ESMO Asia Congress 2022

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.

Poster viewing 03

243P - Induction bio-chemotherapy or bio-chemoimmunotherapy for locally advanced betel-nut-related HNSCC in Taiwan

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Abstract 243P

Background

Methods

Results

Conclusions

Clinical trial identification

Editorial acknowledgement

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Abstract 243P

Background

Methods

Results

Conclusions

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Funding

Disclosure

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