tbuckley/cabot-search huggingface dataset:
Clinical prognostic factors to guide treatment strategy for HPV-positive oropharyngeal cancer from treatment outcomes of induction chemotherapy: A real-world experience.
Authors: Hyun Jin Bang, Hyeon-Jong Kim, Seung Hyuk Lee, Hyun Jeong Shim, Jun Eul Hwang, Woo Kyun Bae, Ik-Joo Chung, Sang Hee Cho
Journal: Journal of Clinical Oncology (2024)

e18014 Background: The role of induction chemotherapy (IC) in locally advanced oropharyngeal cancer (OPC) remains a topic of debate and suitable candidates for de-escalation treatment in these patients have not been fully identified. This study aimed to identify high-risk groups for HPV-positive OPC by analyzing patients who underwent IC followed by chemoradiotherapy (CRT) to guide optimal treatment strategies. Methods: Between 2004 and 2020, we reviewed patients with OPC diagnosed with stage III-IVA who underwent a treatment regimen comprising a minimum of two cycles of IC followed by CRT.In this study, all patients were re-staged according to the American Joint Committee on Cancer (AJCC) 8 th edition, and we analyzed the overall response rate and survival outcomes associated with clinical factors based on HPV status by utilizing univariate and multivariate analyses. Results: This study analyzed 105 patients with a median age of 60 years (range: 40–76 years). Among 105 patients, 40 (38.1%) were HPV-negative, and 65 (61.9%) were HPV-positive. Through a median follow-up of 60.0 months (range, 5–60 months), no significant differences in progression-free survival (PFS) (p = 0.172) and overall survival (OS) (p = 0.064) were observed based on HPV status, regardless of no differences in relative dose intensity of IC and cumulative dose of radiation and cisplatin in CRT. In all patients, survival outcomes were notably poorer in patients aged ≥ 60 years ( p = 0.006) and those who did not achieve complete response (non-CR) post-CRT ( p &lt; 0.001), irrespective of HPV status. All have received sufficient IC with a median RDI of 80% or more in both age &lt; 60 years and age ≥ 60 years. Unlike HPV-negative OPC, where age and T stage showed no significant correlation, in HPV-positive OPC, age ≥ 60 years ( p = 0.011) and T4 stage ( p = 0.019) emerged as substantial poor prognostic factors for survival outcomes despite IC and CRT. Utilizing these results, we categorized HPV-positive OPC patients into three groups based on the number of clinical risk factors at diagnosis (age, T4 stage), the PFS and OS showed significant stratification across each group as the number of clinical risk factors increased. Conclusions: This study revealed that age and T stage significantly influenced on prognosis in HPV-positive OPC but not in HPV-negative OPC. Considering our result, HPV-positive OPC exhibiting these risk factors requires a careful treatment strategy, and combined treatments, including immunotherapy, may be considered to enhance treatment outcomes for these patients.
METTL3 as a potential predictive biomarker for immunotherapy response in metastatic head and neck cancer.
Authors: Paramasivam Arumugam, Vijayashree Priyadharsini Jayaseelan, Abilasha Ramasubramanian
Journal: Journal of Clinical Oncology (2024)

