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

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

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.