Real-world data of use of nivolumab in platinum refractory head and neck cancers.

Abstract

e18686 Background: Nivolumab is one of the approved agents for platinum refractory and second line treatment in head and neck cancers as per NCCN guidelines. However, accessibility of nivolumab in low- and middle-income countries is less than 1-3%.There is data suggesting that low doses of nivolumab can also be effective. Hence in this analysis we explore the outcomes and adverse events with low doses of nivolumab in the second line and beyond setting. Methods: The head and neck medical oncology unit of Tata memorial hospital maintains a prospective database of all patients undergoing immunotherapy. A query was raised in this database to identify head and neck cancer patients who were treated with low doses of nivolumab. We identified 42 patients. The baseline characteristics, compliance to nivolumab, the reason for administration of low dose and the outcomes (progression free survival, date of progression, date of death) were recorded. The dose of nivolumab used in this study was 40 mg flat dose every 2 weeks. Descriptive statistics were performed. Kaplan Meier estimates were used to see overall survival (OS) and progression free survival (PFS). Results: The median age of the patients was 55.8 (IQR: 25.8-82.8) Male to female ratio was 53:11. All patients were platinum refractory and had progressive disease within the last 6 months of the last dose of platinum. The ECOG performance status was 0- 1 in 56 (88.9%) in patients and 2 in 8 (11.1%) patients. Median number of immunotherapy cycles received was 2 (1-4). The response was seen in 15 (23.1%) patients. The median OS was 6.7months (3.4-8.8) and PFS was 2.3 months (0.6-4.02) The details regarding PD L-1 expression and effectiveness of nivolumab will be presented at the conference. Conclusions: Low doses of nivolumab can be an option which is efficacious in patients who do not have access to standard dose nivolumab. There is a need for testing this regimen in large randomized studies as full doses of nivolumab are not accessible to the vast majority of the patients in low- and middle-income countries.