e18019 Background: Head and neck squamous cell carcinoma (HNSCC) that has metastasized presents a significant challenge for cancer treatment, requiring innovative approaches to predict immunotherapy response. Methyltransferase-like 3 (METTL3), a key component of the m6A RNA methylation machinery, has been shown to have various roles in cancer, including its potential impact on immunotherapy responses. In this study, we aim to explore the expression and related function of METTL3 in metastatic HNSCC. Methods: We investigated the expression level and its clinicopathological significance of METTL3 using The Cancer Genome Atlas Head-Neck Squamous Cell Carcinoma (TCGA-HNSC) datasets. Further validation of the METTL3 mRNA and protein expression were carried out with real-time PCR and Western blot on tissues from 112 cases of HNSCC patients. In addition, the functional role of METTL3 was investigated in vitro studies. The treatment response prediction values of METTL3 in metastatic HNSCC were calculated using ROC-plotter. Results: Our investigation revealed a significant overexpression of METTL3 in HNSCC tissue samples than in normal tissues ( p &lt; 0.001). The high expression of METTL3 was significantly correlated with nodal metastasis, advanced cancer stages, and higher tumor grades in HNSCC samples, indicating that METTL3 plays an important role in driving HNSCC progression and aggressiveness. The functional study revealed intricate connections between METTL3 and immune regulatory genes expression, highlighting its potential to influence the tumor immune microenvironment. Silencing or pharmacological inhibition of METTL3 by METTL3 inhibitor STM2457 reduced tumorigenic activity through decreasing PD-L1 expression. ROC-plotter calculations showed that the high METTL3 expression predicted powerful immunotherapy (AUC=0.588, p=6.3e-06) in metastatic HNSCC patients. Conclusions: In conclusion, METTL3 appears to be a promising predictive biomarker for the response to immunotherapy in patients with metastatic HNSCC. This research provides valuable insights into the multifaceted role of METTL3 and promising therapeutic response predictor in metastatic HNSCC.
Anti-LAG-3 antibody LBL-007 in combination with anti-PD-1 antibody tislelizumab with or without chemotherapy in patients with advanced nasopharyngeal cancer and other malignant tumors: A phase Ib/II dose escalation/expansion study.
Authors: Yunpeng Yang, Yu Chen, Song Qu, Lei Liu, Lisha Chen, Kunyu Yang, Xiaoming Huang, Jingao Li, Rensheng Wang, Haisheng Zhu, Shiwei Zhao, Tao Li, Shengli Cai, Li Zhang
Journal: Journal of Clinical Oncology (2024)

6033 Background: Dual inhibition of PD-1 and LAG-3 is expected to synergistically increase immune response against tumor growth while chemotherapy can enhance the efficacy of immunotherapy through various mechanisms. Here we report the safety and efficacy of LBL-007 (anti-LAG-3) in combination with tislelizumab (anti-PD1) with or without chemotherapy in advanced solid tumors (Phase Ⅰb) and previously untreated patients with advanced nasopharyngeal carcinoma (NPC) (Phase II). Methods: In phase Ⅰb, patients with relapsed and refractory advanced solid tumor received LBL-007 (300 or 600 mg) plus tislelizumab (200 mg) (both i.v. Q3W), and in phase Ⅱ, patients with previously untreated recurrent or metastatic NPC patients received LBL-007 (600 mg) plus tislelizumab (200 mg) in combination with GC chemotherapy [gemcitabine (1000 mg/m 2 ) and cisplatin (80mg/m 2 )] (i.v. Q3W). The primary endpoints were tolerability, safety, and efficacy. Results: Updated data with more follow up including duration of response and progression free survival will be available to report at the meeting. As of January 10, 2024, 21 patients (4 NPC, 7 NSCLC, 7 melanoma and 3 others) and 42 NPC patients were enrolled in in phase Ⅰb and phase Ⅱ respectively. The median follow-up was 13.1 months. During the study, no Dose limiting Toxicity (DLT) was observed, and Recommended Phase 2 Dose (RP2D) was determined to be 600mg Q3W for both chemo and chemo free regimens. In phase II, all grades TRAEs occurred in 39 patients (92.9%), with grade ≥3 TRAE in 24/42 patients (57.1%). The most common TRAEs (≥20%) included white blood cell count decreased, neutrophil count decreased, anaemia, ALT increased, AST increased, platelet count decreased, nausea, hyponatraemia, hypochloraemia, blood creatinine increased, vomiting, and hypothyroidism. Treatment interruption due to TEAEs occurred in 31 (73.8%) patients. 13 patients (31%) experienced SAEs. 1 patient experienced Grade 5 AE due to exacerbation of cachexia unrelated to LBL-007/tislelizumab. The clinical efficacy is shown in the table. Conclusions: LBL-007/tislelizumab combination is well-tolerated in patients with advanced malignant tumors. LBL-007/tislelizumab/GC combination showed manageable, no new safety concerns and encouraging antitumor activity in previously untreated and advanced NPC patients. The encouraging efficacy and safety profile may support a pivotal study with LBL-007 in combination with tislelizumab and GC chemotherapy for NPC development in 1L setting. Clinical trial information: NCT05516914 . [Table: see text]
Long-term survival, toxicities, and the role of chrono-chemotherapy with different infusion rates in patients with locally advanced nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: A retrospective study with a 5-year follow-up.
Authors: Lina Liu, Xunyan Luo, Weili Wu, Yuanyuan Li, Jinhua Long, Xiuling Luo, Xiaoxiao Chen, Xiuyun Gong, Chaofen Zhao, Zhuoling LI, Kai Shang, Xinyu Xu, Feng Jin
Journal: Journal of Clinical Oncology (2024)

