The standard treatment for recurrent or metastatic head and neck caners has always been chemotherapy. But that’s now changing, after several phase 3 studies showed that immunotherapy is more effective.
The current treatment plan for patients with recurrent or metastatic head and neck cancers usually includes platinum-based chemotherapy with an EGFR inhibitor called cetuximab, which are given in six 3-week cycles. The protocol is known as the EXTREME regimen.
The results of the three randomized studies were presented at HemOnc Today New York.
One study, KEYNOTE 040, was published last year. It revealed that the anti-PD-1 drug pembrolizumab (Keytruda) increased overall survival in comparison with standard chemotherapy in patients with recurrent or metastatic head and neck squamous cell carcinoma.
Another study, KEYNOTE 048, showed that pembrolizumab monotherapy significantly extended the median overall survival rate in comparison to the EXTREME regimen in patients with a PD-L1 combined positive score (CPS) of 20 or higher. It also showed a smaller life extension in patients with a CPS of 1 or higher. Researchers anticipate that this study will have the biggest impact in change of care for patients with recurrent or metastatic head and neck cancers.
According to Robert Haddad, MD, chief of the division of head and neck oncology at Dana-Farber Cancer Institute, patients with metastatic head and neck cancers have extremely poor quality of life. They are typically living with extensive pain and cannot work, take care of their families, or enjoy a social life. The results of these studies are thus very positive for these patients as they could improve their outcomes.
Haddad said the results were “a big surprise” for many of the researchers. “What this is telling us,” he said,” is that using these drugs earlier increases the chances of seeing a response rate.”
It’s still unclear whether the standard treatment for these patients will be immunotherapy alone or a combination of chemotherapy and immunotherapy. The research did reveal that pembrolizumab combined with chemotherapy showed better overall survival rates then the EXTREME regimen.
Haddad said that “data are currently being reviewed by the FDA,” and the team “expect[s] a decision to come in the next few months.” His guess is that the EXTREME regimen will be eliminated as a first line treatment since it seems to be less useful than immunotherapy.