The UK Divide: Does Having a Pembrolizumab-Chemotherapy Option in Head and Neck Cancer Matter? Real-world Experience of First-line Palliative Pembrolizumab Monotherapy and Pembrolizumab-Chemotherapy Combination in Scotland

AIMS

The Scottish Medical Consortium recently approved first-line pembrolizumab monotherapy or in combination with chemotherapy for head and neck squamous cell carcinoma in the palliative setting, contrasting with the decision made by the National Institute for Health and Care Excellence, who approved monotherapy alone in England and Wales. The aim of this study was to provide real-world performance data for first-line pembrolizumab-containing treatments for head and neck squamous cell carcinoma in the palliative setting in Scotland.

MATERIALS AND METHODS

We analysed the electronic records of patients who started pembrolizumab-containing treatment between 1 March 2020 and 30 September 2021. Outcomes included overall survival, progression-free survival (PFS), the duration of response and the disease control rate. Data were compared with the KEYNOTE-048 study and clinical factors were evaluated for association with survival.

RESULTS

Our cohort included 91 patients (median follow-up 10.8 months). Patient characteristics were similar to those in the KEYNOTE-048 study, although our cohort had a higher proportion of patients with newly diagnosed, non-metastatic disease. For patients receiving monotherapy (n = 76), 12- and 24-month overall survival were 45% and 27%, respectively. For patients receiving pembrolizumab-chemotherapy (n = 15), 12-month overall survival was 60% (24-month overall survival had not yet been reached). Experiencing one or more immune-related adverse event (irAE; versus no irAEs), of any grade, was associated with favourable overall survival and PFS for patients receiving monotherapy in both univariable Log-rank analysis (median overall survival 17.4 months versus 8.6 months, respectively, P = 0.0033; median PFS 10.9 months versus 3.0 months, respectively, P < 0.0001) and multivariable analysis (Cox proportional hazards regression: overall survival hazard ratio 0.31, P = 0.0009; PFS hazard ratio 0.17, P < 0.0001).

CONCLUSION

Our real-world data support the KEYNOTE-048 study findings and the value of combination treatment options. Additionally, our data show that irAEs of any grade, as reported in routine clinical records, are associated with better outcomes in this patient group, adding to the growing body of evidence showing that irAEs are generally a positive marker of programmed death-ligand 1 (PD-L1) inhibitor response.

Feasibility of Virtual Reality Audiological Testing: Prospective Study

Background

It has been noted in the literature that there is a gap between clinical assessment and real-world performance. Real-world conversations entail visual and audio information, yet there are not any audiological assessment tools that include visual information. Virtual reality (VR) technology has been applied to various areas, including audiology. However, the use of VR in speech-in-noise perception has not yet been investigated.

Objective

The purpose of this study was to investigate the impact of virtual space (VS) on speech performance and its feasibility to be used as a speech test instrument. We hypothesized that individuals’ ability to recognize speech would improve when visual cues were provided.

Methods

A total of 30 individuals with normal hearing and 25 individuals with hearing loss completed pure-tone audiometry and the Korean version of the Hearing in Noise Test (K-HINT) under three conditions—conventional K-HINT (cK-HINT), VS on PC (VSPC), and VS head-mounted display (VSHMD)—at –10 dB, –5 dB, 0 dB, and +5 dB signal-to-noise ratios (SNRs). Participants listened to target speech and repeated it back to the tester for all conditions. Hearing aid users in the hearing loss group completed testing under unaided and aided conditions. A questionnaire was administered after testing to gather subjective opinions on the headset, the VSHMD condition, and test preference.

Results

Provision of visual information had a significant impact on speech performance between the normal hearing and hearing impaired groups. The Mann-Whitney U test showed statistical significance (P<.05) between the two groups under all test conditions. Hearing aid use led to better integration of audio and visual cues. Statistical significance through the Mann-Whitney U test was observed for –5 dB (P=.04) and 0 dB (P=.02) SNRs under the cK-HINT condition, as well as for –10 dB (P=.007) and 0 dB (P=.04) SNRs under the VSPC condition, between hearing aid and non–hearing aid users. Participants reported positive responses across almost all items on the questionnaire except for the weight of the headset. Participants preferred a test method with visual imagery, but found the headset to be heavy.

Conclusions

Findings are in line with previous literature that showed that visual cues were beneficial for communication. This is the first study to include hearing aid users with a more naturalistic stimulus and a relatively simple test environment, suggesting the feasibility of VR audiological testing in clinical practice.

No Effect of Partial-Body Cryotherapy on Restoration of Countermovement Jump or Well-Being Performance in Elite Rugby Union Players During the Competitive Phase of the Season

PURPOSE

Partial body cryotherapy (PBC) has been shown to be beneficial for postexercise recovery; however, no study has demonstrated the effectiveness of PBC for recovery following elite rugby union training. Rugby union is a unique sport that involves high-velocity collisions and may induce greater performance decrements than other sports; thus, PBC could be beneficial. The application of PBC in "real world" has rarely been investigated during the competitive phase of a playing season and warranted investigation.

METHODS

In a counterbalanced sequential research design, professional rugby athletes (n = 18; age 25.4 [4.0] y; training age 7.2 [4.0] y; mass 99.8 [10.6] kg; height 188.3 [6.0] cm) were assigned to a 12-week PBC intervention, washout period (4 wk), and reassessed as their own controls. Self-reported well-being, muscle soreness, sleep quality, and countermovement jump height were assessed before and 40 hours after "real-world" training. Wilcoxon signed-rank tests and Cohen d were used for statistical analysis.

RESULTS

No differences were observed between PBC and control conditions (P > .05; d = 0.00-0.14) for well-being (-0.02% [0.08%] vs 0.01% [0.06%]), muscle soreness (-0.01% [0.11%] vs 0.01% [0.16%]), sleep quality (-0.03% [0.14%] vs 0.10% [0.29%]), or countermovement jump height (36.48-36.59 vs 38.13-37.52 cm; P = .54).

CONCLUSIONS

These results suggest PBC is ineffective for the restoration of selected performance parameters during the performance maintenance phase of the competitive season. To ascertain the appropriation of its use, future investigations should seek to assess the use of cryotherapies at various phases of the elite rugby union competitive season.