Dr. Cohen Discusses Promise of Immunotherapy in Head and Neck Cancer

Ezra Cohen, MD, associate director, Moores Cancer Center at the University of California, San Diego, discusses the promise of immunotherapy in the treatment of patients with head and neck cancer.

There are currently 2 FDA-approved checkpoint inhibitors in this space: nivolumab (Opdivo) and pembrolizumab (Keytruda). Importantly, Cohen says, these PD-1 inhibitors are much better tolerated than the cytotoxic chemotherapy regimens that used to be the standard of care. The rates of grade 3 toxicity with immunotherapy are approximately one-third of what had been seen with chemotherapy or cetuximab (Erbitux), says Cohen.

Additionally, there are patients who derive dramatic benefit from immunotherapy, and the tail of the overall survival curve shows this, he notes. This is being confirmed as the data mature from the 2 pivotal trials, KEYNOTE-040 and CheckMate 141. Immunotherapy, Cohen reiterates, is less toxic, more effective, and about 10% of patients derive significant benefit.

Based on these positive data, pembrolizumab was recently moved into the frontline recurrent metastatic setting; these are patients who were treated with curative intent and developed progressive disease, explains Cohen. These patients used to be treated with the EXTREME regimen, a toxic triplet comprised of platinum, 5-fluourouracil, and cetuximab, and now they are deriving benefit from a single agent.