Pembrolizumab Use With CRT Safe in Locally Advanced HNSCC
The addition of the monoclonal antibody pembrolizumab to CRT appears safe for HNSCC treatment.
|The following article features coverage from the 2017 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois. Click here to read more of Oncology Nurse Advisor's conference coverage.|
CHICAGO — Pembrolizumab combined with weekly cisplatin-based chemoradiotherapy (CRT) is safe and does not significantly impair radiation or chemotherapy dosing in patients with locally advanced squamous cell carcinoma of the head and neck (HNSCC), investigators concluded in a presentation at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.
Pembrolizumab, a humanized monoclonal antibody that blocks the programmed death receptor-1 interaction with its ligands, is approved for platinum-refractory, recurrent or metastastic HNSCC. Its role in definitive therapy for locally advanced HNSCC is not yet defined, Steven Francis Powell, MD, of Sanford Health in Sioux Falls, South Dakota, and colleagues explained.
Dr Powell's team enrolled 27 patients with oropharyngeal, hypopharyngeal, and laryngeal stage III-IVB HNSCC (any HPV status) and who were eligible for cisplatin-based definitive CRT. Patients were administered pembrolizumab at a fixed dose of 200 mg IV 4 to 7 days prior to initiation of CRT, and then every 3 weeks during CRT (2 concomitant doses). Following CRT, patients were administered 5 additional doses.
CRT consisted of weekly cisplatin 40 mg/m2 IV for a total of 6 doses (240 mg/m2 maximum) given concurrently with radiation at a dose of 2 Gy once daily for 35 fractions (total 70 Gy).
The researchers defined efficacy as the complete response rate on imaging or with salvage surgery at 100 days post-CRT completion.
The study population consisted of 20 patients (74%) with oropharyngeal HPV-positive and 7 (26%) with HPV-negative tumors. Twenty-one patients (78%) completed all planned doses of pembrolizumab, 3 discontinued because of immune-related adverse events, and 3 discontinued due to protocol reasons. All patients completed the full radiation dose without significant delay (defined as more than 5 days). In addition, 23 patients (85%) received the goal target dose of cisplatin (200 mg/m2 or more). One death occurred as a result of concurrent illness and was unrelated to treatment.
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1. Powell SF, Gitau MM, Sumey CJ, et al. Safety of pembrolizumab with chemoradiation (CRT) in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Oral presentation at: 2017 American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago, IL.