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Published on: April 22, 2019
Short-course pembrolizumab and continuous afatinib therapy for recurrent or metastatic head and neck squamous cell
Hsiang-Fong Kao1, Huai-Cheng Huang2, Bin-Chi Liao1
1Department of Medical Oncology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd, Da'an Dist, Taipei, 106, Taiwan.
Objectives:
The optimal duration of anti-PD-1 for cancer therapy has not been tested, especially when using combination therapy. Epidermal growth factor receptor (EGFR) pathway blocker was the top compound that enhanced T-cell killing of tumor cells in a high-throughput immune-oncology screen, possibly by stimulate the antigen presentation machinery and other mechanisms. We explored the effect of combination of EGFR inhibition with a short course of anti-PD-1 therapy in patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC).
Method:
We analyzed the effect of a short course of anti-PD-1 with continuous afatinib on the survival of a real-world cohort of R/M HNSCC patients. Patient characteristics, treatments, efficacies, and toxicities were reviewed and recorded for analysis.
Results:
From November 2016 to May 2018, 51 consecutive patients received pembrolizumab and afatinib. The cutoff date was June 30, 2022. The most common toxicities (all grades) were diarrhea (62.7%), skin rash (43.1%), mucositis (31.4%), and paronychia (23.5%). The objective response rate was 54.9% (95% confidence interval [CI] 40.3-68.9%). Median progression-free survival was 5.9 months (95% CI: 4.4-7.6 months), and the median overall survival was 10.5 months (95% CI: 6.8-16.5 months). The 12-month, 24-month, 36-month, and 48-month survival rate was 47.0%, 22.5%, 17.7%, and 12.6% respectively.
Conclusions:
This retrospective study showed that short course pembrolizumab with afatinib therapy has acceptable efficacy in R/M HNSCC patients. The durable response and long-term survival rates were similar to prospective clinical trials. Short course anti-PD-1 therapy, especially in combination with EGFR blocker, is worth for further prospective study.
Insights
This study found that a short course of anti-PD-1 therapy combined with an EGFR inhibitor (afatinib) showed promising efficacy and acceptable toxicity in recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients.
Area of Science:
- Oncology
- Immunotherapy
- Head and Neck Cancer Research
Background:
- The optimal duration of anti-PD-1 therapy in combination regimens is not well-established.
- Epidermal growth factor receptor (EGFR) pathway inhibitors enhance T-cell mediated tumor killing.
- Recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) has limited treatment options.
Purpose of the Study:
- To evaluate the efficacy and safety of a short course of anti-PD-1 therapy combined with continuous EGFR inhibition (afatinib).
- To assess survival outcomes in patients with R/M HNSCC treated with this combination regimen.
Main Methods:
- Retrospective analysis of a real-world cohort of 51 R/M HNSCC patients treated with pembrolizumab and afatinib.
- Review of patient characteristics, treatment details, efficacy, and toxicity data.
- Survival analysis including progression-free survival (PFS) and overall survival (OS).
Main Results:
- The objective response rate was 54.9% with a median PFS of 5.9 months and median OS of 10.5 months.
- Common toxicities included diarrhea (62.7%), skin rash (43.1%), and mucositis (31.4%).
- Long-term survival rates at 12, 24, 36, and 48 months were 47.0%, 22.5%, 17.7%, and 12.6%, respectively.
Conclusions:
- Short course pembrolizumab with afatinib demonstrates acceptable efficacy and manageable toxicity in R/M HNSCC.
- The observed durable responses and survival rates are comparable to those in prospective trials.
- Further prospective investigation of short-course anti-PD-1 therapy, particularly with EGFR inhibitors, is warranted.
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