NSAIDs May Offer ‘Survival Advantage’ For Definitive Chemoradiation HNSCC Patients

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: Patients who take nonsteroidal anti-inflammatory drugs (NSAIDs) during definitive chemoradiotherapy for head and neck squamous cell carcinoma (HNSCC) may have better overall survival (OS) than nonusers, say US researchers. 

But on finding no correlation between NSAID use and disease-specific survival or likelihood of distant metastasis in this patient population, the team postulates that the “observed survival advantage may be associated with cardiovascular benefits of NSAIDs rather than any chemoprotective properties they may have”. 

The study follows on from earlier findings indicating a similar correlation between NSAID use and OS in surgical HNSCC patients, the researchers write in JAMA Network Open. 

Overall, 43.7% of 460 patients treated with definitive chemoradiotherapy for invasive HNSCC between 2005 and 2017 at the Roswell Park Comprehensive Cancer Institute in Buffalo, New York, reported taking NSAIDs on at least a daily basis at time of consultation and during treatment. 

Over half (53.7%) of NSAID users used low-dose aspirin (81 mg/day), 10.9% took high-dose aspirin (325 mg/day) and 34.8% used ibuprofen, naproxen or meloxicam. 

Initial analysis suggested that OS was significantly better among NSAID users than nonusers, with a hazard ratio (HR) for death of 0.63, say Anurag Singh, from the institution, and co-authors. 

This was confirmed by Cox regression analysis, with a significant HR of 0.59 after adjusting for concurrent anticoagulant use, cardiac history, clinical T and N stage, disease subsite and smoking status. 

The 5-year OS rate was significantly higher among NSAID users than nonusers, at 63.6% versus 56.1%. 

However, use of NSAIDs was not significantly associated with the likelihood of local control or disease-specific survival before or after adjusting for confounding factors, the team reports. Nor did NSAID use significantly correlate with the rate of distant failure. 

Anurag Singh et al highlight that patients taking NSAIDs were significantly more likely than nonusers to have diabetes (17.9 vs 8.1%) and coronary artery disease (10.0 vs 4.2%). 

“This is increasingly important because the risk of noncancer death now surpasses that of cancer death, with heart disease being the leading cause of noncancer mortality”, they write.

Noting that adjusting for anticoagulant use did not significantly alter OS, the authors suggest that anti-cyclooxygenase effect of NSAIDs may play a role, perhaps through a “combination of local recurrence reduction through cyclooxygenase inhibition and treatment of underlying cardiovascular disease.”

Acknowledging that the study was unable to assess the reason for or duration of NSAID use, and that the NSAID user and nonuser groups had imbalances in their smoking history and primary tumour sites, the team concludes: “Further studies examining this association are warranted.” 

Reference 

Iovoli AJ, Hermann GM, Ma SJ, et al. Association of nonsteroidal anti-inflammatory drug use with survival in patients with squamous cell carcinoma of the head and neck treated with chemoradiation therapy. JAMA Netw Open; 3: e207199. Published online 30 June 2020. doi:10.1001/jamanetworkopen.2020.7199