Obata Kazufumi, Kano Satoshi, Ohkoshi Akira, Kakiuchi Akito, Inoue Takahiro, Taguchi Jun, Tagawa Ai, Matsushita Daisuke, Miyaguchi Jun, Endo Tentaro, Ishii Ryo, Ito Kazue, Ishida Eiichi, Suzuki Takahiro, Araki Naoto, Kawase Tomotaka, Takano Kenichi
Department of Otolaryngology-Head and Neck Surgery, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo 060-8556, Japan.
Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1143, Japan.
Jpn J Clin Oncol. 2025 Sep 5;55(9):1013-1021. doi: 10.1093/jjco/hyaf088.
Immune checkpoint inhibitors (ICIs) improve outcomes in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, some patients remain unresponsive to treatment, necessitating further investigation into optimal therapeutic strategies and prognostic biomarkers. This study aimed to evaluate the efficacy of various therapies and identify factors influencing overall survival (OS) in these patients.
We retrospectively analyzed 606 patients (517 men, 89 women; median age 68 years) treated at 13 head and neck cancer specialty facilities in Japan between January 2018 and December 2022. Associations between OS and variables, including age, sex, primary site, Eastern Cooperative Oncology Group performance status, estimated glomerular filtration rate, therapeutic target lesion, history of drug use in systemic chemotherapy, number of treatment lines, nondrug treatments, de novo metastasis, programmed death-ligand 1 combined positive score, and platinum resistance were statistically examined.
Median OS was 14.2 months, and median progression-free survival was 5.0 months. Multivariate analysis identified poor OS in patients with oral cavity tumors and performance status 2-3, whereas ICI therapy and nondrug salvage interventions were associated with improved OS. ICI/non-ICI subgroup analysis revealed that ICI may have a limited effect on oral cancer. Additionally, our results indicated that a history of platinum therapy for R/M HNSCC may not affect the therapeutic efficacy of ICIs.
For patients with R/M HNSCC, further OS improvement may be achieved using ICIs or aggressive nondrug salvage therapy and by considering the use of chemotherapy other than ICI for patients with oral cancer or poor PS.
免疫检查点抑制剂（ICI）可改善复发/转移性头颈部鳞状细胞癌（R/M HNSCC）的治疗效果。然而，一些患者对治疗仍无反应，因此有必要进一步研究最佳治疗策略和预后生物标志物。本研究旨在评估各种治疗方法的疗效，并确定影响这些患者总生存期（OS）的因素。
我们回顾性分析了2018年1月至2022年12月期间在日本13家头颈癌专科机构接受治疗的606例患者（517例男性，89例女性；中位年龄68岁）。对OS与变量之间的关联进行了统计学检验，这些变量包括年龄、性别、原发部位、东部肿瘤协作组体能状态、估计肾小球滤过率、治疗靶病灶、全身化疗用药史、治疗线数、非药物治疗、新发转移、程序性死亡配体1联合阳性评分和铂耐药性。
中位OS为14.2个月，中位无进展生存期为5.0个月。多变量分析确定口腔肿瘤患者和体能状态为2-3级的患者OS较差，而ICI治疗和非药物挽救干预与OS改善相关。ICI/非ICI亚组分析显示，ICI对口腔癌的影响可能有限。此外，我们的结果表明，R/M HNSCC的铂类治疗史可能不会影响ICI的治疗效果。
对于R/M HNSCC患者，使用ICI或积极的非药物挽救治疗，以及考虑对口腔癌或PS较差的患者使用ICI以外的化疗，可能会进一步提高OS。
