在免疫治疗时代，每周化疗作为体弱头颈癌患者的一线治疗方法。
Weekly chemotherapy as first line treatment in frail head and neck cancer patients in the immunotherapy era.
作者信息
Botticelli Andrea, Pomati Giulia, Cirillo Alessio, Mammone Giulia, Ciurluini Fabio, Cerbelli Bruna, Sciattella Paolo, Ralli Massimo, Romeo Umberto, De Felice Francesca, Catalano Carlo, Vullo Francesco, Della Monaca Marco, Amirhassankhani Sasan, Tomao Silverio, Valentini Valentino, De Vincentiis Marco, Tombolini Vincenzo, Della Rocca Carlo, Polimeni Antonella, di Gioia Cira, Corsi Alessandro, D'Amati Giulia, Mezi Silvia, Marchetti Paolo
机构信息
Department of Clinical and Molecular Oncology, "Sapienza" University of Rome, 00185, Rome, Italy.
Department of Molecular Medicine, "Sapienza" University of Rome, 00185, Rome, Italy.
出版信息
J Transl Med. 2021 Jul 12;19(1):303. doi: 10.1186/s12967-021-02975-3.
OBJECTIVE
First-line therapy for metastatic squamous cell carcinoma of the head and neck (R/M HNSCC) has been revolutionized by the introduction of anti-checkpoint monoclonal antibodies, which have shown a significant improvement in overall survival (OS) gaining approval in a first line setting. Efficacy and safety of first-line weekly chemotherapy, compared to 3-weeks treatment, was retrospectively evaluated in a frail patient population with R/M HNSCC with the aim to evaluate its role as part of a personalized first-line approach.
METHODS
A total of 124 patients with locally incurable R/M HNSCC receiving weekly (21) or three-weekly (103) chemotherapy plus cetuximab in a first line setting from December 2010 to September 2020 were retrospectively reviewed. Treatment outcomes in terms of objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and toxicities were analysed.
RESULTS
Patients in the three-week subgroup were ECOG PS 0 (39) and 1 (64) while patients in weekly group (21) were all PS 2. No significant differences were reported in terms of age, sex, smoking and previous alcohol abuse considering the two distinct subgroups. Moreover, no statistically significant difference was found in PFS and OS between the two treatment subgroups. The response rate was 35% (36 patients) and 34% (7 patients) in three-week and weekly treatment group, respectively. Seventy patients (68%) in the three-week group experienced chemotherapy-related toxicities, predominantly G3. In the weekly group a predominantly low-grade toxicity was found in a lower number of patients (52%).
CONCLUSION
The weekly schedule appears to be an active and safe strategy in frail patients with R/M HNSCC. Based on these data, a weekly schedule could be considered as a first line treatment in all frail patients excluded from pembrolizumab treatment and a study on the combination of weekly chemotherapy and immunotherapy should be performed.
目的
抗检查点单克隆抗体的引入彻底改变了转移性头颈部鳞状细胞癌（R/M HNSCC）的一线治疗，这些抗体已显示出总生存期（OS）有显著改善，并在一线治疗中获得批准。本研究对体弱的R/M HNSCC患者群体进行回顾性评估，比较一线每周化疗与三周化疗的疗效和安全性，以评估其作为个性化一线治疗方案一部分的作用。
方法
回顾性分析了2010年12月至2020年9月期间124例局部不可治愈的R/M HNSCC患者，这些患者在一线治疗中接受每周（21例）或每三周（103例）化疗加西妥昔单抗治疗。分析了客观缓解率（ORR）、无进展生存期（PFS）、总生存期（OS）和毒性方面的治疗结果。
结果
每三周治疗亚组的患者ECOG体能状态评分为0（39例）和1（64例），而每周治疗组（21例）的患者体能状态均为2。考虑到两个不同亚组，在年龄、性别、吸烟和既往酗酒方面未报告显著差异。此外，两个治疗亚组之间在PFS和OS方面未发现统计学显著差异。每三周治疗组和每周治疗组的缓解率分别为35%（36例患者）和34%（7例患者）。每三周治疗组中有70例患者（68%）出现化疗相关毒性，主要为3级。在每周治疗组中，较少患者（52%）出现主要为低级别毒性。
结论
每周化疗方案似乎是体弱的R/M HNSCC患者的一种有效且安全的策略。基于这些数据，每周化疗方案可被视为所有被排除在帕博利珠单抗治疗之外的体弱患者的一线治疗方案，并且应开展每周化疗与免疫治疗联合的研究。
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