1058P - Does hyper-progression exist among head and neck cancer patients treated with immunotherapy?

Date 10 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Cancer in Adolescents
Cancer Immunology and Immunotherapy
Head and Neck Cancers
Presenter Ana Ortega Franco
Citation Annals of Oncology (2017) 28 (suppl_5): v372-v394. 10.1093/annonc/mdx374
Authors A. Ortega Franco1, M. Plana1, I. Braña2, M. Taberna Sanz3, M. Oliva Bernal1, S. Vázquez1, M. Domenech Vinyolas4, G. Berenguer1, E. Vilajosana1, M. Bergamino1, N. Baste5, R. Mesia Nin6
  • 1Medical Oncology, Institut Catala de Oncologia, 8907 - Barcelona/ES
  • 2Molecular Therapeutics Research Unit, Vall d'Hebron Institute of Oncology, 08015 - Barcelona/ES
  • 3Medical Oncology, Institut Català d'Oncologia Hospital Duran i Reynals, 8907 - Barcelona/ES
  • 4Clinical Oncology, Institut Catala de Oncologia, 8907 - Barcelona/ES
  • 5Medical Oncology, Vall d'Hebron Institute of Oncology, 08015 - Barcelona/ES
  • 6Medical Oncology, Institut Català d'Oncologia Hospital Duran i Reynals, 08907 - Barcelona/ES

Abstract

Background

Immunotherapy (IM) improves survival (OS) in recurrent/metastatic squamous cell carcinoma of the head and neck (HNSCC) patients after platinum progression. Hyper-progression (HP) is a pattern of accelerated tumor growth with ECOG deterioration (ECOGdt) that has been described in patients (p) with solid tumors within the first weeks of IM.

Methods

HP is defined by twofold increase in tumor growth rate (TGR) (1). Our aim was to detect HP in a cohort of HNSCC p treated with IM in clinical trials in 2 cancer centers (ICO, VHIO). 1 S Champiat. Clin Cancer Res, 2016.

Results

From 08/2014 to Dec/2016, 69p were included in IM trials. Among them, 46p were evaluable for TGR. Baseline characteristics and IM are listed in Table. After a median follow-up of 9.4 months (m) (1-27), 36p have progressed and 24 have died. Median overall survival (mOS): 14m (8-20), percentile 75% 5m (3-7). TGR decreased in 33 p. TGR increased in 13p, presenting two-fold TGR in 2p, with 2 IM discontinuation within 2 months and 1 ECOGdt, with no differences in mOS compare to the rest (p = 0.8). We also identify 9p with progression within 2m and rapid ECOGdt, which were defined as early progressors (EP). A comparative analysis between EP and no EP was performed (Table). Within EP p, there is a lower proportion of objective response (OR), PDL-1 positivity and cisplatin sensitive (CS) tumors (p > 0.1). EP p had significantly higher proportion of tumor complications (p = 0.013) and worse mOS: 3m (0.8-5.9) vs 15m (3.9-26), HR 3.9 (1.2-10) p 0.008.Table:

1058P

All cohort n = 46 n (%)Progression n = 36
No EP n = 27EP n = 9p value
Age5856580.6
Male39 (85)2281
Smokers42 (91)2490.6
PDL-1 n = 33 Positive Negative21 (45) 22 (48)14 112 60.2
Locoregional disease (LRD) Metastatic without LRD33 (71) 13 (29)22 55 40.2
Previos systemic therapy 0 1 2 ≥33 (7) 11 (24) 30 (65) 2 (4)1 5 20 10 2 6 10.5 1 0.7 0.4
OR (n = 44)11 (25)700.1
TGR increase13 (28)920.7
CS (n = 40)23 (58)1740.4
AntiPD-1 AntiPDL-1 AntiPDL-1 + CTLA-4 Immunomodulator (IMD) AntiPDL-1 + IMD AntiPD-1 + CT9 (20) 11 (24) 16 (35) 4 (9) 2 (3) 4 (9)5 8 7 4 1 22 1 5 0 1 00.6 0.5 0.1 0.5 0.4 1
Tumor complications8 (17)350.013

Conclusions

In our cohort, we did not detect HP as previously defined. However, there is a proportion of p that has poor survival due natural HNSCC history, these p lack of benefit from IM monotherapy and other strategies should be explored.

Clinical trial identification

Legal entity responsible for the study

Catalan Institute of Oncology

Funding

None

Disclosure

All authors have declared no conflicts of interest.