e18003 Background: This study aimed to evaluate 5-year outcomes and the late toxicity profile of chrono-chemotherapy with different infusion rates in patients with locally advanced nasopharyngeal carcinoma (NPC). Methods: Our retrospective analysis included 70 patients with locally advanced NPC stages III and IVB (according to the 2010 American Joint Committee on Cancer staging system). Patients were treated with two cycles of induction chemotherapy (IC) before concurrent chemoradiotherapy (CCRT) at the affiliated cancer hospital of Guizhou medical university. The IC with docetaxel, cisplatin (DDP) and fluorouracil regimen. Patients were divided into two groups during CCRT. Using a “MELODIE” multi-channel programmed pump, DDP (100 mg/m 2 ) was administered for 12 hours from 10:00 am to 10:00 pm and repeated every 3 weeks for 2-3 cycles. DDP was administered at the peak period of 4:00 pm in the sinusoidal chrono-modulated infusion group (Arm A, n = 35). The patients in Arm B received a constant rate of infusion. Both arms received radiotherapy through the same technique and dose fraction. The long-term survival and disease progression were observed. Results: After a median follow-up of 82.8 months, the 5-year progression-free survival rate was 81.3% in Arm A and 79.6% in Arm B (P = 0.85). The 5-year overall survival rate was not significantly different between Arm A and Arm B (79.6% vs 85.3%, P = 0.79). The 5-year distant metastasis-free survival rate was 83.6% in Arm A and 84.6% in Arm B (P = 0.75). The 5-year local recurrence-free survival rate was 88.2% in Arm A and 85.3% in Arm B (P = 0.16). There were no late toxicities of grade 3-4 in either group. Both groups had grade 1-2 late toxicities. Dry mouth was the most common late toxic side effect, followed by hearing loss and difficulty in swallowing. There was no statistically significant difference between Arm A and Arm B in terms of side effects. Conclusions: Long-term analysis confirmed that in CCRT, cisplatin administration with sinusoidal chrono-modulated infusion was not superior to the constant infusion rate in terms of long-term toxicity and prognosis.
Trastuzumab deruxtecan (T-DXd) in patients (pts) with HER2-expressing head and neck tumors: Outcomes from DESTINY-PanTumor02 (DP-02).
Authors: Funda Meric-Bernstam, Seung Tae Kim, Napa Parinyanitikul, Alberto Moreno, Chia-Chi Lin, Dmitry Gornastolev, Jarin Chindaprasirt, Iwona A. Lugowska, Daniil Stroyakovskiy, Jacek Jassem, Michelle L. Harrison, Vikas S. Ostwal, Flavia Michelini, Lindsey Jung, Nataliya Kuptsova-Clarkson, Soham D. Puvvada, Hui Kong Gan
Journal: Journal of Clinical Oncology (2024)

6037 Background: In DP-02, T-DXd demonstrated an objective response rate (ORR) by investigator (INV) of 37.1% (95% CI 31.3, 43.2) and clinically meaningful survival outcomes in 267 pretreated pts with HER2-expressing tumors. In this post-hoc analysis, we report outcomes and characterize those with an objective response (OR) in a subset of pts with head and neck cancers (previously included in the ‘other tumor’ cohort), most of which were salivary gland tumors. Methods: This open-label, Phase 2 study (NCT04482309) evaluated T-DXd (5.4 mg/kg Q3W) in pts with HER2-expressing (immunohistochemistry [IHC] 3+/2+ by local or central testing) locally advanced/metastatic disease after ≥1 systemic treatment or without treatment options. The primary endpoint was confirmed ORR by INV. Secondary endpoints included duration of response (DOR), progression-free survival (PFS), disease control rate (DCR), and safety. Exploratory endpoints included efficacy outcomes by HER2 expression. Results: At data cutoff (June 2023), 24 pts with head and neck tumors (n=19 salivary gland, n=3 squamous cell carcinoma [SCC], n=1 adenoid cystic carcinoma, n=1 lacrimal gland) had received treatment (median [m] follow up: 20.8 months [range: 4.7–31.6]). Of these pts, 15 (62.5%) had received ≥2 prior treatment regimens. 10/24 pts (41.7%; 95% CI 22.1, 63.4; n=8 salivary gland, n=1 SCC, n=1 lacrimal gland) had a confirmed OR by INV; 9 responders had received prior radiation therapy, and 4 had known PD-L1 immune cell status ≥1%. The Table shows efficacy outcomes in all pts and by HER2 expression (central testing). Grade (G) ≥3 drug-related adverse events occurred in 10/24 (41.7%) pts. Adjudicated drug-related interstitial lung disease / pneumonitis occurred in 3/24 (12.5%) pts (n=1 G1; n=1 G2; n=1 G5). Conclusions: T-DXd showed clinically meaningful benefit in pretreated pts with head and neck tumors. Responses were observed across HER2 expression levels. Safety was consistent with the known profile. These data support T-DXd as a potential treatment for pretreated pts with HER2-expressing head and neck tumors. Clinical trial information: NCT04482309 . [Table: see text]
Identifying patients at high risk of recurrence by rebound of plasma Epstein-Barr virus DNA in nasopharyngeal carcinoma.
Authors: Qixian Zhang, Xin Zhou, Tingting Xu, Chunying Shen, Wei Qian, Lin Zhu, Hongmei Ying, Xiayun He, Chaosu Hu, Xueguan Lu
Journal: Journal of Clinical Oncology (2024)

