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Program Number: AHNS31
Session Name: Scientific Session 7 - HPV-negative Mucosal Disease
Session Date: Thursday, May 15, 2025
Session Time: 3:15 PM - 4:15 PM

Taxane, platinum and cetuximab-based neoadjuvant chemotherapy for patients with locally advanced oral cavity squamous cell carcinoma results in improved survival compared to propensity matched cohort

Kenric Tam, MD; Giovanna Caxeiro, MD; Winston Wong; Alana Eagan, MPH; Marc A Cohen, MD, MPH; Richard J Wong, MD, FACS; Alan L Ho, MD, PhD; Lara A Dunn; Jennifer R Cracchiolo, MD; Snehal G Patel, MD, FRCS; Ian Ganly, MD, PhD; Memorial Sloan-Kettering Cancer Center

Introduction: Neoadjuvant chemotherapy (NACT) with taxane, platinum, and cetuximab (TPC) prior to surgical resection of oral cavity squamous cell carcinoma (OCSCC) can result in dramatic decrease of tumor burden and volume in critical anatomic subsites. While reducing the extent of surgical resection after NACT improves patient morbidity, the impact on oncologic outcomes is unknown. Here, we investigate oncologic outcomes of patients who received a TPC-based neoadjuvant regimen prior to definitive surgical resection compared to a propensity matched cohort.

Methods: Between 2015 to 2023, 44 patients who received TPC prior to definitive surgical resection of OCSCC at Memorial Sloan-Kettering were identified. Patients who had definitive radiation prior to surgery, metastatic disease, or prior treatment for OCSCC were excluded. Propensity score matching based upon age, sex, TNM staging, and postoperative adjuvant therapy (surgery alone, radiation therapy, or chemoradiation therapy) was utilized to identify a matched cohort of patients treated with upfront surgery without neoadjuvant TPC (non-NACT). Patient charts were retrospectively reviewed to classify the extent of surgical resection proposed at initial presentation prior to NACT and the completed surgery after NACT. Patients were classified as having undergone either conservative surgery (CS, reduced extent of surgical resection compared to initial presentation), standard surgery (SS, proposed and completed operation are unchanged), or extended surgery (ES). 

Results: Patients who received NACT TPC had improved 5-year overall survival (OS) and disease specific survival (DSS) compared to propensity matched, non-NACT patients (Figure 1A, p=0.004, 0.008). Of the 44 patients who received NACT TPC, 20 patients underwent CS, 21 patients had SS, and 3 required ES due to progression of disease. There was no statistically significant difference in 2-year OS between the CS cohort (94.7%) and the SS group (77.8%, p=0.39). A trend toward improved 2-year DSS for the CS group compared to the SS group was observed but did not reach statistical significance (Figure 1B, p=0.13). CS patients had a higher rate of OS compared to the non-NACT matched cohort (94.7% vs. 51.4%, p=0.02)

Patients undergoing CS had less extensive operations and decreased morbidity. Among the 20 CS patients, 12 total or subtotal glossectomies were reduced to hemi- or partial glossectomies, 7 no longer required a lip split incision, and 5 avoided a mandibulotomy. 2 segmental mandibulectomies were de-escalated to marginals, and 2 segmental and 3 marginal mandibulectomies were avoided entirely. 4 patients received fasciocutaneous instead of osteocutaneous free flaps, and 2 did not require a free flap.

Conclusion: TPC NACT prior to definitive surgery for OCSCC was associated with improved OS and DSS compared to matched non-NACT patients. Patients who underwent conservative surgery had less extensive and morbid surgeries compared to the standard surgery cohort while maintaining comparable survival outcomes. 

 

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