1. Phase II Trial of Adjuvant Nivolumab Following Salvage Resection in Patients with Recurrent Squamous Cell Carcinoma of the Head and Neck.
- Author
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Leddon, Jennifer L, Gulati, Shuchi, Haque, Sulsal, Allen, Casey, Palackdharry, Sarah, Mathews, Maria, Kurtzweil, Nicky, Riaz, Muhammed Kashif, Takiar, Vinita, Nagasaka, Misako, Patil, Yash, Zender, Chad, Tang, Alice, Cervenka, Brian, McGrath, Julie, Korn, W Michael, Hinrichs, Benjamin H, Jandarov, Roman, Harun, Nusrat, Sukari, Ammar, and Wise-Draper, Trisha M
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Dental/Oral and Craniofacial Disease ,Rare Diseases ,Clinical Research ,Clinical Trials and Supportive Activities ,Cancer ,Patient Safety ,Evaluation of treatments and therapeutic interventions ,6.4 Surgery ,6.1 Pharmaceuticals ,Good Health and Well Being ,B7-H1 Antigen ,Carcinoma ,Squamous Cell ,Head and Neck Neoplasms ,Humans ,Neoplasm Recurrence ,Local ,Nivolumab ,Squamous Cell Carcinoma of Head and Neck ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis - Abstract
PurposeLocoregional relapse in patients with head and neck squamous cell carcinoma (HNSCC) is common, approaching 50% for some subsites despite multimodality therapy. Salvage surgery is the standard of care, but able to achieve durable control in only a minority of patients. While adjuvant radiotherapy or chemo-radiotherapy is offered to select patients, this approach can be prohibitively toxic. Given the activity and tolerability of programmed death-1 inhibitors in metastatic HNSCC, we investigated the safety and efficacy of adjuvant nivolumab after salvage surgical resection.Patients and methodsThis was an open-label, multi-institutional phase II clinical trial (NCT03355560). Patients with recurrent, resectable HNSCC were enrolled within 6 weeks of salvage surgery. Six 28-day cycles of adjuvant nivolumab were planned. The primary endpoint was 2-year disease-free survival (DFS) more than 58%, based on an institutional historical control group of 71 patients with recurrent HNSCC who underwent salvage surgery.ResultsBetween February 2018 and February 2020, 39 patients were enrolled. At a median follow-up of 22.1 months, 2-year DFS was 71.4% [95% confidence interval (CI), 57.8-88.1] and the 2-year overall survival (OS) was 73% (95% CI, 58-91.8). Three of 39 (8%) patients experienced grade 3 treatment-related adverse events and 3 of 39 (8%) discontinued treatment due to side effects. Ten of 39 had locoregional recurrence, while 2 of 10 also had synchronous metastatic disease. There was no difference in DFS between PD ligand-1 (PD-L1)-positive and PD-L1-negative patients. There was a nonsignificant trend toward improved DFS in patients with high tumor mutational burden (P = 0.083).ConclusionsAdjuvant nivolumab after salvage surgery in locally recurrent HNSCC is well tolerated and showed improved DFS compared with historical controls.
- Published
- 2022