Systemic therapy for recurrent and/or metastatic head and neck cancer: a population-based healthcare research study in Thuringia, Germany

Lisa Morkramer,Orlando Guntinas-Lichius,Daniel Boeger,Maren Geitner,Thomas Ernst,Holger Kaftan,Andreas H Mueller,Jens Buentzel

doi:10.1007/s00432-021-03535-4

Abstract

PurposeSystemic therapy choice for patients with recurrent and/or metastatic head and neck cancer (R/M HNC) is a challenge. Not much is known about systemic therapies used in daily clinical routine and their outcome.MethodsData of all 283 patients with R/M HNC (89.4% male, median age: 60 years) registered for first-line systemic therapy between 2015 and 2018 in the cancer registries of Thuringia, a federal state in Germany, were included. Patient characteristics and treatment patterns were summarized. Exploratory univariate and multivariate analyses were conducted on select of systemic therapy and prognostic factors for overall survival.ResultsThe most frequent first-line regimens were platinum-based combinations (71.4%), mainly cetuximab + platinum + 5-fluorouracil (32.5%). 32.5, 13.1, 4.9, and 1.1%, respectively, received, a second, third, fourth, and fifth line of systemic therapy. Median follow-up was 5.5 months. Median real-world overall survival was 16.8 months [95% confidence interval (CI) 11.1–22.6]. Alcohol drinking [hazard ratio (HR) 2.375, CI 1.471–3.831; p < 0.001], no second-line therapy (HR 3.425, CI 2.082–5.635, p < 0.001), and application of three agents compared to one agent in first-line therapy (HR 2.798, CI 1.374–5.697; p = 0.005) were associated to decreased overall survival after start of first-line systemic therapy. Termination of second-line treatment because of deterioration of the general condition was the only independent negative prognostic factor (HR 4.202, CI 1.091–16.129; p = 0.037) after start of second-line systemic therapy.ConclusionsThis study offers useful information, mainly prior to the availability of immunotherapy, on patient characteristics, treatment patterns, and survival in a German real-world population.

Highlights

More than half of patients with head and neck cancer (HNC) initially present with locoregionally advanced disease (Chow 2020; Grunwald et al 2020)
The Phase 3 KEYNOTE-048 trial demonstrated in the first-line recurrent and/or metastatic HNC (R/M HNC) setting, that the checkpoint inhibitor pembrolizumab in combination with chemotherapy and as monotherapy in patients with programmed death-ligand 1 (PD-L1) biomarker expression significantly improved Overall survival (OS) compared to standard treatment with cetuximab in combination with platinum-based chemotherapy (Burtness et al 2019)
About one-third of the patients were chemotherapy/immunotherapy naïve, whereas the others had already received a chemotherapy as part of the primary treatment

Summary

Introduction

More than half of patients with head and neck cancer (HNC) initially present with locoregionally advanced disease (stage III–IVb) (Chow 2020; Grunwald et al 2020). Head and neck cancer guidelines recommend the inclusion of R/M HNC patients into ongoing clinical trials and, with a lower level of evidence, other chemotherapy combinations or single-agent treatment options (David et al 2020). It was shown treatment with immune checkpoint inhibitors like with anti-programmed death 1 (PD1) antibodies nivolumab or pembrolizumab improve overall survival in patients who progress after platinum containing chemotherapy compared to investigator’s choice systemic therapy (Ferris et al 2018; Cohen et al 2019). The NCCN guideline considers pembrolizumab monotherapy as a preferred first-line option for patients with significant biomarker expression

Methods

Results

Discussion

Conclusion