Immune-related adverse events of checkpoint inhibitors as predictive factors in R/M-HNC

Introduction Checkpoint inhibitors (CPI) represent an important component of therapy for recurrent or metastatic head and neck malignancies (R/M-HNC). It is known from other antibody-therapies such as the EGFR antibody cetuximab that the occurrence of drug-induced side effects such as skin reactions is a positive predictive factor. A retrospective evaluation was performed to investigate whether such an association also exists for CPI and the occurrence of immune-related adverse events (irAE).

Material and methods Medical records of patients (n=35) who had received CPI therapy at our University Department of Otolaryngology, Head and Neck Surgery in 2018-2021 were reviewed. The association of any immune-related adverse events and the outcome of the first re-staging was examined using descriptive statistics.

Results The occurrence of pneumonitis was significantly associated with a favorable (partial remission or stable disease) re-staging outcome (p=0.038, Somers’ D=0.24). No significant association was found for other forms of irAE or irAE in general. Significantly higher proportions of lymphocytes were found in the differential blood count of patients with favorable re-staging results (p=0.041).

Discussion The results of meta-analyses investigating this association in other entities come to different conclusions, partly demonstrating an association of irAEs and a favorable re-staging outcome, partly not. Various influences, such as guarantee-time bias and a likely high rate of unreported subclinical irAEs, complicate an assessment. IrAEs do not seem to be an independent predictive factor in HNSCC, but possibly they can be added in combination with e.g. laboratory chemical parameters as a factor in a model for predictive estimation in the future.

Publication History

Article published online:
12 May 2023