Safety outcomes of pembrolizumab with platinum agent chemotherapy combined with 5-fluorouracil or taxane derivative in head and neck cancer

INTRODUCTION

For patients with metastatic head and neck squamous cell cancer (HNSCC), the outcomes of pembrolizumab in combination with a platinum agent and taxane as first-line therapy remain unknown. The purpose of this study is to characterize the impact of substituting the 5-fluorouracil (5-FU) backbone for a taxane in this chemoimmunotherapy regimen on safety/tolerability and survival outcomes.

METHODS

This was an IRB-approved, single-center, retrospective, active comparator, new-user design study in adult patients with HNSCC treated between January 2018 and September 2021. The primary objective was to assess safety and tolerability of pembrolizumab in combination with a platinum agent and taxane against an active comparator arm of pembrolizumab in combination with a platinum agent and 5-FU. Safety and tolerability were evaluated by assessing differences in overall toxicities, with further secondary analysis evaluating differences in hematologic toxicities and pre-defined non-hematologic toxicities.

RESULTS

There was no statistical difference demonstrated with the primary endpoint between the cohorts. Reduced toxicity rates were found in the taxane arm for mucositis and creatinine levels. No grade 4 non-hematologic toxicities were reported. Patients receiving 5-FU were more likely to have dose reductions upfront, discontinue treatment due to intolerances and had significantly higher mucositis.

CONCLUSIONS

This study helps to characterize the safety profile and activity of pembrolizumab in combination with a platinum agent and taxane derivative in HNSCC patients. Within our study, substitution of 5-FU with a taxane did not show an increased risk of toxicities, worsened survival, or decreased odds of achieving a response. Mucositis and elevated creatinine rates were significantly reduced within the taxane arm.

Abstract 5538: Prevalence of factors serving as common cancer clinical trial eligibility criteria by race and ethnicity

Background: Racial/ethnic minority patients remain underrepresented in clinical trials potentially due to restrictive trial eligibility criteria that disproportionally affect minority cancer patients.

Objective: To examine the prevalence of existing medical conditions and abnormal lab values that commonly serve as clinical trial eligibility criteria among cancer patients by race and ethnicity.

Methods: A cross-sectional analysis was conducted among patients new to Moffitt Cancer Center in 2011-2021 with multiple myeloma (n=3,967), breast (n=14,348), lung (n=10,492), and prostate (n=7,823) cancers. Demographics, existing medical conditions, and lab values were obtained from the Electronic Health Record, whereas history of cancer and metastatic disease at diagnosis were obtained from the Cancer Registry. Prevalence of medical conditions and abnormal lab values were reported among all patients and compared by race groups (White, Black, Hispanic, and other races) using age-adjusted logistic regression. For factors with prevalence higher than 5%, stratified analysis was conducted with respect to cancer type and adjusted for multiple comparisons.

Results: Compared to White patients, Black (B) and Hispanic (H) patients were found to have higher prevalence of diabetes (OR [odds ratio] = 2.26 [B]/1.40 [H]), organ transplantation (OR=1.58 [B]/1.77 [H]), hepatitis (OR=1.74 [B]/1.48 [H]), HIV (OR=4.25 [B]/1.92 [H]), and abnormal creatinine value (OR=1.77 [B]/1.23 [H]). In addition, Black patients were more likely to have hypertension (OR=1.41) while patients of other races were more likely to be diabetic (OR=1.36). Similar patterns were observed across cancer types.

Conclusion: Restrictive cancer clinical trial eligibility criteria may post a structural barrier that disproportionately impact racial/ethnic minority patients. Investigators should consider leveraging real-world data to define and design appropriate trial eligibility criteria.

