Immune checkpoint inhibitors (ICIs) have demonstrated clinical efficacy in recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, it remains a matter of debate which patient populations derive clinical benefit from salvage chemotherapy (SCT) following disease progression after ICI therapy. This retrospective study included 97 patients with R/M HNSCC who received ICI therapy (nivolumab or pembrolizumab). Patients were classified into SCT (n=54) and non-SCT (n=43) groups after ICI failure. Survival outcomes, response rates, and clinical variables were compared between groups. The SCT group showed a significantly longer median overall survival (OS) compared to the non-SCT group (16.6 vs. 2.4 months, p<0.0001). These findings indicate that patients who received SCT had markedly better outcomes. Multivariate analysis identified SCT hazard ratio (HR)=4.93, p<0.00001 and ECOG PS0,1 (HR=2.42, p=0.0257) as independent prognostic factors for OS. Patients treated with paclitaxel plus cetuximab (PTX + Cmab) had higher objective response rate (ORR) (50%) and disease control rate (DCR) (68.4%) compared to other regimens. SCT after ICI failure significantly improves survival in R/M HNSCC, particularly when using PTX+Cmab. Patients who received SCT had substantially better outcomes than those who did not. ECOG PS and sarcopenia status should be considered in treatment selection.
Abe et al. (Thu,) studied this question.