275P - Weekly paclitaxel, carboplatin and cetuximab (PCC) combination followed by nivolumab in platinum-sensitive recurrent and /or metastatic squamous cell carcinoma of head and neck: A double institution retrospective analysis from India

Background

First-line TP-Ex-like regimen (taxane-platinum-cetuximab) in recurrent and/or metastatic squamous cell carcinoma of head and neck (R/M SCCHN) followed by 2^nd-line immunotherapy represents one of the standards of care. We report our experience from 2 tertiary care institutions of India.

Methods

This is a retrospective analysis of 54 consecutive patients of platinum-sensitive R/M SCCHN treated between August 2017 and May 2020 with 1^st-line weekly combination paclitaxel 80mg/m2, carboplatin AUC2 and cetuximab 400mg/m2 loading followed by 250mg/m2 (PCC) for upto maximum 12 weeks. Non-progressive patients were then started on cetuximab maintenance. Patients were further treated with 2nd-line nivolumab or oral metronomic chemotherapy (OMCT) on progression as per feasibility. Overall Response rates (ORR), progression-free survival 1 and 2 (PFS-1 & PFS-2), overall survival (OS) and safety were evaluated.

Results

The median age of the study population was 56.5 years with 48 males; 30/24 had oral/non-oral primaries; ECOG PS was 1/2 in 32/22 cases; 50 patients had local disease while 34 had distant metastasis; 41 had history of tobacco abuse; 7/6 patients had renal/cardiac dysfunction respectively. The ORR and median PFS-1 was 79.7% and 7.031 months respectively. Out of the 33 patients who progressed, 19/10/4 received 2^nd-line nivolumab, OMCT or best supportive care respectively. The ORR to 2^nd-line nivolumab / OMCT was 36.8%/10% and the median PFS-2 was 6.5 / 2 months respectively. The median OS of the entire cohort was 15.014 months while that of the selected 2^nd-line nivolumab cohort was 20.4 months. Grade III/IV adverse events on 1^st-line therapy included neutropenia (31.4%), anemia (35.1%), thrombocytopenia (7.4%), febrile neutropenia (11.1%) and skin reaction (16.6%) and there were no grade III/IV treatment related toxicities in 2^nd-line.

Conclusions

First-line weekly PCC is an effective regimen for palliative therapy of platinum-sensitive R/M SCCHN with acceptable toxicity profile. Addition of 2^nd-line nivolumab on progression further improves the outcomes.

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.