Clinical impact of weekly paclitaxel plus cetuximab is comparable to the EXTREME regimen for recurrent/metastatic head and neck squamous cell carcinoma
Clinical impact of weekly paclitaxel plus cetuximab is comparable to the EXTREME regimen for recurrent/metastatic head and neck squamous cell carcinoma
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DOI：
10.1007/s10147-021-01907-x
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发表时间：
2021-04-05
影响因子：
3.3
通讯作者：
Hanai, Nobuhiro
中科院分区：
文献类型：
--
作者：
Motai, Risa;Sawabe, Michi;Hanai, Nobuhiro
背景在免疫检查点抑制剂出现之前，包括铂类化疗加西妥昔单抗的EXTREME方案是复发性/转移性头颈部鳞状细胞癌（R/M HNSCC）的标准治疗。最近的报告表明，紫杉烷类药物联合西妥昔单抗治疗方案对有铂类药物禁忌症的R/M HNSCC患者的治疗选择是有用的。然而，每周紫杉醇加西妥昔单抗（wPTX-Cmab）与EXTREME方案的比较有限。材料和方法我们比较了爱知癌症中心医院作为R/M HNSCC一线治疗的wPTX-Cmab与EXTREME的临床影响。主要结局为总生存期（OS），次要结局为无进展生存期（PFS）、总缓解率（ORR）和疾病控制率（DCR）。使用倾向评分调整的考克斯比例风险模型确定风险比（HR）和95%置信区间（CI）。结果2012年至2018年，分析了77例患者，其中55例接受EXTREME治疗，22例接受wPTX-Cmab治疗的铂类难治性或不耐受患者。wPTX-Cmab在OS方面与EXTREME相当[校正HR 0.82（95% CI 0.39-1.48）]，PFS [校正HR 0.90（95% CI 0.49-1.65）]、ORR [wPTX-Cmab 34.7%（12-43），EXTREME 30.9%（18-43），p = 0.877]和DCR [wPTX-Cmab 72.7%（52-92），EXTREME 65.4%（52-78），p = 0.337]。按铂难治性或不耐受状态分层后，生存趋势保持相似。wPTX-Cmab的疾病控制与更好的OS显著相关[校正HR 0.18（0.05-0.57）]。结论wPTX-Cmab可能是有铂类禁忌症的R/M HNSCC患者的一种合适的治疗选择。
Background Until the emergence of immune checkpoint inhibitors, the EXTREME regimen comprising platinum-based chemotherapy plus cetuximab was the standard of care for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). Recent reports suggest the usefulness of regimens including taxanes in combination with cetuximab as treatment options for R/M HNSCC patients with contraindications for platinum. However, comparisons of weekly paclitaxel plus cetuximab (wPTX-Cmab) to the EXTREME regimen are limited. Materials and methods We compared the clinical impact of wPTX-Cmab to EXTREME as first line treatment for R/M HNSCC in Aichi Cancer Center Hospital. The primary outcome was overall survival (OS) and secondary outcomes were progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR). Propensity score-adjusted Cox proportional hazard models were used to determine hazard ratios (HRs) and 95% confidence intervals (CIs). Results From 2012 to 2018, 77 patients, including 55 treated with EXTREME and 22 refractory or intolerant to platinum treated with wPTX-Cmab, were analyzed. wPTX-Cmab was comparable to EXTREME on OS [adjusted HR 0.82 (95% CI 0.39-1.48)], PFS [adjusted HR 0.90 (95% CI 0.49-1.65)], ORR [wPTX-Cmab 34.7% (12-43), EXTREME 30.9% (18-43), p = 0.877] and DCR [wPTX-Cmab 72.7% (52-92), EXTREME 65.4% (52-78), p = 0.337]. Survival trends remained similar after stratification by platinum-refractory or intolerance status. Disease control with wPTX-Cmab was significantly associated with better OS [adjusted HR 0.18 (0.05-0.57)]. Conclusion wPTX-Cmab may be a suitable treatment option for R/M HNSCC patients with contraindications for platinum.