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6th ICHNO
page 73
6
th
ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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was 77% vs. 79%, for Y vs. O, respectively. Local control
was significantly correlated with T stage (T2 89%, T3 80%,
T4 56%), mobility of the vocal cord (87%, 90% and 71% for
normal, impaired, and fixed cord, respectively). In
multivariate analysis the only independent prognostic
factor for local control was T-stage.
Tube feeding during treatment was given in 24%, equal for
both age groups. Severe late toxicity (PEG tube and/or
tracheotomy dependency) after 2 years was 10% and 12%
for Y and O respectively. In multivariate analysis severe
late toxicity was related to yes or no tube feeding
dependency during treatment, need for tracheotomy or
debulking before treatment, and field size.
Conclusion
In this large group of patients treated with accelerated
fractionation for intermediate size head and neck tumor
age ≥ 70 was not a negative prognostic factor for local
control, disease free survival and risk of complications.
For patients ≥ 70, with a WHO performance 0-1 with our
fractionation schedule excellent outcome is shown.
1: Terhaard CH, Kal HB, Hordijk GJ. Int J Radiat Oncol Biol
Phys. 2005 May 1;62(1):62
Poster: Immunodiagnosis and immunotherapy
PO-151 Immunotherapy for refractory brain metastasis
in cases of oropharangeal squamous cell carcinoma
M. Bhandari
1
, P. Vora
2
, A. Dugar
3
, S. Bhati
4
, A. DeFranco
5
,
E. Guenther
6
1
The Christ Hospital, Medical Oncology, Cincinnati- OH,
USA
2
The Christ Hospital, Medical Oncology, Cincinnati-OH,
USA
3
Wellesley College, Biology, Boston- MA, USA
4
Miami University, Biology, Oxford- OH, USA
5
Cornell Medical School, Biology, New York- NY, USA
6
The Christ Hospital, Rad Oncology, Cincinnati -OH, USA
Purpose or Objective
To investigate the efficacy and tolerability of checkpoint
inhibition in cases of progressive CNS/brain metastasis
from squamous cell carcinoma of the head and neck after
optimal radiation therapy.
Brain metastasis from head and neck squamous cell
carcinoma (HNSCC) is a unfortunately clinical entity and
can occur in HPV positive as well as smoking associated,
HPV negative HNSCC. Disease progression after optimal
radiation therapy to the sites of brain metastasis is
difficult to control and has almost no viable therapeutic
options. These patients are often recommended hospice
based supportive care only. Herein, we investigate and
report the case series of the first 3 patients with disease
progression post-optimal radiotherapy revealing disease
control beyond median of 6 months utilizing systemic
immunotherapy with pembrolizumab (Ketruda
R
, Merck).
Material and Methods
Institution approved, compassionate access program
guided therapy utilizing pembrozulimab (Ketruda) at
2mg/kg every 3 weeks until disease progression or
intolerable toxicity.
Results
We report a case series of the first 3 patients treated with
metastatic squamous cell carcinoma of oropharynx with
brain metastasis in our institutional protocol. Patients
were treated upon disease progression in CNS post optimal
radiotherapy. Two patients had HPV negative, smoking
associated primary HNSCC prior to development of
systemic relapse and CNS metastasis and one patient had
HPV positive primary HNSCC. One smoking associated
HNSCC patient has stayed on continuous therapy beyond 1
year with no CNS or systemic disease progression and with
radiographic evidence of CNS disease regression. Two
other patients have stayed on therapy for 9 and 6 months
respectively, with one experiencing disease progression at
the 7
th
month of therapy. Overall disease control rate &
data from further patients enrolling this study will be
reported in this small case series. The first 3 patients have
a median time to disease progression of over 8 months,
which is unprecedented in these clinical settings.
Responses are seen irrespective of PD-1 staining, but all
three patients had a gene signature of high tumor
mutation burden (TMB).
Conclusion
Checkpoint inhibitors may have a large role to play as
salvage therapy or as maintenance post primary
radiotherapy for CNS metastasis from HNSCC. Disease
control is seen so far in smoking and HPV associated HNSCC
brain metastasis. Tumor mutation burden has been found
to predict clinical disease control, rather than IHC for PD-
1 or PDL-1 in our single instruction case series. Further
clinical trials of immunotherapy for CNS metastasis from
HNSCC is warranted.