229MO - Immune checkpoint inhibitors in locally advanced and recurrent/metastatic head and neck cancer: An updated meta-analysis of phase II/III randomized controlled trials

Background

The standard of care systemic therapy for R/M HNSCC is platinum-based chemotherapy with fluorouracil (5-FU) and cetuximab. Median survival for patients treated with chemotherapy alone is less than a year. Immune checkpoint inhibitor (ICI) has shown positive results in recent research.

Methods

A comprehensive search was conducted in PubMed, Embase and Scopus for all relevant articles from database inception to April 2022. We also searched all proceedings from the Annual Meetings of the American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO) during the last four years (2018 to 2021) and reviewed citation lists. We found total of 2000 articles which were reviewed by title and abstracts to include studies describing ICI in either recurrent/metastatic (R/M) setting or locally advanced (LA) setting.

Results

Ten studies were included in the final analysis with total of 4289 patients. 7 studies evaluated the use of ICI in R/M setting, and 3 studies evaluated the use in LA setting. 7 studies compared ICI with chemotherapy. Three studies compared ICI +combination chemoradiotherapy with chemoradiotherapy alone. Two studies combine 2 ICI and compared combination against chemotherapy. The overall survival (OS) significantly improved with the use of ICI as compared to chemotherapy (HR 0.87,95%CI 0.80-0.94, P 0.0004). This benefit was significant in ICI vs chemotherapy (HR 0.81, 95%CI 0.73-0.90, P<0.0001) but not in ICI+CRT vs CRT (HR 1.12, 95%CI 0.88-1.41 P 0.35). The progression-free survival (PFS) was not significant for overall population (HR 1.08,95%CI 0.97-1.19 P 0.15). but was significantly improved when ICI were used in first line setting (HR 1.17,95%CI 1.07-1.27, P 0.0003) but not in second line setting. Grade 3 adverse events (AEs) were significantly lower in the ICI group when compared to chemotherapy (HR 0.65,95%CI 0.50-0.83, P0.0005).

Conclusions

ICI improve OS when compared to chemotherapy alone however PFS was not significant. There was decrease grade 3 AE with ICI.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.