复发性/转移性头颈部鳞状细胞癌免疫治疗进展后的挽救性化疗。
Salvage chemotherapy after progression on immunotherapy in recurrent/metastatic squamous cell head and neck carcinoma.
作者信息
Llop Sandra, Plana Maria, Tous Sara, Ferrando-Díez Angelica, Brenes Jesús, Juarez Marc, Vidales Zara, Vilajosana Esther, Linares Isabel, Arribas Lorena, Duch Maria, Fulla Marta, Brunet Aina, Lozano Alicia, Cirauqui Beatriz, Mesía Ricard, Oliva Marc
机构信息
Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.
Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
出版信息
Front Oncol. 2024 Nov 25;14:1458479. doi: 10.3389/fonc.2024.1458479. eCollection 2024.
OBJECTIVES
Anti-PD-(L)1 agents changed the landscape of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) treatment. Previous studies showed improved response rates to salvage chemotherapy (SCT) after progression to anti-PD-(L)1 agents. This study aims to evaluate the outcomes of SCT and to identify predictors of response and survival in patients with R/M HNSCC.
MATERIALS AND METHODS
Retrospective cohort analysis of 63 R/M patients treated with SCT after antiPD-(L1)-based therapy between January 2015 and August 2022. The overall response rate (ORR) was evaluated. Progression-free survival (PFS) and overall survival (OS) were estimated with Kaplan-Meier method. Progression-free survival 2 was calculated from anti-PD-(L)1-therapy start until progression to SCT (PFS2-I). Logistic regression and Cox regression analyses were performed to identify predictors of outcome.
RESULTS
A total of 63 patients were included: 76% were men, and median age was 60 years. PD-L1 status was available in 68% (61% positive). Up to 71% received SCT as third line or beyond. ORR to SCT was 49% with higher rates in PD-L1 positive tumors, 71% vs. 18% (p=0.001), and cetuximab-containing regimens, 68% vs. 39% (p=0.026). PD-L1 status was the only predictor of ORR in the adjusted model (OR=8.6, 95% CI 1.7-43.0). OS and PFS were 9.3 months (95% CI, 6.5-12.3) and 4.1 months (95% CI, 3.0-5.8) respectively. PFS2-I was 8.6 months (95% CI, 6.6-10.5). In the multivariate analysis, PD-L1 was the only independent factor for OS (HR=0.3; 95% CI, 0.1-0.7), PFS (HR=0.2; 95% CI, 0.1-0.5; p<0.001), and PFS2-I (HR=0.2; 95% CI 0.1-0.5; p<0.001).
CONCLUSION
PDL1 status appeared as a strong predictor of response of efficacy for SCT after anti-PD-(L)1 agents. Patients receiving cetuximab-containing regimens trended towards greater benefit. This highlights the importance of treatment sequencing and personalized treatment strategies.
目的
抗程序性死亡蛋白（PD）-(L)1药物改变了复发或转移性头颈部鳞状细胞癌（R/M HNSCC）的治疗格局。既往研究显示，在进展至抗PD-(L)1药物治疗后，挽救性化疗（SCT）的缓解率有所提高。本研究旨在评估SCT的疗效，并确定R/M HNSCC患者缓解和生存的预测因素。
材料与方法
对2015年1月至2022年8月间接受基于抗PD-(L)1治疗后接受SCT的63例R/M患者进行回顾性队列分析。评估总缓解率（ORR）。采用Kaplan-Meier法估计无进展生存期（PFS）和总生存期（OS）。无进展生存期2从抗PD-(L)1治疗开始计算至进展至SCT（PFS2-I）。进行逻辑回归和Cox回归分析以确定结局的预测因素。
结果
共纳入63例患者：76%为男性，中位年龄为60岁。68%的患者可获得PD-L1状态（61%为阳性）。高达71%的患者接受SCT作为三线或更后线治疗。SCT的ORR为49%，PD-L1阳性肿瘤的缓解率更高，分别为71%和18%（p=0.001），含西妥昔单抗方案的缓解率分别为68%和39%（p=0.026）。在调整模型中，PD-L1状态是ORR的唯一预测因素（OR=8.6, 95%CI 1.7-43.0）。OS和PFS分别为9.3个月（95%CI, 6.5-12.3）和4.1个月（95%CI, 3.0-5.8）。PFS2-I为8.6个月（95%CI, 6.6-10.5）。在多变量分析中，PD-L1是OS（HR=0.3; 95%CI, 0.1-0.7）、PFS（HR=0.2; 95%CI, 0.1-0.5; p<0.001）和PFS2-I（HR=0.2; 95%CI 0.1-0.5; p<0.001）的唯一独立因素。
结论
PD-L1状态似乎是抗PD-(L)1药物治疗后SCT疗效的强有力预测因素。接受含西妥昔单抗方案治疗患者的获益趋势更大。这凸显了治疗顺序和个性化治疗策略的重要性。
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