Chemotherapy Following Immune Checkpoint Inhibitors in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: Clinical Effectiveness and Influence of Inflammatory and Nutritional Factors

Overview

Journal Discov Oncol

Publisher Springer

Specialty Oncology

Date 2023 Aug 29

PMID 37642856

Authors

Akihiro Sakai

Koji Ebisumoto

Hiroaki Iijima

Mayu Yamauchi

Takanobu Teramura

Aritomo Yamazaki

Takane Watanabe

Toshihide Inagi

Daisuke Maki

Kenji Okami

Affiliations

Soon will be listed here.

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.

Citing Articles

Prognostic role of geriatric nutritional risk index (GNRI) and controlling nutritional status (CONUT) on outcomes in patients with head and neck cancer: a systematic review and meta-analysis.

Huang Y, Chen S, Chiang Y BMC Cancer. 2025; 25(1):242.

PMID: 39934700 PMC: 11817134. DOI: 10.1186/s12885-025-13565-7.

The efficacy and safety of a taxane-based chemotherapy regimen combined with a PD-1 inhibitor in HNSCC: a multicenter real-world study.

Ouyang M, Sun H, Liu X, Wu H, Deng F, Shen E World J Surg Oncol. 2025; 23(1):6.

PMID: 39754263 PMC: 11699790. DOI: 10.1186/s12957-024-03644-7.

Immune-Modified Glasgow Prognostic Score Predicts Therapeutic Effect of Pembrolizumab in Recurrent and Metastatic Head and Neck Cancer.

Ueda N, Kuroki M, Shibata H, Matsubara M, Akita S, Yamada T Cancers (Basel). 2024; 16(23).

PMID: 39682242 PMC: 11640115. DOI: 10.3390/cancers16234056.

MRI radiomics and nutritional-inflammatory biomarkers: a powerful combination for predicting progression-free survival in cervical cancer patients undergoing concurrent chemoradiotherapy.

Yan Q, Wu M, Zhang J, Yang J, Lv G, Qu B Cancer Imaging. 2024; 24(1):144.

PMID: 39449107 PMC: 11515587. DOI: 10.1186/s40644-024-00789-2.

Efficacy of Nanoparticle Albumin-Bound Paclitaxel (nab-PTX) Monotherapy Can Be Improved after Treatment with Immune Checkpoint Inhibitor in Patients with Non-Small Cell Lung Cancer: Long-Term Follow-Up and Updated Analysis of Two Previous....

Nakashima K, Umeda Y, Demura Y, Sonoda T, Tada T, Yamaguchi M Oncology. 2024; 102(7):593-603.

PMID: 38290482 PMC: 11216350. DOI: 10.1159/000535994.

References

Jacobs C, Lyman G, Velez-Garcia E, Sridhar K, Knight W, Hochster H . A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. J Clin Oncol. 1992; 10(2):257-63. DOI: 10.1200/JCO.1992.10.2.257. View

Forastiere A, Metch B, Schuller D, Ensley J, Hutchins L, Triozzi P . Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol. 1992; 10(8):1245-51. DOI: 10.1200/JCO.1992.10.8.1245. View

Brockstein B, Haraf D, Rademaker A, Kies M, Stenson K, Rosen F . Patterns of failure, prognostic factors and survival in locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy: a 9-year, 337-patient, multi-institutional experience. Ann Oncol. 2004; 15(8):1179-86. DOI: 10.1093/annonc/mdh308. View

Cohen M, Chen H, Shord S, Fuchs C, He K, Zhao H . Approval summary: Cetuximab in combination with cisplatin or carboplatin and 5-fluorouracil for the first-line treatment of patients with recurrent locoregional or metastatic squamous cell head and neck cancer. Oncologist. 2013; 18(4):460-6. PMC: 3639534. DOI: 10.1634/theoncologist.2012-0458. View

Hitt R, Irigoyen A, Cortes-Funes H, Grau J, Garcia-Saenz J, Cruz-Hernandez J . Phase II study of the combination of cetuximab and weekly paclitaxel in the first-line treatment of patients with recurrent and/or metastatic squamous cell carcinoma of head and neck. Ann Oncol. 2011; 23(4):1016-22. DOI: 10.1093/annonc/mdr367. View

