Influence of the results of international studies on the choice of treatment tactics for unresectable forms of squamous cell carcinoma of the head and neck

The results of the clinical studies have a direct impact on clinical practice. The main criteria for the effectiveness of treatment method are increasing the overall life expectancy and improving its quality. In the treatment of common forms of squamous cell carcinoma of the head and neck, induction chemotherapy can be used, including platinum drugs, preferably in combination with cetuximab. Next immuno-oncological drugs should be prescribed. In the future, in the 1st line of therapy, it is possible to replace cetuximab with pembrolizumab or monotherapy with pembrolizumab, which allows to increase the effectiveness of treatment and reduce its toxicity. The article presents 3 clinical observations that demonstrate the possibility of integration the results of clinical research in practice.

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OPTIMAL TREATMENT STRATEGY FOR PATIENTS WITH PROGRESSIVE SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

Research n Practical Medicine Journal ◽

10.17709/2409-2231-2019-6-3-11 ◽

2019 ◽

Vol 6 (3) ◽

pp. 115-128

Author(s):

L. V. Bolotina ◽

C. A. Kravtsov ◽

T. V. Ustinova ◽

E. Yu. Karpenko ◽

A. L. Kornietskaya ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Drug Therapy ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Control Points ◽

Response Control ◽

Clinical Observations ◽

Platinum Preparations ◽

Optimal Treatment Strategy

The treatment of common forms of squamous cell carcinoma of the organs located on the head and neck that are not subject to surgical treatment is limited to the use of chemoradiotherapy with platinum derivatives or drug therapy with platinum-containing regimens. With the progression of the disease, ineffective 2‑line cytostatics were prescribed that did not fundamentally change the course of the tumor process. The introduction into clinical practice of drugs of the original mechanism of action has significantly increased the effectiveness of drug therapy during progression after platinum-containing chemotherapy. The article presents two clinical observations that demonstrate the relevance of the strategy of using inhibitors of immune response control points after platinum preparations.

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Methotrexate and cetuximab for metastatic advanced head and neck squamous cell carcinoma: A retrospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e16019 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e16019-e16019

Author(s):

Bassel Atassi ◽

Khaled Alsibai ◽

George H. Yoo ◽

Ho-Sheng Lin ◽

Gregory Dyson ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Palliative Chemotherapy ◽

Single Agent ◽

Palliative Therapy ◽

Neck Squamous Cell Carcinoma ◽

First Line ◽

Line Of Therapy

e16019 Background: After the failure of first line palliative chemotherapy in recurrent non-resectable or metastatic head and neck squamous-cell carcinoma (HNSCC), there is no standard of care treatment that improves survival or quality of life. Both, methotrexate and cetuximab have single agent activity in metastatic HNSCC. We are presenting our institutional experience in using unique combination chemotherapy with methotrexate plus cetuximab (MC). Methods: Retrospectively, single institution’s charts were reviewed from 2004-2010, all patients have documented recurrent non-resectable or metastatic HNSCC. Patients received weekly IV methotrexate 25 mg/m2 plus IV cetuximab 250 mg/m2. Each cycle is 4 weeks treatments. Patients who completed at least 2 cycles were included. Patients can receive MC as first line if they have poor performance status. Treatment was continued until progression. Results: Total of 39 patients were included, 27 male and 12 female. Median patients’ age was 57 years old. 35 patients received methotrexate plus cetuximab (MC) after failure of prior line of palliative chemotherapy. 17, 10 and 8 patients received MC as second, third and fourth line therapy, respectively. 4 patients received MC as 1st line because they were not candidate for more aggressive therapy. The average received number of weekly treatments was 31 (8-95) and average number of cycles was 7 (2-23). Prior chemotherapy regimens include taxanes, platinum, 5-flurouracil, and gemcitabin. 13 patients received prior cetuximab as single agent or in combination. Median progression free survival was 7.1 months and overall survival was 9.8 months. Considering the line of therapy, the median survival was 6.9, 10.1, 13.5 and 9.9 months for patients received MC as 1st, 2nd , 3rd and 4th line of therapy respectively (P= 0.356). Grade 1 and 2 skin rash and hypomagnesimia were observed in 47% and 36% of patients. Conclusions: Methotrexate plus cetuximab is a well tolerated regimen with a significant survival benefit. Prospective well designed studies are warranted in order to evaluate this regimen as a second line palliative therapy for patients with advanced non-curable head and neck squamous cell carcinoma.

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Efficacy and safety of apatinib as second-line or beyond therapy in patients with recurrent and/or metastatic head and neck squamous cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e17517 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e17517-e17517

Author(s):

You Qin ◽

Qian Ding ◽

Xinhua Xu ◽

Fengjun Cao ◽

Siqing Ning ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Neck Squamous Cell Carcinoma ◽

Efficacy And Safety ◽

Open Label ◽

Line Of Therapy ◽

Unacceptable Toxicity ◽

Clinical Trial Information

e17517 Background: The aim of this study was to evaluate the efficacy and safety of apanitib in the treatment of patients with recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC) who failed from one or more lines of therapy. Methods: Patients with recurrent and/or metastatic HNSCC after failure of at least one line of therapy were recruited in this open-label exploratory study. Subjects were initially given apatinib 250mg qd until disease progression or unacceptable toxicity. Dose reduction to 125 mg was allowed. Herein, we reported the preliminary results at the cut-of date of Jan 31, 2019. Results: Between Jul 2017 to Dec 2018, 17 patients were enrolled. The median age was 59 years; 94% were male; 88% had more than 2 lines of chemotherapy. The median PFS and OS were 5.71 and 7.86 months, respectively. Most treatment related adverse events (AEs) were in grade ½. The grade ¾ AEs were hypertension (1/17, 5.88%), fistula (2/17, 11.76%), mouth mucositis (2/17, 11.76%), proteinuria (2/17, 11.76%), and f bleeding (6/17, 35.29%). Conclusions: Apatinib showed promising efficiency with tolerable toxicity for recurrent and/or metastatic HNSCC patients who failed from one or more lines of therapy. Clinical trial information: ChiCTR1800015278.

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