scholarly journals Long-term survival in patients with metastatic head and neck squamous cell carcinoma treated with metastasis-directed therapy

2019 ◽  
Vol 121 (11) ◽  
pp. 897-903 ◽  
Author(s):  
Thomas H. Beckham ◽  
Jonathan E. Leeman ◽  
Peng Xie ◽  
Xiaolin Li ◽  
Debra A. Goldman ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Metastatic Disease ◽  
Squamous Cell ◽  
Disease Burden ◽  
Neck Squamous Cell Carcinoma ◽  
Risk Of Death ◽  
Definitive Therapy ◽  
Limited Metastatic Disease

Abstract Background Our objective was to evaluate the outcomes of metastatic head and neck squamous cell carcinoma (HNSCC) by disease burden with an emphasis on metastasis-directed therapy (MDT) in patients with limited metastatic disease burden. Methods In total, 186 patients who developed metastatic disease after definitive therapy for HNSCC were included. Clinically and radiographically apparent metastases were enumerated. Kaplan–Meier methods were used to estimate survival. Cox regression was used to assess the association between clinical variables. Results Patients with a single metastasis had a 5-year overall survival (OS) of 35% (95% CI 16–54%) in contrast to patients with multiple metastases with a 5-year OS of 4% (95% CI 2–9%). Thirty patients (16.1%) underwent MDT. On multivariable analysis, oral cavity or sinonasal primary (HR 2.22 95% CI 1.16–4.25, p = 0.015; HR 4.88, 95% CI 1.10–21.70, p = 0.037, respectively) were associated with higher risk of death, whereas receipt of MDT (HR 0.36, 95% CI 0.17–0.74, p = 0.006) was associated with lower hazard of death. Median subsequent metastasis-free survival and 5-year survival after MDT (n = 30) were estimated at 26.4 months (95% CI: 9.8–54.0) and 31%, (95% CI: 15–48%). Conclusions HNSCC patients with limited metastatic disease may derive significant benefit from MDT. Prospective trials evaluating MDT in HNSCC are warranted.

High expression of S100A4 and endoglin is associated with metastatic disease in head and neck squamous cell carcinoma

2014 ◽  
Vol 31 (6) ◽  
pp. 639-649 ◽  
Author(s):  
Marcos Vinícius Macedo de Oliveira ◽  
Carlos Alberto de Carvalho Fraga ◽  
Lucas Oliveira Barros ◽  
Camila Santos Pereira ◽  
Sérgio Henrique Sousa Santos ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Metastatic Disease ◽  
Squamous Cell ◽  
Neck Squamous Cell Carcinoma ◽  
High Expression

scholarly journals The abscopal effect in head-and-neck squamous cell carcinoma treated with radiotherapy and nivolumab: a case report and literature review

2020 ◽  
Vol 27 (6) ◽  
Author(s):  
D. Forner ◽  
P. Horwich ◽  
J.R. Trites ◽  
H. Hollenhorst ◽  
M. Bullock ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Metastatic Disease ◽  
Squamous Cell ◽  
Disease Burden ◽  
Single Agent ◽  
Palliative Radiotherapy ◽  
Abscopal Effect ◽  
First Case

Introduction The abscopal effect is a rarely observed outcome of radiotherapy wherein there is a reduction in metastatic disease burden outside of the targeted treatment area. Likely due to an in situ vaccine effect of radiother­apy, the abscopal effect may be augmented by immunotherapy. This report is the first case of the abscopal effect observed in metastatic head-and-neck squamous cell carcinoma (hnscc) treated with concurrent radiotherapy and single-agent nivolumab. Case Description An otherwise healthy 57-year-old man underwent craniofacial resection and adjuvant chemo­radiotherapy for advanced sinonasal squamous cell carcinoma. Distant metastatic disease developed shortly after primary treatment, and immunotherapy in the form of nivolumab was initiated. Subsequent oligometastatic progres­sion despite immunotherapy prompted palliative radiotherapy to a single metastasis due to pending symptomatology. Post-radiotherapy, the abscopal effect was observed with all distant sites of metastatic disease shrinking. Five months following treatment, a sustained reduction in disease burden has been demonstrated. Summary We present the first case of the abscopal effect in a patient with metastatic hnscc treated with palliative radiotherapy concurrent with single-agent nivolumab immunotherapy, and only the third case of the abscopal effect in metastatic head-and-neck cancer. Dual treatment with immunotherapy and radiotherapy may be an important treatment option in the future, mediated through the abscopal effect.

