在局部晚期口咽癌术前化疗中添加程序性细胞死亡蛋白1抑制剂的疗效和安全性。
The efficacy and safety of the addition of programmed cell death protein 1 inhibitor to preoperative chemotherapy in locoregionally advanced oropharyngeal carcinoma.
作者信息
Lu Guan-Zhong, Hong Zhi-Cong, Yu Yi-Feng, Guo Lin-Feng, Ginat Daniel T, Wu San-Gang, Guan Li-Mei
机构信息
Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Department of Otolaryngology-Head and Neck Surgery, Xiamen Key Laboratory of Otolaryngology-Head and Neck Surgery, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
出版信息
Transl Cancer Res. 2025 Feb 28;14(2):1401-1414. doi: 10.21037/tcr-2025-202. Epub 2025 Feb 26.
BACKGROUND
Immune checkpoint inhibitors have shown promise in improving the survival rates for recurrent and/or metastatic head and neck cancers. However, their impact on curative outcomes in head and neck cancers remains undefined, especially for those with locoregionally advanced oropharyngeal carcinoma (LAOPC), a subtype of head-and-neck malignancy closely associated with human papillomavirus infection. This study aimed to clarify the efficacy and safety of the addition of programmed cell death protein 1 (PD-1) inhibitor into preoperative chemotherapy in LAOPC.
METHODS
We retrospectively included patients with LAOPC who underwent preoperative immunochemotherapy between 2021 and 2024. Statistical analyses were conducted using chi-square tests. The efficacy was assessed using Response Evaluation Criteria in Solid Tumors (RECIST; version 1.1). Safety was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) 5.0.
RESULTS
A total of 23 patients were identified, and 11 (47.8%) had P16-positive tumors. There were 22 patients (95.7%) who completed two cycles of preoperative treatment. Among the 23 patients, the response to primary tumors and neck metastatic lymph nodes could be assessed in 21 and 22 patients, respectively. Additionally, 13 (61.9%) patients had a major pathologic response to the primary tumor, including 12 patients (57.1%) who achieved a pathologic complete response (PCR). In addition, 11 (50.0%) patients had a PCR in the metastatic cervical lymph nodes, while 11 (50.0%) patients still had residual tumors in the lymph nodes. The combined positive score and P16 status were not significantly associated with PCR to the primary tumor or neck metastatic lymph nodes. Moreover, 19 (82.6%) patients experienced treatment-related adverse effects, with the majority being grade 1-2 toxicities, and only 2 (8.7%) patients had grade 3 or higher toxicities. No treatment-related deaths occurred.
CONCLUSIONS
The incorporation of a PD-1 inhibitor into preoperative chemotherapy may be an effective approach for treating LAOPC and involve acceptable toxicity.
背景
免疫检查点抑制剂在提高复发性和/或转移性头颈癌的生存率方面显示出前景。然而，它们对头颈癌根治性治疗结果的影响仍不明确，尤其是对于那些局部晚期口咽癌（LAOPC）患者，这是一种与人类乳头瘤病毒感染密切相关的头颈恶性肿瘤亚型。本研究旨在阐明在LAOPC患者的术前化疗中添加程序性细胞死亡蛋白1（PD-1）抑制剂的疗效和安全性。
方法
我们回顾性纳入了2021年至2024年间接受术前免疫化疗的LAOPC患者。使用卡方检验进行统计分析。疗效采用实体瘤疗效评价标准（RECIST；1.1版）进行评估。安全性采用不良事件通用术语标准（CTCAE）5.0进行评估。
结果
共确定了23例患者，其中11例（47.8%）肿瘤P16阳性。22例（95.7%）患者完成了两个周期的术前治疗。在这23例患者中，分别有21例和22例患者的原发肿瘤和颈部转移淋巴结的反应可进行评估。此外，13例（61.9%）患者对原发肿瘤有主要病理反应，其中12例（57.1%）达到病理完全缓解（PCR）。另外，11例（50.0%）患者颈部转移淋巴结达到PCR，而11例（50.0%）患者淋巴结仍有残留肿瘤。联合阳性评分和P16状态与原发肿瘤或颈部转移淋巴结的PCR无显著相关性。此外，19例（82.6%）患者出现治疗相关不良反应，大多数为1-2级毒性，只有2例（8.7%）患者出现3级或更高等级毒性。未发生与治疗相关的死亡。
结论
在术前化疗中加入PD-1抑制剂可能是治疗LAOPC的有效方法，且毒性可接受。
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