Immune Checkpoint Inhibitors Offer New Approaches in Head and Neck Cancer

Joseph M. Curry, MD, a professor in the department of otolaryngology and vice chairman of research at Thomas Jefferson University, discusses the introduction of immune checkpoint inhibitors (ICIs) for the treatment of patients with head and neck cancers.

Anti–PD-1 therapies have shown efficacy in head and neck cancer in clinical trials, leading to the approval of pembrolizumab (Keytruda) based on the KEYNOTE-012 trial (NCT01848834), and nivolumab (Opdivo) based on the CheckMate 141 trial (NCT02105636) for recurrent and metastatic head and neck squamous cell carcinoma. Curry notes that pembrolizumab is now considered first-line therapy for unresectable metastatic disease based on the results of the KEYNOTE-048 trial (NCT02358031).

ICIs also have potential for use in the neoadjuvant setting even for resectable disease. Curry and other investigators are conducting a phase 1 trial (NCT03618654) of durvalumab (Imfinzi) and metformin in head and neck squamous carcinoma. The trial is exploring the efficacy of PD-1 inhibition in the 4-week window prior to surgery, indicating that ICIs play multiple valuable roles in treating head and neck cancer.

TRANSCRIPTION:

0:08 | ICIs have been a popular and exciting development because of the efficacy they've shown in head and neck cancer—specifically within head and neck cancer, anti–PD-1 therapy. So, both pembrolizumab and nivolumab have been approved for the treatment of recurrent and metastatic head and neck cancer and squamous cell carcinoma because of the efficacy that they've shown in a number of clinical trials. And in fact, after the initial approval, they've moved up in the algorithm such that pembrolizumab is now included in first line therapy for metastatic and inoperable disease.

And so, these therapies have really expanded what we think of as options in terms of non-surgical therapies. And in terms of this specific clinical trial, they've also expanded how we approach disease, which is in some cases operable, looking at neoadjuvant strategies for the use of immune checkpoint inhibitors.