Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Immunotherapy with PD-1 and PDL-1 immune checkpoint inhibitors (ICIs) are now first-line to treat recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). Despite this advancement, overall success with ICIs in HNSCC remains limited. Additionally, there is a paucity of data describing the activity of these agents among underrepresented minorities. This study aims to investigate outcomes and tumor response to immune checkpoint inhibitors in a diverse cohort of patients.
Methods: We performed a retrospective chart review of patients with HNSCC diagnosed and treated at Montefiore Medical Center in the Bronx, NY between 2013-2023. Comprehensive demographic, treatment, and outcome information was collected. Patients who received at least 1 cycle of PD-1 or PDL-1 ICIs (pembrolizumab, durvalumab, nivolumab) with or without concurrent chemotherapy were identified. Radiographically determined tumor response criteria (complete response (CR), partial response (PR), stable disease (SD), progression of disease (POD), mixed response (MR)) were collected from patient records. Outcomes measured included overall survival (OS) and progression-free survival (PFS). A swimmer’s plot was used to visually display treatment duration and tumor response over time. Kaplan Meier survival analysis was used to determine median OS and PFS. A multivariate Cox proportional hazards regression model was utilized to evaluate PFS hazards ratios adjusted for covariates like race, age, CPS score, clinical T stage, and stratified by primary tumor site.
Results: 27 patients were analyzed. The mean age at diagnosis was 68 years, 89% were male, 42% were African American, 15% were White, 42% identified as Other, 48% were Hispanic vs 52% non-Hispanic, 15% were HPV positive, and 85% of the patients were diagnosed with distant metastasis. 37% of patients had a primary tumor site in the oral cavity, 26% laryngeal, 22% hypopharyngeal, and 15% oropharyngeal. Duration of treatment ranged from 1 day - 64.2 months, with a median of 4.4 months. Median OS was 12.8 months (CI, 8.3-24.2 months), while median PFS was 3.3 months (CI, 2.1 to 9.7 months). Multivariate Cox proportional hazards regression showed that those who identified as Other were associated with significantly decreased risk of disease progression or death compared to African Americans (HR 0.06, 95% CI: 0.005-0.7, p=0.03). OS and PFS were not significantly different between Hispanic vs. non-Hispanic ethnicity classifications.
Conclusion: Our data suggest that African Americans with recurrent/metastatic HNSCC may experience higher risk of disease progression in response to ICIs compared to Other counterparts. Our report contributes to very limited data describing responses to ICIs among underrepresented minorities.