Dr Wong on Atezolizumab After Definitive Local Therapy in High-Risk HNSCC

Deborah J. Wong, MD, PhD, HS associate clinical professor, medicine, University of California, Los Angeles School of Medicine, discusses findings from the phase 3 IMvoke010 trial (NCT03452137) investigating atezolizumab (Tecentriq) vs placebo after definitive local therapy in patients with high-risk, locally advanced head and neck squamous cell carcinoma (HNSCC).

Findings presented at the 2024 AACR Annual Meeting showed that treatment with atezolizumab after definitive local therapy did not provide a statistically significant improvement in event-free survival (EFS) compared with placebo, missing the trial’s primary end point. At a median follow-up of 46.5 months, patients in the experimental arm (n = 203) experienced a median EFS of 59.5 months (95% CI, 46.8-not evaluable [NE]) compared with 52.7 months (95% CI, 41.4-NE) for those in the control arm (n = 203; HR, 0.94; 95% CI, 0.70-1.26; P = .680). The 2-year EFS rates were 67.4% and 63.8% for atezolizumab and placebo, respectively.

Despite the integration of immunotherapy into the treatment of patients with recurrent or metastatic HNSCC, the data from IMvoke010 add to the growing body of evidence that has demonstrated the limited activity of immune checkpoint inhibitors in the locally advanced setting, Wong explains. Previously, the phase 3 JAVELIN Head and Neck 100 trial (NCT02952586), which evaluated the addition of avelumab (Bavencio) to chemoradiotherapy vs chemoradiotherapy alone, did not meet its progression-free survival end point. Additionally, the phase 3 KEYNOTE-412 trial (NCT03040999), which investigated pembrolizumab (Keytruda) plus concurrent chemoradiotherapy vs chemoradiotherapy alone, missed its EFS end point.

Given the findings of IMvoke010, atezolizumab after multimodal therapy should not be incorporated into the standard-of-care treatment for patients with high-risk, locally advanced HNSCC, Wong continues. When looking at these results in the context of prior data from JAVELIN Head and Neck 100 and KEYNOTE-412, the role of immune checkpoint inhibitors in the treatment of patients with locally advanced HNSCC is yet to be determined, Wong concludes.