Recurrent/metastatic head and neck squamous cell cancer (r/mHNSCC) patients (pts) are treated with platinum based chemotherapy and the anti-EGFR-antibody cetuximab (C) in first-line. Prognostic factors were identified in an era before the advent of targeted therapy C (Argiris et al 2004). We analyzed whether neutrophil-to-lymphocyte ratio (NLR), as shown in other tumor entities, is associated with outcome in r/mHNSCC.
We retrospectively analyzed a series of consecutive r/mHNSCC pts treated with C in first-line from 2009 to 2014 at Istituto Nazionale Tumori of Milan. C was applied in combination with a platinum agent alone or in combination with 5-fluorouracil or paclitaxel. Baseline neutrophil and lymphocyte was required to be performed within one week before treatment start. We used univariable Cox models for studying the association beween overall survival (OS) and the NLR evaluated at baseline. Patients with missing values were excluded from statistical modelling.
We identified 115 pts admissible for OS analysis. 76 pts were treated with a doublet consisting of C in combination with cisplatin or carboplatin (32% and 68% respectively), while 39 pts received triplet combination with the adjunct of 5-fuorouracil or paclitaxel (62and 38% respectively). Baseline NLR was present in 106 pts. Mean age was 62.7 years (range 37-82). 73% of pts were male and 27% female. 86% had an ECOG PS (performance status) of 0 or 1. Oropharynx, oral cavity, larynx/hypopharynx were the primary cancer sites in 33, 35, 24% respectively, with 8% other sites. Median survival from start of systemic treatment was 12 months (95% CI, 10-13 months). Baseline NLR was significantly associated with OS (HR comparing the 3rd and the 1st quartiles of the variable distribution = 1.32; 95% CI:1.08-1.63, p = 0.008).
In this cohort of non selected pts with r/mHNSCC pts treated in first-line with a C containing regimen NLR was of prognostic value and confirmation on larger series is needed. Correlation of NLR with host inflammatory and immune status in r/mHNSCC requires further studies.
Clinical trial identification
Legal entity responsible for the study
M. Siano: Advisor for: MSD, BMS, Merck Serono, Bayer, Eisai. L. Licitra: Advisor: Eisai, BMS, MSD, Merck-Serono, Boehringer Ingelheim, Debiopharm, Sobi, Novartis, AstraZeneca, Bayer, Roche. Research funds: Eisai, MSD, Merck-Serono, B. Ingelheim, Novartis, AstraZeneca, Roche. Travel: Merck-Serono, Debiopharm, Sobi, Bayer. All other authors have declared no conflicts of interest.