Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
Oral Oncol. 2024 Nov;158:106997. doi: 10.1016/j.oraloncology.2024.106997. Epub 2024 Aug 17.
Pembrolizumab +/- chemotherapy is standard therapy for r/m HNSCC. Despite regulatory approval of platinum/5FU/pembrolizumab, a taxane is often substituted for 5FU for convenience and tolerability. We aimed to characterize nationwide use patterns and compare outcomes between platinum/taxane/pembrolizumab vs platinum/5FU/pembrolizumab.
Patients in a US nationwide database with r/m HNSCC treated from 2017 to 2022 with pembrolizumab plus platinum chemotherapy were included. Demographic and cancer-specific characteristics were summarized. Overall survival (OS) was estimated using Kaplan-Meier methodology, and compared between groups using log-rank test and multivariable Cox regression. Time on treatment, number of cycles, receipt of second-line therapy, and toxicities were compared between groups.
Of 438 patients, 320 (73 %) received 5FU and 118 (27 %) received a taxane. Taxane use became more frequent over time and was higher in academic vs community practices (51 % vs 23 %, p < 0.001). OS did not differ between taxane and 5FU groups (mOS 12.2 vs 13.4 months, p = 0.662). On multivariable Cox regression, HR for death associated with taxane vs 5FU was 0.99 (95 %CI 0.71-1.38). Receipt of 2L therapy was numerically higher for 5FU patients (46 %) compared to taxane patients (35 %, p = 0.071). Grade ≥ 3 anemia was more common in taxane patients (33 % vs 20 %, p = 0.003), whereas grade ≥ 3 lymphopenia and thrombocytopenia were numerically higher in 5FU patients.
In patients with r/m HNSCC undergoing chemoimmunotherapy, taxane vs 5FU use varies by practice setting and geographical region. Platinum/taxane/pembrolizumab was associated with similar survival as platinum/5FU/pembrolizumab; these results suggest that chemoimmunotherapy with taxane is a reasonable alternative to 5FU.
帕博利珠单抗联合化疗是复发/转移性头颈部鳞状细胞癌（r/m HNSCC）的标准治疗方法。尽管监管机构批准了铂类/5-FU/帕博利珠单抗，但出于方便和耐受性的考虑，紫杉烷类药物通常替代 5-FU。本研究旨在描述全美范围内的使用模式，并比较铂类/紫杉烷类/帕博利珠单抗与铂类/5-FU/帕博利珠单抗的治疗结局。
纳入了 2017 年至 2022 年期间在全美数据库中接受铂类联合帕博利珠单抗化疗治疗 r/m HNSCC 的患者。总结了患者的人口统计学和癌症特征。使用 Kaplan-Meier 法估计总生存期（OS），并通过对数秩检验和多变量 Cox 回归比较组间差异。比较了两组患者的治疗时间、周期数、二线治疗的接受情况和毒性反应。
在 438 名患者中，320 名（73%）接受了 5-FU，118 名（27%）接受了紫杉烷类药物。随着时间的推移，紫杉烷类药物的使用频率逐渐增加，在学术医疗中心的使用率（51%）明显高于社区实践（23%）（p<0.001）。紫杉烷类药物和 5-FU 组的 OS 无显著差异（mOS 分别为 12.2 个月和 13.4 个月，p=0.662）。多变量 Cox 回归分析显示，紫杉烷类药物与 5-FU 相比，死亡风险的 HR 为 0.99（95%CI 0.71-1.38）。5-FU 组患者接受二线治疗的比例（46%）略高于紫杉烷类药物组（35%）（p=0.071）。紫杉烷类药物组的 3 级及以上贫血发生率（33%）明显高于 5-FU 组（20%）（p=0.003），而 5-FU 组的 3 级及以上淋巴细胞减少症和血小板减少症发生率略高于紫杉烷类药物组。
在接受铂类联合免疫检查点抑制剂治疗的 r/m HNSCC 患者中，紫杉烷类药物与 5-FU 的使用因实践环境和地理位置而异。铂类/紫杉烷类/帕博利珠单抗与铂类/5-FU/帕博利珠单抗的生存结果相似；这些结果表明，紫杉烷类药物的化疗免疫治疗是 5-FU 的合理替代方案。
