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

Cameron Chalker, Jenna M. Voutsinas, Qian Vicky Wu, Rafael Santana-Davila, Victoria Hwang, Christina S. Baik, Sylvia Lee, Brittany Barber, Neal D. Futran, Jeffrey J. Houlton, George E. Laramore, Jay Justin Liao, Upendra Parvathaneni, Renato G. Martins, Keith D. Eaton, Cristina P. Rodriguez

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)4104-4111
Number of pages8
JournalCancer Medicine
Volume11
Issue number22
DOIs
StatePublished - Nov 2022
Externally publishedYes

Keywords

  • checkpoint control
  • clinical cancer research
  • clinical management
  • head and neck cancer
  • immunology
  • prognostic factor

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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