Immunotherapy with PD-1 Inhibitor Nivolumab in Recurrent/Metastatic Platinum Refractory Head and Neck Cancers—Early Experiences from Romania and Literature Review
Prognosis in recurrent/metastatic head and neck squamous-cell carcinoma (HNSCC) refractory to platinum-based chemotherapy is poor, making therapy optimization a priority. Anti-programmed cell death protein 1 (anti-PD-1) monoclonal antibody Nivolumab was approved in such cases. We present the early e...
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| Format: | Article |
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MDPI AG
2023-08-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/16/2620 |
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| author | Camil Ciprian Mireștean Mihai Cosmin Stan Michael Schenker Constantin Volovăț Simona Ruxandra Volovăț Dragoș Teodor Petru Iancu Roxana Irina Iancu Florinel Bădulescu |
| author_facet | Camil Ciprian Mireștean Mihai Cosmin Stan Michael Schenker Constantin Volovăț Simona Ruxandra Volovăț Dragoș Teodor Petru Iancu Roxana Irina Iancu Florinel Bădulescu |
| author_sort | Camil Ciprian Mireștean |
| collection | DOAJ |
| description | Prognosis in recurrent/metastatic head and neck squamous-cell carcinoma (HNSCC) refractory to platinum-based chemotherapy is poor, making therapy optimization a priority. Anti-programmed cell death protein 1 (anti-PD-1) monoclonal antibody Nivolumab was approved in such cases. We present the early experience with Nivolumab immunotherapy at three cancer clinics from south and northeast Romania, aiming to describe the main characteristics and outcomes relative to literature reports, and to suggest patient selection criteria. Diagnostic, clinical, biological, therapeutic, and outcomes-related data from January 2020 until March 2023 were analyzed retrospectively. Eighteen patients with platinum refractory HNSCC (85.7% men, median age 58.9) were administered Nivolumab for 1–14 months (median 5.6 months) in addition to other treatments (surgery, radiotherapy, chemotherapy), and monitored for up to 25 months. Median neutrophil-to-lymphocyte ratio (NLR) ranged from 2.72 initially to 6.01 during treatment. Overall survival (OS) was 16 months, and patients who died early had the sharpest NLR increases (13.07/month). There were no severe immune-related adverse events. Lower NLR values and combined intensive chemotherapy, radiotherapy, and immunotherapy were related to better outcomes. To our knowledge, we also report the first two cases of second primary malignancy (SPM) in the head and neck region treated with Nivolumab in Romania (for which the sequential administration of radiotherapy and immunotherapy seems better). The work of other Romanian authors on the role of HPV status in HNC is also discussed. Multi-center trials are needed in order to investigate and confirm these observations. |
| first_indexed | 2024-03-11T00:00:42Z |
| format | Article |
| id | doaj.art-e9598733e8e942289a0359c6ac798936 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T00:00:42Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-e9598733e8e942289a0359c6ac7989362023-11-19T00:47:42ZengMDPI AGDiagnostics2075-44182023-08-011316262010.3390/diagnostics13162620Immunotherapy with PD-1 Inhibitor Nivolumab in Recurrent/Metastatic Platinum Refractory Head and Neck Cancers—Early Experiences from Romania and Literature ReviewCamil Ciprian Mireștean0Mihai Cosmin Stan1Michael Schenker2Constantin Volovăț3Simona Ruxandra Volovăț4Dragoș Teodor Petru Iancu5Roxana Irina Iancu6Florinel Bădulescu7Department of Medical Oncology and Radiotherapy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, RomaniaDepartment of Medical Oncology and Radiotherapy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, RomaniaDepartment of Medical Oncology and Radiotherapy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, RomaniaDepartment of Medical Oncology and Radiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, RomaniaDepartment of Medical Oncology and Radiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, RomaniaDepartment