Chemoradiotherapy Plus Avelumab in Advanced Head/Neck Cancer
Posted: Monday, December 2, 2019
In combination with cetuximab and radiotherapy, the PD-L1 inhibitor avelumab seems to be an effective alternative treatment for patients with head and neck squamous cell carcinoma who are unfit for cisplatin treatment, according to a report published in Radiotherapy & Oncology. Jan Paul de Boer, PhD, MD, of The Netherlands Cancer Institute, and colleagues found that immune-related and radiotherapy-related toxicities appeared to be manageable and comparable to those with the standard of care.
The investigators assigned 10 patients with advanced-stage head and neck squamous cell carcinoma who were unfit for cisplatin treatment to receive conventional cetuximab with radiotherapy plus avelumab. Of those patients, two patients withdrew from the study before avelumab was administered due to grade 2 cetuximab-related infusion reactions. After two avelumab and radiotherapy treatments, one patient discontinued the study for personal reasons. Of the eight remaining patients, two patients stopped receiving avelumab after four and eight courses due to toxicity and tumor progression, respectively.
Grade 3 immune-related adverse events were reported by four patients; however, the investigators reported that they were manageable. No grade 4 or grade 5 toxicities were noted. High-dose prednisone was given to three patients for grade 3 elevated liver enzymes (n = 1) and pneumonitis (n = 2). Topical steroids were applied for one patient for a grade 3 maculopapular rash. Most patients (n = 7) experienced grade 3 radiotherapy-related toxicity but no severe cetuximab-specific toxicity. After a median of 12 months of follow-up, 50% of patients experienced tumor recurrence (n = 4).
“Although the principal limitation of this pilot trial is the limited small sample size, our findings provide ground for further evaluation within larger efficacy trials,” the authors concluded.
Disclosure: For full disclosures of the study authors, visit thegreenjournal.com.