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Performance status (PS) as a predictor of poor response to immune checkpoint inhibitors (ICI) in recurrent/metastatic head and neck cancer (RMHNSCC) patients. | LitMetric

AI Article Synopsis

  • - The study reviewed recurrent/metastatic head and neck squamous cell carcinoma patients treated with anti-PD1 checkpoint inhibitors, focusing on those with poorer performance statuses (ECOG PS ≥2), a group often excluded from clinical trials.
  • - Results showed that patients with ECOG PS ≥2 had significantly shorter overall survival (OS), lower objective response rates (ORR), and higher rates of unplanned hospitalizations (UH) compared to those with better performance scores.
  • - The findings underscore the need for tailored treatment discussions for patients with poor performance status, as they may not benefit as much from standard ICI therapies used for healthier patients.

Article Abstract

Background: Anti-PD1 checkpoint inhibitors (ICI) represent an established standard-of-care for patients with recurrent/metastatic head and neck squamous cell carcinoma (RMHNSCC). Landmark studies excluded patients with ECOG performance status (PS) ≥2; the benefit of ICI in this population is therefore unknown.

Methods: We retrospectively reviewed RMHNSCC patients who received 1+ dose of ICI at our institution between 2013 and 2019. Demographic and clinical data were obtained; the latter included objective response (ORR), toxicity, and any unplanned hospitalization (UH). Associations were explored using uni- and multivariate analysis. Overall survival (OS) was estimated using a Cox proportional hazards model; ORR, toxicity, and UH were evaluated with logistic regression.

Results: Of the 152 patients, 29 (19%) had an ECOG PS ≥2. Sixty-six (44%) experienced toxicity; 54 (36%) had a UH. A multivariate model for OS containing PS, smoking status, and HPV status demonstrated a strong association between ECOG ≥2 and shorter OS (p < 0.001; HR = 3.30, CI = 2.01-5.41). An association between OS and former (vs. never) smoking was also seen (p < 0.001; HR = 2.17, CI = 1.41-3.35); current smoking did not reach statistical significance. On univariate analysis, poor PS was associated with inferior ORR (p = 0.03; OR = 0.25, CI = 0.06-0.77) and increased UH (p = 0.04; OR = 2.43, CI = 1.05-5.71). There was no significant association between toxicity and any patient characteristic.

Conclusions: We observed inferior OS, ORR, and rates of UH among ICI-treated RMHNSCC patients with ECOG 2/3. Our findings help frame discussion of therapeutic options in this poor-risk population.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9678089PMC
http://dx.doi.org/10.1002/cam4.4722DOI Listing

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