Yao Zhuowei, Wang Jingshuo, Jiang Yongquan, Zhang Yi, Liu Jun, Dai Li, Shen Silin, Zhou Xiang, Liu Qiang, Zheng Luying, Qian Minfei, Li Jiping
Department of Otolaryngology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Head Neck. 2025 Jan;47(1):289-299. doi: 10.1002/hed.27915. Epub 2024 Aug 13.
Head and neck cancer cells commonly express programmed death ligand 1 (PD-L1) and epidermal growth factor receptor (EGFR), both of which play pivotal roles in the antitumor cellular immune response. Pembrolizumab, a PD-1 inhibitor, and cetuximab, an EGFR inhibitor, are typically effective agents combined with neoadjuvant platinum-based chemotherapy for the treatment of head and neck squamous cell carcinoma (HNSCC). This study aims to evaluate the efficacy and safety of neoadjuvant immunochemotherapy in patients with HNSCC.
Patients with HNSCC underwent radical surgery and complete cervical lymph node dissection following neoadjuvant immunochemotherapy at RenJi Hospital from January 2021 to June 2024 were retrospectively analyzed. The primary endpoint was major pathological response (MPR). We further explored the relationship between the efficacy and immune estimators.
Twenty-one patients were enrolled in this retrospective study. The MPR was 66.7%, including 11 patients who achieved a pathological complete response (pCR). The overall response rate (ORR) was 90.5%, and the complete response (CR) rate was 28.6%. The oropharynx, as the primary site, was the sensitive tumor type to neoadjuvant immunochemotherapy. The most common adverse event (AEs) was anemia (61.9%). No grade 4 AE or delayed surgery was reported. Laryngeal preservation rates were 90.9% (10/11), and pathological findings confirmed negative surgical margins for all patients. Moreover, pre-treatment peripheral lymphocyte count, monocyte count, and platelet to lymphocyte ratio (PLR) displayed a significant correlation with the treatment response.
Pembrolizumab plus cetuximab with chemotherapy for patients with HNSCC is a feasible and safe clinical protocol fulfilling organ preservation and life quality improvement. Pre-treatment peripheral immune estimators could help to screen patients who may respond to the neoadjuvant immunochemotherapy.
头颈癌细胞通常表达程序性死亡配体1（PD-L1）和表皮生长因子受体（EGFR），二者在抗肿瘤细胞免疫反应中均起关键作用。帕博利珠单抗（一种PD-1抑制剂）和西妥昔单抗（一种EGFR抑制剂）通常是与新辅助铂类化疗联合用于治疗头颈鳞状细胞癌（HNSCC）的有效药物。本研究旨在评估新辅助免疫化疗在HNSCC患者中的疗效和安全性。
回顾性分析2021年1月至2024年6月在仁济医院接受新辅助免疫化疗后行根治性手术及完整颈淋巴结清扫术的HNSCC患者。主要终点是主要病理反应（MPR）。我们进一步探讨了疗效与免疫评估指标之间的关系。
21例患者纳入本回顾性研究。MPR为66.7%，包括11例达到病理完全缓解（pCR）的患者。总缓解率（ORR）为90.5%，完全缓解（CR）率为28.6%。口咽作为主要部位，是对新辅助免疫化疗敏感的肿瘤类型。最常见的不良事件（AE）是贫血（61.9%）。未报告4级AE或延迟手术。喉保留率为90.9%（10/11），所有患者的病理结果均证实手术切缘阴性。此外，治疗前外周血淋巴细胞计数、单核细胞计数和血小板与淋巴细胞比值（PLR）与治疗反应呈显著相关。
帕博利珠单抗联合西妥昔单抗及化疗用于HNSCC患者是一种可行且安全的临床方案，可实现器官保留并提高生活质量。治疗前外周免疫评估指标有助于筛选可能对新辅助免疫化疗有反应的患者。
