Meeting
2023 ASCO Annual Meeting
The smart options of induction therapy for locally advanced betel-nuts related HNSCC in Taiwan.
Authors
Jo-Pai Chen
Department of Oncology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
Jo-Pai Chen , Wei-Chen Lu , Keng-Man Chiang , Hsing-wu Chen , Huai-Cheng Huang , Chen-Han Chang , Sung-Hsin Kuo
Organizations
Department of Oncology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan, National Taiwan University Hospital, Yun-lin Branch, Yun-Lin, Taiwan, Department of Oncology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, National Taiwan University Hospital, Taipei, Taiwan
Research Funding
No funding received
None.
Background: The treatment of HNSCC in Taiwan is still very challenging and might be related to betel-nuts use. Betel nut chewing might contribute to strong angiogenesis/invasion and treatment refractoriness. In western countries where HPV+ oropharyngeal cancer prevalence is high, induction TPF (TAX323/324) response rate in locally advanced HNSCC is around 70%; Erbitux and TP (Argiris in JCO2008) induction response rate is 86%. In the analysis from KGMH in Taiwan, induction chemotherapy response for locally advanced HNSCC was 55% in betel-nuts chewers compared with 75% in non-users (p=0.038; From Su in World Journal of Surgical Oncology 2016). In further studies from Taiwan, Avastin-PF induction benefit (ORR 80%) was also prominent from NTUH (Huang in ESMO Asia2016); Erbitux-TPF induction response rate was 88% from VGH by Lu in Head & Neck2019. Neoadjuvant biochemotherapy seemed to bring more benefits in betel-nuts related HNSCC. In the era of incorporating immunotherapy to neoadjuvant setting of HNSCC, triple therapy of bio-chemoimmunotherapy deserves more attention. Methods: From 2012 to 2022, 111 unresectable stage IVA & IVB betal-nuts related HNSCC patients (OSCC 69, Hypopharynx 26, OPC 13) had ever received induction Bio-chemotherapy or triple therapy (Bio-chemoimmunotherapy) in Yun-lin Branch of National Taiwan University Hospital. We have reviewed basic characteristics, therapeutic regimens, induction response, and final outcomes of these patients. Results: See table. Conclusions: Induction TPF response in locally advanced betel-nuts related HNSCC in Taiwan was not so prominent. Flexible chemotherapy backbones, such as TP/DP-HDFL(weekly docetaxel or paclitaxel with cisplatin and 24-hr high dose 5-fluorouracil/leucovorin infusion), might produce acceptable response rates with less toxicity. Bio(EGFR or VEGFR-targeting)-chemotherapy or Bio-chemoimmunotherapy has brought encouraging induction response with favorable toxicity profiles to conversion surgery or definite CCRT. Further investigation and clinical trials will be urgently warranted.
| Regimen | 2 to 3 cycles of TPF or TP/DP-HDFL(weekly docetaxel or paclitaxel with cisplatin and 24-hr high dose 5-fluoroucail/leucovorin infusion)-43 patients from 2012-2022 in our hospital for the comparison | 2 to 3 cycles of APF in 48 patients | 2 to 3 cycles of Erbitux with TPF or TP/DP-HDFL in 48 patients | Pembrolizumab or Nivolumab with Erbitux and TP/DP-HDFL for 2 to 3 cycles in 15 patients |
|---|---|---|---|---|
| ORR(%) | 51% | 73% | 79% | 93% |
| Conversion rate to definite CCRT or curative surgery | CCRT: 28% Surgery: 44% | CCRT:19% Surgery: 63% | CCRT: 27% Surgery: 60% | CCRT: 27% Surgery: 73% |
| 2-year disease-free survival | 35%; Induction mortality 12%(mostly in TPF) | 56%; ≥ Gr. 3 bleeding: 10% | 69%; Induction mortality 4% | 80%; No induction mortality |
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Abstract Details
Session Type
Publication Only
Session Title
Publication Only: Head and Neck Cancer
Track
Head and Neck Cancer
Sub Track
Local-Regional Disease
Citation
J Clin Oncol 41, 2023 (suppl 16; abstr e18080)
DOI
10.1200/JCO.2023.41.16_suppl.e18080
Abstract #
e18080
Abstract Disclosures
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