Leon X, Hitt R, Constenla M, Rocca A, Stupp R, Kovacs A . A retrospective analysis of the outcome of patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck refractory to a platinum-based chemotherapy. Clin Oncol (R Coll Radiol). 2005; 17(6):418-24. DOI: 10.1016/j.clon.2005.02.014. View

Ferris R, Blumenschein Jr G, Fayette J, Guigay J, Colevas A, Licitra L . Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck. N Engl J Med. 2016; 375(19):1856-1867. PMC: 5564292. DOI: 10.1056/NEJMoa1602252. View

Burtness B, Harrington K, Greil R, Soulieres D, Tahara M, de Castro Jr G . Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet. 2019; 394(10212):1915-1928. DOI: 10.1016/S0140-6736(19)32591-7. View

Matsuo M, Yasumatsu R, Masuda M, Toh S, Wakasaki T, Hashimoto K . Relationship between immune-related adverse events and the long-term outcomes in recurrent/metastatic head and neck squamous cell carcinoma treated with nivolumab. Oral Oncol. 2019; 101:104525. DOI: 10.1016/j.oraloncology.2019.104525. View

10.

Cabezas-Camarero S, Cabrera-Martin M, Merino-Menendez S, Paz-Cabezas M, Garcia-Barberan V, Saiz-Pardo Sanz M . Safety and Efficacy of Cetuximab-Based Salvage Chemotherapy After Checkpoint Inhibitors in Head and Neck Cancer. Oncologist. 2021; 26(6):e1018-e1035. PMC: 8176971. DOI: 10.1002/onco.13754. View

11.

Fushimi C, Baba D, Masubuchi T, Yamazaki M, Kitani Y, Kitajima T . Weekly Cetuximab and Paclitaxel for Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma. In Vivo. 2020; 34(5):2653-2657. PMC: 7652519. DOI: 10.21873/invivo.12084. View

12.

Kurosaki T, Mitani S, Tanaka K, Suzuki S, Kanemura H, Haratani K . Safety and efficacy of cetuximab-containing chemotherapy after immune checkpoint inhibitors for patients with squamous cell carcinoma of the head and neck: a single-center retrospective study. Anticancer Drugs. 2020; 32(1):95-101. PMC: 7748051. DOI: 10.1097/CAD.0000000000001006. View

13.

Wakasaki T, Manako T, Yasumatsu R, Hara H, Toh S, Masuda M . Effectiveness and safety of weekly paclitaxel and cetuximab as a salvage chemotherapy following immune checkpoint inhibitors for recurrent or metastatic head and neck squamous cell carcinoma: A multicenter clinical study. PLoS One. 2022; 17(7):e0271907. PMC: 9333293. DOI: 10.1371/journal.pone.0271907. View

14.

Yasumatsu R, Shimizu Y, Hanai N, Kariya S, Yokota T, Fujii T . 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(1):95-104. PMC: 8732924. DOI: 10.1007/s10147-021-02047-y. View

15.

Wakasaki T, Yasumatsu R, Uchi R, Taura M, Matsuo M, Komune N . Outcome of chemotherapy following nivolumab treatment for recurrent and/or metastatic head and neck squamous cell carcinoma. Auris Nasus Larynx. 2019; 47(1):116-122. DOI: 10.1016/j.anl.2019.05.001. View

16.

Forrest L, McMillan D, McArdle C, Angerson W, Dunlop D . Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003; 89(6):1028-30. PMC: 2376960. DOI: 10.1038/sj.bjc.6601242. View

17.

Wang S, Kang K, Chang C, Lin M, Hsu W . Voice Change After Adenotonsillectomy in Children: A Systematic Review and Meta-Analysis. Laryngoscope. 2023; 134(6):2538-2550. DOI: 10.1002/lary.31140. View

18.

Onodera T, Goseki N, KOSAKI G . [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984; 85(9):1001-5. View

19.

Luo Z, Zhou L, Balde A, Li Z, He L, ZhenWei C . Prognostic impact of preoperative prognostic nutritional index in resected advanced gastric cancer: A multicenter propensity score analysis. Eur J Surg Oncol. 2018; 45(3):425-431. DOI: 10.1016/j.ejso.2018.09.004. View

20.

Tokunaga R, Sakamoto Y, Nakagawa S, Ohuchi M, Izumi D, Kosumi K . CONUT: a novel independent predictive score for colorectal cancer patients undergoing potentially curative resection. Int J Colorectal Dis. 2016; 32(1):99-106. DOI: 10.1007/s00384-016-2668-5. View