo, SP 05652-900, Brazil
| | - Tialfi Bergamin De Castro
- Department of Molecular Biology, School of Medicine of São José do Rio Preto-FAMERP, São José do Rio Preto, São Paulo, SP 15090-000, Brazil
- Microbial Pathogenesis Department, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA
| | - Eloiza H. Tajara
- Department of Molecular Biology, School of Medicine of São José do Rio Preto-FAMERP, São José do Rio Preto, São Paulo, SP 15090-000, Brazil
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP 05508-090, Brazil
| |
Collapse
|
3
|
Hélène C, Conrad O, Pflumio C, Borel C, Voegelin M, Bernard A, Schultz P, Onea MA, Jung A, Martin S, Burgy M. Dynamic profiling of immune microenvironment during anti-PD-1 immunotherapy for head and neck squamous cell carcinoma: the IPRICE study. BMC Cancer 2023; 23:1209. [PMID: 38066522 PMCID: PMC10704641 DOI: 10.1186/s12885-023-11672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors of programmed cell death protein 1 (PD-1) represent a significant breakthrough in treating head and neck squamous cell carcinoma (HNSCC), with long-lasting responses and prolonged survival observed in first- and second-line therapy. However, this is observed in < 20% of patients and high primary/secondary resistance may occur. The primary objective of the identification of predictive factors for the response to anti-PD-1 immunotherapy in head and neck squamous cell carcinoma (IPRICE) study is to identify predictive factors of response to anti-PD-1 immunotherapy. METHODS The IPRICE study is a single-center, prospective, non-randomized, open-label, and interventional clinical trial. Liquid and tumor biopsies will be performed in 54 patients with recurrent/metastatic (R/M) HNSCC undergoing anti-PD-1 immunotherapy alone to compare the evolution of gene expression and immunological profile between responders and non-responders. We will use a multidisciplinary approach including spatial transcriptomics, single seq-RNA analysis, clinical data, and medical images. Genes, pathways, and transcription factors potentially involved in the immune response will also be analyzed, including genes involved in the interferon-gamma (IFN-γ) pathway, immunogenic cell death and mitophagy, hypoxia, circulating miRNA-mediated immunomodulation, cytokines, and immune repertoire within the tumor microenvironment (TME). With a follow-up period of 3-years, these data will help generate effective biomarkers to define optimal therapeutic strategy and new immunomodulatory agents based on a better understanding of primary/secondary resistance mechanisms. Tumor biopsy will be performed initially before the start of immunotherapy at the first tumor assessment and is only proposed at tumor progression. Clinical data will be collected using a dedicated Case Report Form (CRF). DISCUSSION Identifying predictive factors of the response to anti-PD-1 immunotherapy and optimizing long-term immune response require a thorough understanding of the intrinsic and acquired resistance to immunotherapy. To achieve this, dynamic profiling of TME during anti-PD-1 immunotherapy based on analysis of tumor biopsy samples is critical. This will be accomplished through the anatomical localization of HNSCC, which will allow for the analysis of multiple biopsies during treatment and the emergence of breakthrough technologies including single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics. TRIAL REGISTRATION Clinicaltrial.gov. Registered April 14, 2022, https://www. CLINICALTRIALS gov/study/NCT05328024 .
Collapse
Affiliation(s)
- Carinato Hélène
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe France, Strasbourg, France
| | - Ombline Conrad
- Laboratory of Bioimaging and Pathology, University of Strasbourg, UMR7021 CNRS, Strasbourg, France
| | - Carole Pflumio
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe France, Strasbourg, France
| | - Christian Borel
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe France, Strasbourg, France
| | - Manon Voegelin
- Department of Clinical Research, Institut de Cancérologie Strasbourg Europe France, Strasbourg, France
| | - Alexandre Bernard
- Department of Clinical Research, Institut de Cancérologie Strasbourg Europe France, Strasbourg, France
| | - Philippe Schultz
- Laboratory of Bioimaging and Pathology, University of Strasbourg, UMR7021 CNRS, Strasbourg, France
- Department of Otolaryngology and Cervico-Facial Surgery, Strasbourg University Hospital France, Strasbourg, France
| | - Mihaela-Alina Onea
- Department of Pathology, Strasbourg University Hospital France, Strasbourg, France
| | - Alain Jung
- Laboratory of Bioimaging and Pathology, University of Strasbourg, UMR7021 CNRS, Strasbourg, France
- Laboratory of Tumor Biology, Institut de Cancérologie Strasbourg Europe, Strasbourg, 67200, France
| | - Sophie Martin
- Laboratory of Bioimaging and Pathology, University of Strasbourg, UMR7021 CNRS, Strasbourg, France
| | - Mickaël Burgy
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe France, Strasbourg, France.