of Medical Oncology and Radiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, RomaniaOral Pathology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, RomaniaDepartment of Medical Oncology and Radiotherapy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, RomaniaPrognosis in recurrent/metastatic head and neck squamous-cell carcinoma (HNSCC) refractory to platinum-based chemotherapy is poor, making therapy optimization a priority. Anti-programmed cell death protein 1 (anti-PD-1) monoclonal antibody Nivolumab was approved in such cases. We present the early experience with Nivolumab immunotherapy at three cancer clinics from south and northeast Romania, aiming to describe the main characteristics and outcomes relative to literature reports, and to suggest patient selection criteria. Diagnostic, clinical, biological, therapeutic, and outcomes-related data from January 2020 until March 2023 were analyzed retrospectively. Eighteen patients with platinum refractory HNSCC (85.7% men, median age 58.9) were administered Nivolumab for 1–14 months (median 5.6 months) in addition to other treatments (surgery, radiotherapy, chemotherapy), and monitored for up to 25 months. Median neutrophil-to-lymphocyte ratio (NLR) ranged from 2.72 initially to 6.01 during treatment. Overall survival (OS) was 16 months, and patients who died early had the sharpest NLR increases (13.07/month). There were no severe immune-related adverse events. Lower NLR values and combined intensive chemotherapy, radiotherapy, and immunotherapy were related to better outcomes. To our knowledge, we also report the first two cases of second primary malignancy (SPM) in the head and neck region treated with Nivolumab in Romania (for which the sequential administration of radiotherapy and immunotherapy seems better). The work of other Romanian authors on the role of HPV status in HNC is also discussed. Multi-center trials are needed in order to investigate and confirm these observations.https://www.mdpi.com/2075-4418/13/16/2620head and neck squamous cell carcinoma (HNSCC)Nivolumabimmunotherapyneutrophil-to-lymphocyte ratio (NLR)second primary malignancy (SPM)platinum refractory |
| spellingShingle | Camil Ciprian Mireștean Mihai Cosmin Stan Michael Schenker Constantin Volovăț Simona Ruxandra Volovăț Dragoș Teodor Petru Iancu Roxana Irina Iancu Florinel Bădulescu Immunotherapy with PD-1 Inhibitor Nivolumab in Recurrent/Metastatic Platinum Refractory Head and Neck Cancers—Early Experiences from Romania and Literature Review Diagnostics head and neck squamous cell carcinoma (HNSCC) Nivolumab immunotherapy neutrophil-to-lymphocyte ratio (NLR) second primary malignancy (SPM) platinum refractory |
| title | Immunotherapy with PD-1 Inhibitor Nivolumab in Recurrent/Metastatic Platinum Refractory Head and Neck Cancers—Early Experiences from Romania and Literature Review |
| title_full | Immunotherapy with PD-1 Inhibitor Nivolumab in Recurrent/Metastatic Platinum Refractory Head and Neck Cancers—Early Experiences from Romania and Literature Review |
| title_fullStr | Immunotherapy with PD-1 Inhibitor Nivolumab in Recurrent/Metastatic Platinum Refractory Head and Neck Cancers—Early Experiences from Romania and Literature Review |
| title_full_unstemmed | Immunotherapy with PD-1 Inhibitor Nivolumab in Recurrent/Metastatic Platinum Refractory Head and Neck Cancers—Early Experiences from Romania and Literature Review |
| title_short | Immunotherapy with PD-1 Inhibitor Nivolumab in Recurrent/Metastatic Platinum Refractory Head and Neck Cancers—Early Experiences from Romania and Literature Review |
| title_sort | immunotherapy with pd 1 inhibitor nivolumab in recurrent metastatic platinum refractory head and neck cancers early experiences from romania and literature review |
| topic | head and neck squamous cell carcinoma (HNSCC) Nivolumab immunotherapy neutrophil-to-lymphocyte ratio (NLR) second primary malignancy (SPM) platinum refractory |
| url | https://www.mdpi.com/2075-4418/13/16/2620 |
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