Chan Sze Wah Samuel, Al Maqrashi Zainab Ali Amer, Young Jack, Kim Do-Hoon, Pond Gregory, Meyers Brandon M, Kartolo Adi
Department of Oncology, McMaster University, Hamilton, ON, Canada.
Escarpment Cancer Research Institute, Juravinski Cancer Centre, Hamilton, ON, Canada.
Immunotherapy. 2024;16(20-22):1227-1233. doi: 10.1080/1750743X.2024.2436346. Epub 2024 Dec 6.
Head and squamous cell carcinoma (HNSCC) in the locally advanced setting is challenging to treat and remains an area of significant morbidity and mortality. For patients who are cisplatin-ineligible and considered unresectable, there is no clear standard of care including the choice of radiosensitizer.
OVID Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched. Randomized clinical trials (RCTs) of cisplatin-ineligible unresectable HNSCC patients who were randomized to an immune checkpoint inhibitor concurrent with radiation compared to a control arm were included. Data was pooled and assessed using a random-effects model for the meta-analysis.
Three eligible RCTs were identified and analyzed which comprised 594 patients whose median age ranged from 65-72 years. There was no difference in overall survival (pooled HR 1.02, 95% CI 0.76-1.37, = 0.88) or PFS (pooled HR 0.92, 95% CI 0.68-1.23, = 0.56). Grade greater than or equal to 3 adverse events were favored to be less in the immunotherapy arm.
Immune-checkpoint inhibitors are not superior to cetuximab when used with definitive radiation in HNSCC. Further study is warranted, given its potential signal for non-inferior survival with less toxicity profile trends.
局部晚期头颈部鳞状细胞癌（HNSCC）的治疗具有挑战性，仍然是发病率和死亡率较高的领域。对于不符合顺铂治疗条件且被认为无法切除的患者，尚无明确的治疗标准，包括放射增敏剂的选择。
系统检索了OVID Medline、EMBASE和Cochrane对照试验中央注册库。纳入了不符合顺铂治疗条件的不可切除HNSCC患者的随机临床试验（RCT），这些患者被随机分配接受免疫检查点抑制剂联合放疗，与对照组进行比较。采用随机效应模型对数据进行汇总和评估，以进行荟萃分析。
确定并分析了三项符合条件的RCT，共纳入594例患者，中位年龄在65至72岁之间。总生存期（合并风险比1.02，95%置信区间0.76 - 1.37，P = 0.88）或无进展生存期（合并风险比0.92，95%置信区间0.68 - 1.23，P = 0.56）无差异。免疫治疗组大于或等于3级不良事件的发生率较低。
在HNSCC的根治性放疗中，免疫检查点抑制剂与西妥昔单抗相比并无优势。鉴于其在生存方面有非劣效性且毒性较低的潜在趋势，有必要进一步研究。