- Laboratory of Bioimaging and Pathology, University of Strasbourg, UMR7021 CNRS, Strasbourg, France.
| |
Collapse
|
4
|
Chauffert B, Zhou Y, Medjkoune L, Ouikene A, Galez A, Belkhir F, Saint-Germain P, Youssef A, Chehimi M. High Response Rate to Carboplatin-Paclitaxel-Cetuximab and Pembrolizumab in Patients with Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma. Case Rep Oncol 2023; 16:13-20. [PMID: 36743882 PMCID: PMC9893993 DOI: 10.1159/000528326] [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: 05/31/2022] [Accepted: 11/16/2022] [Indexed: 01/18/2023] Open
Abstract
The management of R/M HNSCC is rapidly evolving with new available treatment molecules and combination modalities. Anti-EGFR cetuximab (CTX) and immune checkpoint inhibitors (ICI) can be used either alone or in combination with conventional platinum-based doublet chemotherapy (with taxanes or fluorouracil). No data have been reported to date on the association of doublet chemotherapy concomitantly with both CTX and ICI. We present a case series of patients treated with 4 cycles of quadritherapy, every 3 weeks, including paclitaxel 175 mg/m2, carboplatin AUC 5, pembrolizumab 200 mg, and weekly 250 mg/m2 CTX. All patients achieved an objective response (6 complete responses, 2 partial responses). Clinical response was fast, so 1 patient avoided an emergency tracheostomy for laryngeal dyspnea. Four patients furtherly benefited from cisplatin-based chemoradiotherapy on residual tumor sites after the response to quadritherapy. Adverse events were manageable, except for an ICI-related liver toxicity in a patient. Overall, this short series indicates that a quadruple therapy with carboplatin-paclitaxel-CTX and pembrolizumab seems to be safe and active in patients with R/M HNSCC. This observation could be confirmed through further clinical trials.
Collapse
Affiliation(s)
- Bruno Chauffert
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Yuedan Zhou
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Liza Medjkoune
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Abdenour Ouikene
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Agnes Galez
- Department of Head and Neck Surgery, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Farid Belkhir
- Department of Radiation Oncology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | | | - Ali Youssef
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Mohamad Chehimi
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| |
Collapse
|
5
|
Fuereder T. Optimizing the prescription doses and tolerability of systemic therapy in head and neck cancer patients. Curr Opin Oncol 2022; 34:204-211. [PMID: 35266908 DOI: 10.1097/cco.0000000000000832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Squamous cell carcinoma of the head and neck accounts for 330 000 deaths and 650 000 cases worldwide annually. Systemic therapy is an essential pillar of multimodal therapy despite being accompanied with substantial toxicity. This article reviews the latest advances in systemic therapy for the treatment of locoregionally advanced and reccurent/metastatic head and neck cancer from a tolerability perspective. RECENT FINDINGS Multiple recent attempts have been made to optimize tolerability (and efficacy) of systemic therapy utilizing new regimens, modified prescription doses, drugs such as immunotherapies or genotyping to tailor the systemic therapy to the individual patient. SUMMARY Although treatment benefit has to be weighed against potential toxicity, it is reasonable to anticipate potential side effects of systemic therapies. In a vulnerable elderly or Asian patient population upfront dose modifications of cytotoxic chemotherapies might be reasonable. Special attention should be laid on the patient's nutritional status and early intervention recommended. Dihydropyrimidine dehydrogenase genotyping can predict 5-fluorouracil toxicity and identify patients for whom alternative regimens are more suitable. As for immune checkpoint inhibitor therapy, despite being well tolerated, the identification of biomarkers to predict reduced tolerability or severe toxicity would be highly desirable.
Collapse
Affiliation(s)
- Thorsten Fuereder
- Division of Oncology, Department of Medicine I & Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|