Prevalence of factors commonly included as clinical trial eligibility by race/ethnicity. Factors All White Black Hispanic Other Prevalence (%) % % OR (95% CI) % OR (95% CI) % OR (95% CI) Diabetes 6.30 5.90 10.00 2.26 (1.97-2.58) 6.50 1.40 (1.20-1.63) 6.50 1.36 (1.07-1.70) Chronic obstructive pulmonary disease 10.30 11.40 6.20 0.61 (0.52-0.72) 6.10 0.61 (0.52-0.71) 5.90 0.57 (0.44-0.72) Hypertension 18.00 18.50 19.80 1.41 (1.27-1.55) 13.40 0.87 (0.78-0.97) 13.50 0.84 (0.71-1.00) Heart condition 3.00 3.10 2.60 1.10 (0.86-1.39) 2.00 0.80 (0.61-1.03) 1.80 0.70 (0.44-1.05) Organ transplant 0.90 0.90 1.40 1.58 (1.11-2.20) 1.50 1.77 (1.28-2.41) 0.40 0.46 (0.16-1.00) Autoimmune disease 2.50 2.60 2.10 0.84 (0.63-1.09) 1.90 0.78 (0.59-1.01) 2.20 0.90 (0.60-1.30) Hepatitis 0.70 0.70 1.20 1.74 (1.17-2.49) 1.00 1.48 (0.99-2.15) 0.40 0.60 (0.21-1.30) HIV infection 0.30 0.20 0.90 4.25 (2.62-6.74) 0.40 1.92 (1.01-3.40) 0.20 0.71 (0.12-2.30) History of any cancer 15.90 17.20 10.30 0.69 (0.60-0.78) 10.30 0.69 (0.61-0.77) 10.90 0.71 (0.59-0.85) Metastasis at diagnosis 21.20 21.40 22.60 1.13 (1.02-1.24) 19.80 0.96 (0.87-1.05) 18.60 0.88 (0.75-1.02) Abnormal neutrophil count 19.70 20.10 20.20 1.00 (0.86-1.16) 16.60 0.79 (0.67-0.93) 18.20 0.89 (0.69-1.13) Abnormal creatinine 14.00 13.50 19.30 1.77 (1.57-1.99) 14.10 1.23 (1.08-1.39) 13.40 1.13 (0.93-1.38) Abnormal glomerular filtration rate 14.00 13.50 22.40 2.32 (1.99-2.70) 11.20 1.07 (0.88-1.30) 10.10 0.91 (0.66-1.22) Abnormal bilirubin 2.40 2.50 2.40 1.02 (0.69-1.45) 2.40 1.03 (0.70-1.46) 2.40 0.99 (0.52-1.69) Abnormal aspartate aminotransferase 9.40 9.40 9.20 0.88 (0.72-1.07) 9.70 0.92 (0.76-1.12) 8.50 0.82 (0.59-1.12)

Citation Format: Yayi Zhao, Rossybelle P. Amorrortu, Rachel Howard, Kedar S. Kirtane, Susan T. Vadaparampil, Dana E. Rollison. Prevalence of factors serving as common cancer clinical trial eligibility criteria by race and ethnicity. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5538.

Oncology Providers' and Professionals' Experiences With Suicide Risk Screening Among Patients With Head and Neck Cancer: A Qualitative Study

PURPOSE

There has been limited study of the implementation of suicide risk screening for patients with head and neck cancer (HNC) as a part of routine care. To address this gap, this study assessed oncology providers' and professionals' perspectives about barriers and facilitators of implementing a suicide risk screening among patients with HNC.

MATERIALS AND METHODS

All patients with HNC with an in-person visit completed a suicide risk screening on an electronic tablet. Patients reporting passive death wish were then screened for active suicidal ideation and referred for appropriate intervention. Interviews were conducted with 25 oncology providers and professionals who played a key role in implementation including nurses, medical assistants, patient access representatives, advanced practice providers, physicians, social workers, and informatics staff. The interview guide was based on the Consolidated Framework for Implementation Research. Interviews were transcribed and analyzed for themes.

RESULTS

Participants identified multilevel implementation barriers, such as intervention level (eg, patient difficulty with using a tablet), process level (eg, limited nursing engagement), organizational level (eg, limited clinic Wi-Fi connectivity), and individual level (eg, low clinician self-efficacy for interpreting and acting upon patient-reported outcome scores). Participants noted facilitators, such as effective care coordination across nursing and social work staff and the opportunity for patients to be screened multiple times. Participants recommended strengthening patient and clinician education and providing patients with other modalities for data entry (eg, desktop computer in the waiting room).

CONCLUSION

Participants identified important intervention modifications that may be needed to optimize suicide risk screening in cancer care settings.

Promise of Patient-Reported Outcomes, Biometric Data, and Remote Monitoring for Adoptive Cellular Therapy

Patient-Reported Outcomes, Biometric Data, and Remote Monitoring for Adoptive Cellular Therapy.

Transplant-Associated Thrombotic Microangiopathy Is a Multifactorial Disease Unresponsive to Immunosuppressant Withdrawal

Transplant-associated thrombotic microangiopathy (TA-TMA) after allogeneic hematopoietic cell transplantation (HCT) has not been well characterized in large population studies with clinically adjudicated cases. We performed a retrospective cohort study of adults who underwent allogeneic HCT between 2006 and 2015 to determine the incidence of and risk factors for TA-TMA and to describe its natural history and response to immunosuppressant withdrawal management. Among 2145 patients in this study, 192 developed TA-TMA with a cumulative incidence of 7.6% by 100days post-transplant. Independent pretransplant risk factors included the receipt of a second (or third) allogeneic HCT, HLA-mismatched donor, and myeloablative conditioning with or without total body irradiation; post-transplant risk factors included the antecedent development of acute graft-versus-host disease, diffuse alveolar hemorrhage, bacteremia, invasive aspergillosis, BK viremia, and higher sirolimus trough level. Among TA-TMA patients 27% achieved hematologic resolution and 57% remained alive as of 90days after diagnosis. Antecedent risk factors stratified patients into different survival groups, and immunosuppressant withdrawal alone did not improve patient outcomes. In conclusion, TA-TMA is a heterogenous disease that occurs after allogeneic transplantation. Management with immunosuppressant withdrawal does not impact patient outcomes. Until further evidence becomes available, the management of TA-TMA should focus on the treatment of underlying diseases.