Abstract
Background Head and neck squamous cell carcinoma (HNSCC) in Asia and South Pacific is associated with betel-nut chewing. In Lux-Head & Neck1, the impact of afatinib for betel-nut-chewing associated HNSCC is not well characterized. The biology of betel-nut-chewing associated HNSCC is not similar to other types of HNSCC. This retrospective study is aimed to evaluate the efficacy of afatinib for this population. Methods Patients with locally advanced or metastatic HNSCC were retrospectively reviewed in a university hospital in Taiwan from Apr 2014 to Feb 2015. Patients taking afatinib for palliative intent were recorded for analysis. The history of alcohol drinking, betel nut chewing, and cigarette smoking were coded according to medical records. The clinical response described in medical records were retrieved. Results Eighty HNSCC patients taking afatinib for palliative intent were recorded. In this population, 72 (90%) were male, 58 (72.5%) were oral cavity HNSCC, 53(66%) had history of betel-nut chewing, 46 (57.5%) had history of smoking, 67 (84%) had local recurrence, and 26 (32%) had distant metastases. The progression free survival between betel-nut-chewing and non-betel-nut-chewing were: median (95% confidence interval): 2.6 (2.0-3.2) vs 3.0 (2.2-3.9) months (hazard ratio:1.23 (95% CI: 0.732-2.072), p = 0.433). Patients without distant metastases had a better survival (HR: 0.31, 95% CI: 0.15-0.62), p = 0.001). Patients with poorly differentiated squamous cell carcinoma may predict worse survival (HR: 5.51, 95% CI: 0.87-34. 82, p = 0.069). An earlier treatment with a fatinib may predict better survival (palliative chemotherapy lines before afatinib: 0 or 1 line vs 2 lines or more: HR: 0.5, 95% CI: 0.29-0.86, p = 0.013). Conclusions The effect of afatinib for betel-nut-chewing associated HNSCC is comparative to the result of LUX-Head & Neck 1. Further confirmatory study of afatinib for this population is mandatory. Legal entity responsible for the study Hsiang-Fong Kao Funding National Taiwan University Hospital Disclosure All authors have declared no conflicts of interest.
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