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Survival impact of sequential chemotherapy following pembrolizumab for recurrent or metastatic head and neck squamous cell carcinoma

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Abstract

Background

Pembrolizumab alone or combined with chemotherapy is the standard of care for first-line treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) with positive programmed death-ligand 1 combined positive scores. However, data on second-line chemotherapy following pembrolizumab are scarce.

Methods

A single-center, retrospective study was conducted to determine the efficacies of pembrolizumab and pembrolizumab plus chemotherapy as first-line treatments and the efficacy of second-line chemotherapy for patients with R/M HNSCC who were refractory or intolerant to first-line treatment.

Results

Fifty-four patients were treated with pembrolizumab, and 29 received second-line therapy, with 27 opting for cetuximab-containing regimens. The median progression-free survival (PFS), overall survival (OS), and PFS on next-line therapy for first-line treatment were 4.7 (95% confidence interval [CI], 2.1–8.7), 22.1 (95% CI, 12.6–not reached), and 15.6 months (95% CI, 9.7–not reached) in the pembrolizumab group and 5.4 (95% CI, 3.3–6.8), 15.8 (95% CI, 8.6–not reached), and 13.7 months (95% CI, 8.1–not reached) in the pembrolizumab plus chemotherapy group, respectively. The overall response rate and median PFS for second-line treatment were 48.3% (95% CI, 30.4–67.0) and 6.1 months (95% CI, 2.30–8.84). The median OS for patients who received second-line treatment was 18.4 months, which was superior to the median OS of 6.0 months for patients who received the best supportive care (log-rank p = 0.10).

Conclusion

This study indicates that cetuximab-containing second-line chemotherapy can improve outcomes in R/M HNSCC, even after first-line therapy failure or intolerance.

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

Funding

This study was conducted without any funding.

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Authors and Affiliations

  1. Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan

    Sho Iwaki, Michi Sawabe, Hidenori Suzuki, Daisuke Nishikawa, Shintaro Beppu, Hoshino Terada, Toshihiro Kishikawa & Nobuhiro Hanai

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Sho Iwaki & Daisuke Kawakita

  3. Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan

    Shigenori Kadowaki, Kazunori Honda, Yukiya Narita, Toshiki Masuishi, Hiroya Taniguchi, Masashi Ando & Kei Muro

  4. Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan

    Toshihiro Kishikawa

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  1. Sho Iwaki
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Corresponding author

Correspondence to Shigenori Kadowaki.

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Conflict of interest

K. Honda reports research funding from Pfizer. S. Kadowaki reports honoraria from Bristol-Myers Squibb, Ono Pharmaceutical, Bayer, Merck Biopharma, Taiho Pharmaceutical, Eisai, Daiichi Sankyo, MSD, Chugai, and Otsuka Pharmaceutical and research funding from Bristol-Myers Squibb, Ono Pharmaceutical, Bayer, Daiichi Sankyo, MSD, Chugai, Janssen, Nobelpharma, and Eli Lilly. Y. Narita reports honoraria from Ono Pharmaceutical, Bristol-Myers Squibb, Yakult Honsha, Taiho Pharmaceutical, Eli Lilly, Daiichi Sankyo, and AstraZeneca and research funding from Ono Pharmaceutical, Bristol-Myers Squibb, and AstraZeneca. T. Masuishi reports honoraria from Takeda Pharmaceutical, Chugai, Merck Biopharma, Taiho Pharmaceutical, Bayer, Eli Lilly, Yakult Honsha, Sanofi, Daiichi Sankyo, Ono Pharmaceutical, Bristol-Myers Squibb, and Nippon Kayaku and research funding from MSD, Daiichi Sankyo, Ono Pharmaceutical, Novartis, Amgen, Syneos Health Clinical, Boehringer Ingelheim, Pfizer, Cimic Shift Zero, and Eli Lilly. H. Taniguchi reports honoraria from Takeda Pharmaceutical, Taiho Pharmaceutical, Eli Lilly, Merck Biopharma and research funding from Takeda Pharmaceutical and Daiichi Sankyo. M. Ando reports honoraria from Eisai, Ono Pharmaceutical, Chugai, and Taiho Pharmaceutical. K. Muro reports honoraria from Ono Pharmaceutical, Bristol-Myers Squibb, Eli Lilly, Daiichi Sankyo, MSD, and Taiho Pharmaceutical and research funding from Amgen, Astellas, PRA Health Sciences, Taiho Pharmaceutical, Chugai, PAREXEL International, Ono Pharmaceutical, Sanofi, MSD and Novartis. N. Hanai reports honoraria from MSD, Merck Biopharma, Eisai, Bristol-Myers Squibb, Rakuten Medical, and Ono Pharmaceutical and research funding from GlaxoSmithKline, Chugai, Rakuten Medical, MSD, and Adlai Nortye. No disclosures were reported by the other authors.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Boards of the Aichi Cancer Center Hospital (IR051031).

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Iwaki, S., Kadowaki, S., Honda, K. et al. Survival impact of sequential chemotherapy following pembrolizumab for recurrent or metastatic head and neck squamous cell carcinoma. Int J Clin Oncol (2024). https://doi.org/10.1007/s10147-024-02508-0

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