614 / 1096
S598
ESTRO 36
_______________________________________________________________________________________________
Material and Methods
A total of 110 HNSCC patients undergoing chemotherapy
with Cetuximab were retrospectively analyzed. Patients
were treated in our Institution between February 2007 and
May 2016. Performance Status (PS) evaluated with the
Eastern Cooperative Oncology Group (ECOG) scale.
Relevant comorbidity were evaluated with the Charlson
Comorbidity Index (CCI). Skin toxicity was evaluated
according to Common Terminology Criteria for Adverse
Events (CTCAE) version 4.03.
Results
The median age was 67 years (range 32-84 years); 83
(75.5%) patients were male. Ninety (82%) were smokers,
most of them had a smoking history > 20 pack/years. PS
was scored ≤ 1 in 100 (90.9%) patients. The median CCI
was 6 (range 1- 13). The most represented head and neck
subsites in the study were the oropharynx (27%) and the
larynx (32%). Fourty-three (39.1%) patients underwent a
curative treatment with a concomitant CTX-RT treatment,
while 67 (60.9%) received a CTX-containing chemotherapy
regimen. In patients undergoing a curative treatment, the
median number of CTX cycles administered amounted to 6
(range 2-8) ; median RT dose was 67Gy (range 66-70).
Acute mucositis G≤2 and G3 was observed in 24
(55,8%) and 18 (41,9%) patients respectively. Actinic
dermatitis
G≤2
was
observed
in
25
(58,1%) patients, while G3 and G4 dermatitis was present
in 17 (39,5%) and in 1 (2.3%) patient, respectively. In the
advanced disease subgroup, CTX was administered as first-
line CT in 39 cases (53.6%) as a triplet
combination (cis/carboplatin, 5-FU, CTX), and in 21
(26.8%) as a 2-drugs regimen (carboplatin / CTX); 7
patients (19.6%) received CTX monotherapy. Incidence of
acneiform rash G1-G2 was 37.3%, while G3 was 3.0%(25
and 2 patients, respectively); incidence of
hypomagnesemia G1-G2 was 4.5% (3 patients), no G3
toxicity was reported. Infusion reactions G2 was reported
in 2 (3.0%) patients.
Conclusion
Cetuximab is a mainstay in the radical and palliative
treatment in HNSCC patients but its toxicity in our serie is
not negligible, though in line with data from literature.
Accurate patients selections and toxicity management
during treatment are mandatory to ensure safety and
clinical benefit.
EP-1088 EGFR as blood biomarker improves prognostic
value of nomogram for survival in laryngeal carcinoma
F.W.R. Wesseling
1
, G. Feliciani
1
, C. Oberije
1
, M.P. Van de
Waarenburg
2
, C.G. Schalkwijk
2
, P. Lambin
1
, F.J. Hoebers
1
1
Maastricht Radiation Oncology MAASTRO clinic- GROW -
School for Oncology and Developmental Biology-
Maastricht University Medical Centre, Department of
Radiation Oncology, Maastricht, The Netherlands
2
Laboratory for Metabolism and Vascular Medicine-
Maastricht University, Department of Internal Medicine,
Maastricht, The Netherlands
Purpose or Objective
To improve
the prognostic value of a previously validated
nomogram for laryngeal carcinoma derived from clinical
parameters
1
by adding blood biomarker results for
hypoxia, inflammation, tumor load and cell growth.
Material and Methods
For 50 patients treated for laryngeal carcinoma at our
clinic by radiotherapy with curative intent, blood samples
were stored in a blood biobank (
ClinicalTrials.gov:
NCT01084785)
before start of treatment. Eight
biomarkers representing hypoxia, inflammation, tumor
load and cell growth were selected and measured with
commercially available kits: IL6, IL8, CEA, c-kit, E-cad,
EGFR, MMP-9 and osteopontin. Primary outcome was
overall survival (OS). Blood biomarker results and a
prognostic score, based on our previously developed
nomogram were entered in a Cox regression analysis using
least absolute shrinkage and selection operator (LASSO)
variable selection procedure with 10-fold cross validation.
Significant biomarkers were added to the nomogram score
to investigate whether the prognostic value would be
improved. Concordance index (C-index) was used to
evaluate the performance of the model.
Results
Clinical staging was: St. I: 18%, St. II: 20%, St. III: 34% and
St. IV: 28%. Most patients were treated with accelerated
locoregional radiotherapy (68%) or local radiotherapy
(16%). After a median follow up of 56 months, 2 and 5 year
OS was 75% and 58%. LASSO procedure selected EGFR and
the nomogram score as variables significantly associated
with OS. Spearman ρ coefficient and visual inspection
showed no correlation between EGFR and nomogram score
(ρ=0.29). After validating the existing nomogram with this
new cohort, its performance was comparable to the
published data
1
(C-index = 0.68). By performing
multivariate Cox regression, the addition of EGFR to the
nomogram improved its concordance index to 0.73 as
shown in table 1. Interestingly we found that high-risk
patients had lower EGFR levels in blood samples compared
to low-risk patients. This is opposite to results obtained
from tissue samples as reported in literature.
2
Conclusion
EGFR as blood biomarker is an independent predictor for
OS of patients with laryngeal carcinoma. OS curves for
patients in high vs low EGFR group are visible in figure 1.
Based on this small cohort the prognostic value of our
existing nomogram was improved, but an independent
cohort would be needed for external validation. Further
research is needed to correlate EGFR blood values
with EGFR expression in tumor samples.
References:
1. Egelmeer AGTM et al. Development and validation of a
nomogram for prediction of survival and local control in
laryngeal carcinoma patients treated with radiotherapy
alone: A cohort study based on 994 patients.
Radiother
Oncol
. 2011;100(1):108.