Adjuvant nivolumab following salvage resection in head and neck squamous cell carcinoma patients previously treated with definitive therapy: A single-arm phase II multi-institutional study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6031-6031
Author(s):  
Jennifer Leddon ◽  
Sulsal Haque ◽  
Shuchi Gulati ◽  
Casey Allen ◽  
Sarah Palackdharry ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
High Risk ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Phase Ii ◽  
Squamous Cell ◽  
Salvage Surgery ◽  
Neck Squamous Cell Carcinoma ◽  
Term Survival ◽  
Definitive Therapy

6031 Background: Salvage surgery for locally recurrent head and neck squamous cell carcinoma (rHNSCC) results in local control rates of 33-50% but only 20-40% of patients achieve long-term survival necessitating additional therapy (Haque et al., Oral Oncol. 2019). Many patients are ineligible for re-irradiation and chemotherapy alone after salvage surgeryhas shown no survival benefit. The clinical activity and tolerability of immune checkpoint inhibitors has been demonstrated in metastatic HNSCC, but the benefit after salvage surgery (SS) has not been studied. Here we report the results of a multi-center phase II investigation of nivolumab, a PD-1 inhibitor, after SS in recurrent HNSCC (NCT03355560). Methods: HNSCC patients undergoing curative-intent SS were enrolled to receive 6 months of nivolumab beginning 4-11 weeks after surgery. All received radiation with or without chemotherapy as prior definitive therapy and had no other curative treatment options at the time of surgery. Key exclusion criteria included: distant metastatic disease, gross residual disease, or a history of immunodeficiency, autoimmunity, or pneumonitis. The primary endpoint was 2-year disease-free survival (DFS) measured by Kaplan Meier curves. Safety was evaluated by CTCAE v5.0. Results: 39 patients were enrolled. Median age was 68 years (range, 49-85). 12/39 (31%) were female. 34/39 (87%) were white. Disease sites included oropharynx 9/39 (23%), oral cavity 14/39 (36%), and larynx 16/39 (41%). P16 status was 26% (+), 48% (-), and 26% (unknown). 17/39 (44%) had high risk pathologic features (positive margins or extranodal spread) at time of SS. 28/39 (72%) patients experienced treatment-related adverse events (TRAE), the most common of which were fatigue (26%), hypothyroidism (10%) and acneiform rash (13%). Grade 3-4 TRAEs were rare, occurring in 3/39 (8%) patients and included diarrhea, oral pain, neck pain, productive cough, stridor, and COPD exacerbation. 3/39 (8%) required treatment discontinuation and there were no grade 5 events. The 2-year DFS was 60% (95%CI 0.39-0.91). 2-year overall survival was 74% (95% CI 0.54-1). In single-cell multiplex cytokine analysis, patients who relapsed following adjuvant nivolumab had a significantly higher proportion of peripheral blood CD8 T cells which displayed a polyfunctional cytokine profile. IFN-γ and Granzyme were the dominant CD8 cytokines in both responders and non-responders, however CD8 expression of MIP1a and TNF-α were significantly higher in patients who ultimately relapsed. Conclusions: Nivolumab after salvage surgery in rHNSCC is well tolerated and shows promising antitumor activity in this high-risk patient population with unmet need. Immunotherapy after salvage surgery should be studied in randomized clinical trials. Clinical trial information: NCT03355560.

scholarly journals Prognostic Significance of CD4+ and CD8+ Tumor-Infiltrating Lymphocytes in Head and Neck Squamous Cell Carcinoma: A Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 781
Author(s):  
Daniele Borsetto ◽  
Michele Tomasoni ◽  
Karl Payne ◽  
Jerry Polesel ◽  
Alberto Deganello ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Tumor Infiltrating Lymphocytes ◽  
Neck Squamous Cell Carcinoma ◽  
Risk Of Death ◽  
Infiltrating Lymphocytes

