Best practices for immunotherapy for metastatic head and neck cancer
Source: www.medpagetoday.com Author: Mark L. Fuerst , Contributing Writer, MedPage Today Immunotherapy with anti–programmed cell death protein 1 (PD-1) immune checkpoint inhibitors (ICIs) is now an essential treatment for patients with recurrent and metastatic head and neck squamous cell carcinoma (HNSCC), and ICIs also show promise for patients with nasopharyngeal carcinoma and other rare head and neck cancer types. A recently released ASCO Guideline on immunotherapy and biomarker testing in recurrent and metastatic HNSCCs provided evidence-based recommendations. A new related document by expert panel co-chairs Emrullah Yilmaz, MD, PhD, of the Cleveland Clinic, and Loren K. Mell, MD, of the University of San Diego, and colleagues poses questions and answers about the guideline. The following is a summary: For patients with recurrent and metastatic head and neck cancer, which biomarkers should be used in the selection of anti–PD-1 immune checkpoint inhibitor therapy? We recommend programmed death ligand 1 (PD-L1) combined positive score (CPS) testing for recurrent and metastatic HNSCC. PD-L1 reports come via immunohistochemistry using CPS or tumor proportion score. CPS has emerged as a preferred biomarker in HNSCC and has been used in landmark head and neck clinical trials such as KEYNOTE-048. Tumor mutational burden (TMB), another emerging biomarker for predicting response to anti–PD-1 ICIs, was studied in KEYNOTE-158. TMB is not used routinely in HNSCC, but may help in cases where PD-L1 CPS is unavailable or for rare head and neck cancers. In first-line treatment of patients with PD-L1 CPS ≥ 1 recurrent and metastatic HNSCC, can pembrolizumab [...]