Interest to consider re-challenging by cetuximab and platinum containing regimen in recurrent Head and Neck Cancer
Abstract
Background: The EXTREME protocol is the standard first-line treatment for recurrent or metastatic head and neck squamous-cell carcinoma (R/M HNSCC). Outside of first-line therapy, immunotherapy has shown promise, but second-line chemotherapy generally has poor efficacy. One potential option for treatment beyond first-line therapy could be a re-challenge strategy using a platinum and cetuximab regimen, repeating the first-line approach.
Methods: We conducted a retrospective study to evaluate the efficacy of a cetuximab plus platinum doublet chemotherapy regimen in patients with R/M HNSCC who progressed after at least 3 months of cetuximab maintenance following the EXTREME protocol. We reviewed the medical records of R/M HNSCC patients treated with the EXTREME regimen and who subsequently received a re-challenge strategy between January 2010 and December 2014 at Centre Paul Strauss, Strasbourg, France.
Results: A total of 33 patients were included in the study. The re-challenge strategy resulted in an overall response rate (ORR) of 33.3% and a disease control rate (DCR) of 69.6%. The median overall survival (OS) and progression-free survival (PFS) from the second-line treatment were 11.2 months and 6.5 months, respectively, for those re-challenged with EXTREME or PCC regimens. Response rates were similar in patients with a platinum-free interval of 3 to 6 months compared to those with intervals longer than 6 months. Additionally, drug dose intensity was higher with the PCC protocol than with the EXTREME regimen when used as a re-challenge.
Conclusions: Our study suggests that a re-challenge strategy using platinum and cetuximab-based regimens could be a viable treatment option for patients with R/M HNSCC, particularly when the platinum-free interval exceeds 3 months.