Objective: It has been suggested that the presence of tumor-infiltrating lymphocytes (TILs) in the tumor microenvironment is associated with a better prognosis in different types of cancer. In this systematic review and meta-analysis, we investigated the prognostic role of CD4+ and CD8+ TILs in head and neck squamous cell carcinoma (HNSCC). Methods: PubMed, Cochrane, Embase, Scopus, and Web of Science were searched up to September 2020. This study was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Risk ratios from individual studies were displayed in forest plots and the pooled hazard ratios (HR) of death and corresponding confidence intervals (CI) were calculated according to random-effects models. Risk of bias of the included studies was assessed through the Newcastle–Ottawa scale. Results: 28 studies met the inclusion criteria. Studies conducted on HNSCC subsites combined reported a significant reduction in the risk of death for both high CD4+ (HR: 0.77; 95% CI: 0.65–0.93) and high CD8+ TILs (HR: 0.64; 95% CI: 0.47–0.88). High CD4+ TILs were associated with significantly better overall survival among oropharyngeal HNSCC (HR: 0.52; 95% CI: 0.31–0.89), as well as high CD8+ TILS in Human papillomavirus −ve and +ve cancers (HR: 0.39; 95% CI: 0.16–0.93 and HR: 0.40; 95% CI 0.21–0.76 respectively). CD8+ TILs were also associated with improved survival in hypopharyngeal cancers (HR = 0.43 CI: 0.30–0.63). No significant association emerged for patients with cancer of the oral cavity or larynx. Conclusions: The findings from this meta-analysis demonstrate the prognostic significance of CD8+ and CD4+ TILs in HNSCC and variation in tumor subsite warrants further focused investigation. We highlight how TILs may serve as predictive biomarkers to risk stratify patients into treatment groups, with applications in immune-checkpoint inhibitors notable areas for further research.

Intraoperative Radiolymphoscintigraphy for Detection of Occult Nodal Metastasis in Patients with Head and Neck Squamous Cell Carcinoma

2000 ◽  
Vol 122 (5) ◽  
pp. 662-666 ◽  
Author(s):  
Robert P. Zitsch ◽  
Daniel W. Todd ◽  
Gregory J. Renner ◽  
Amolak Singh
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Metastatic Disease ◽  
Squamous Cell ◽  
Ex Vivo ◽  
Gamma Probe ◽  
Nodal Metastasis ◽  
Neck Squamous Cell Carcinoma ◽  
Elective Neck Dissection

OBJECTIVES: We sought to determine the feasibility and utility of intraoperative radiolymphoscintigraphy as a screening procedure for the detection of occult metastatic disease in selected cases of head and neck squamous cell carcinoma (HNSCC). METHODS: Patients with accessible primary HNSCC and no evidence of metastatic disease who were already undergoing planned surgical resection of the primary tumor and elective neck dissection met the inclusion criteria. Before resection, a handheld gamma probe was used to find the radiolabeled sentinel lymph node (SLN). The neck specimen was examined ex vivo by using the gamma probe; the SLN or SLNs were dissected free from the specimen and sent separately for histopathologic examination. RESULTS: At least one SLN was identified in all patients enrolled thus far. Four patients had microscopic carcinoma found in the SLN. Two of these had cancer only in the SLN, and two had disease both in the SLN and the remaining specimen. CONCLUSIONS: Intraoperative radiolymphoscintigraphy appears to be a feasible and promising procedure to aid the surgeon in more accurately detecting occult metastatic HNSCC.

Intraoperative radiolymphoscintigraphy for detection of occult nodal metastasis in patients with head and neck squamous cell carcinoma

2000 ◽  
Vol 122 (5) ◽  
pp. 662-666 ◽  
Author(s):  
Robert P. Zitsch ◽  
Daniel W. Todd ◽  
Gregory J. Renner ◽  
Amolak Singh
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Metastatic Disease ◽  
Squamous Cell ◽  
Ex Vivo ◽  
Gamma Probe ◽  
Nodal Metastasis ◽  
Neck Squamous Cell Carcinoma ◽  
Elective Neck Dissection

OBJECTIVES: We sought to determine the feasibility and utility of intraoperative radiolymphoscintigraphy as a screening procedure for the detection of occult metastatic disease in selected cases of head and neck squamous cell carcinoma (HNSCC). METHODS: Patients with accessible primary HNSCC and no evidence of metastatic disease who were already undergoing planned surgical resection of the primary tumor and elective neck dissection met the inclusion criteria. Before resection, a handheld gamma probe was used to find the radiolabeled sentinel lymph node (SLN). The neck specimen was examined ex vivo by using the gamma probe; the SLN or SLNs were dissected free from the specimen and sent separately for histopathologic examination. RESULTS: At least one SLN was identified in all patients enrolled thus far. Four patients had microscopic carcinoma found in the SLN. Two of these had cancer only in the SLN, and two had disease both in the SLN and the remaining specimen. CONCLUSIONS: Intraoperative radiolymphoscintigraphy appears to be a feasible and promising procedure to aid the surgeon in more accurately detecting occult metastatic HNSCC.

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