Abstract 243P
Background
The treatment of HNSCC in Taiwan is still very challenging and might be related to betel-nuts use. Betel nut chewing might contribute to strong angiogenesis/invasion and treatment refractoriness. In western countries where HPV+ oropharynheal cancer prevalence is high, induction TPF (TAX323/324) response rate in locally advanced HNSCC is around 70%; cetuximab and TP (Argiris et al. J Clin Oncol 2008) induction response is 86%. In the analysis from KGMH in Taiwan, induction chemotherapy response for locally advanced HNSCC was 55% in betel nut chewers compared with 75% in non-users (p=0.038; Su in World J Surgical Oncol 2016). In further studies from Taiwan, bevacizumab-PF induction benefit (ORR 80%) was also prominent from NTUH in Taiwan (Huang in ESMO Asia 2016); cetuximab-TPF induction response rate was 88% (Lu in Head & Neck2019). Neoadjuvant biochemotherapy seemed to bring more benefits in betelnut-related HNSCC. In the era of incorporating immunotherapy to neoadjuvant setting of HNSCC, triple therapy of bio-chemoimmunotherapy deserves more attention.
Methods
From 2012 to 2022, 99 unresectable stage IVA & IVB betal-nut-related HNSCC patients( OSCC 60, Hypopharynx 22, OPC 11) had ever received induction bio-chemotherapy or triple therapy (bio-chemoimmunotherapy) in Yun-lin Branch of National Taiwan University Hospital. We have reviewed basic characteristics, therapeutic regimens, induction response, and final outcomes of these patients.
Results
Results are shown in the table. Table: 243P
| Regimen | 2 to 3 cycles of TPF or TP/DP-HDFL (weekly docetaxel or paclitaxel with cisplatin and 24-hr high dose 5-fluorouracil/leucovorin infusion)-40 patients from 2012-2022 in our hospital for the comparison | 2 to 3 cycles of APF in 46 patients | 2 to 3 cycles of cetuximab with TPF or TP/DP-HDFL in 43 patients | Pembrolizumab or nivolumab with cetuximab and TP/DP-HDFL for 2 to 3 cycles in 10 patients |
| ORR(%) | 50% | 74% | 79% | 90% |
| Conversion rate to definite CCRT or curative surgery | CCRT: 27.5% Surgery: 42.5% | CCRT:17% Surgery: 63% | CCRT: 26% Surgery: 60% | CCRT: 20%' Surgery: 80% |
| 2-year disease-free survival | 32.5%; Induction mortality 12.5% | 54%; >= Gr. 3 bleeding: 11% | 65%; Induction mortality: 5% | 70%; No induction mortality |
Conclusions
PF response in locally advanced betel-nut-related HNSCC in Taiwan was not so prominent. Flexible chemotherapy backbones, such as TP/DP-HDFL (weekly docetaxel or paclitaxel with cisplatin and 24-hr high dose 5-fluoroucail/leucovorin infusion), might produce acceptable response rates with less toxicity. Bio(EGFR or VEGFR-targeting)-chemotherapy or bio-chemoimmunotherapy has brought encouraging induction response with favorable toxicity profiles to conversion surgery or definite CCRT. Further investigation and clinical trials will be urgently warranted.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
IRB from National Taiwan University Hospital.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
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