Head and neck cancers that are metastatic or resistant to cisplatin are notoriously aggressive. The prognosis for patients in this group is grim at less than 6 months. However, a new immunotherapy may prove to be a game-changer for these patients, as more promising results are coming to light.
The drug is called nivolumab, and belongs to a class of medicines called PD-1 immune checkpoint inhibitors. Essentially this drug works by blocking a programmed death receptor in the body’s immune cells, allowing these cells to perk up longer and attack the tumor. The drug is marketed under the name Opdivo by Bristol-Myers Squibb, and is FDA-approved for the treatment of other cancer types, including melanoma, lung and kidney cancer.
"We don't have effective treatments for advanced head and neck cancers - these cancers are notoriously difficult to treat. So it's exciting that this phase III trial has been the first to show a significant survival benefit with an immunotherapy," said Kevin Harrington, Professor of Biological Cancer Therapies at The Institute of Cancer Research, London, and the senior study author.
"Once it has relapsed or spread, head and neck cancer is extremely difficult to treat, with surgery and radiotherapy often impossible. So it's very good news for patients that these interim results indicate we now have a new treatment that works, and can significantly extend life."
Presenting their work in both at the European Society for Medical Oncology 2016 Congress in Copenhagen, Denmark, and in print in the New England Journal of Medicine, Harrington sees much hope in nivolumab.
The phase III study involved 361 patients with metastatic head and neck cancer. The patients were randomized to receive three different chemotherapies, or the immunotherapy with nivolumab. At the one-year mark, the number of patients still alive with nivolumab was more than doubled that of chemotherapy (36 versus 17. Median survival was also extended in patients treated with the immunotherapy.
"Overall survival was significantly longer with nivolumab than with standard therapy, and nivolumab-treated patients had a risk of death that was 30 percent lower than the risk among patients assigned to standard therapy,” the authors wrote.
"Nivolumab was not only more effective than chemotherapy for patients with head and neck cancer but also had fewer side-effects, and has the potential to significantly extend life and increase quality of life,” Harrington added. They reported side effects were seen in about 13 percent of patients on nivolumab, whereas over 35 percent of patients on standard chemotherapy had side effects.
"Nivolumab could be a real game-changer for patients with advanced head and neck cancer. This trial found that it can greatly extend life among a group of patients who have no existing treatment options, without worsening quality of life,” said Harrington.
Additional sources: MNT, Institute of Cancer Research