6030 Background: About 10-30% of patients with nasopharyngeal carcinoma (NPC) would develop disease recurrence following treatment. The optimal method to screen patients needing early medical intervention remains to be studied. We investigated the potential cut-off values of plasma EBV DNA in identifying patients at high risk of recurrence. Methods: From 2012 to 2020, 950 patients with detectable pre-treatment plasma EBV DNA and undetectable EBV DNA within 3 months after treatment were retrospectively reviewed. Survival outcomes of patients with different plasma EBV DNA rebound patterns were analyzed. The diagnostic performance of different cut-off values was evaluated in patients with ≥ 2 positive tests. Results: The number of patients with continuous negative plasma EBV DNA, only 1 positive test, and ≥ 2 positive tests during post-treatment surveillance were 747, 89, and 114, respectively. Patients with ≥ 2 positive plasma EBV DNA tests had worse PFS, LRRFS, and DMFS when compared with the ones with negative tests ( P &lt; 0.001, P &lt; 0.001, and P &lt; 0.001) and only 1 positive test ( P &lt; 0.001, P &lt; 0.001, and P &lt; 0.001). Superior PFS was observed for patients with negative tests compared to patients with only 1 positive test ( P = 0.006). Of 56 patients with more than 50 copies/ml plasma EBV DNA in both tests, 48 developed recurrences within 4 years. The sensitivity, specificity, PPV, and NPV of this cut-off for recurrence prediction were 35.8%, 99.0%, 85.7%, and 90.4, respectively. Then, the whole population was divided into the low-risk group (≤ 1 positive test), the intermediate-risk group (≥ 2 positive tests and at least one test had &lt; 50 copies/ml) and the high-risk group (≥ 2 positive tests and both tests had ≥ 50 copies/ml). The PFS of the high-risk group was worse than that of the low-risk group ( P &lt; 0.001) and the intermediate-risk group ( P &lt; 0.001). The PFS of the high-risk patients with and without capecitabine or tegafur/gimeracil/oteracil before clinical confirmed relapse were 59.3% and 15.0% ( P = 0.004). Conclusions: NPC patients with ≥ 2 positive tests and ≥ 50 copies/ml in both tests during follow-up were at high risk of relapse. Early medical intervention could bring survival benefits to this cohort.
Four-year overall survival follow-up and dynamic EBV titer analysis of toripalimab versus placebo in combination with gemcitabine and cisplatin as first-line treatment for recurrent or metastatic nasopharyngeal carcinoma (r/m NPC).
Authors: Qiu-Yan Chen, Hai-Qiang Mai, Dong-Ping Chen, Chao-su Hu, Kunyu Yang, Jiyu Wen, Jingao Li, Yingrui Shi, Feng Jin, Ruilian Xu, Jian-ji Pan, Shenhong Qu, Ping Li, Chunhong Hu, Yi-Chun Liu, Yi Jiang, Xia He, Hung-Ming Wang, Darren Wan-Teck Lim, Rui-Hua Xu
Journal: Journal of Clinical Oncology (2024)

6039 Background: In October 2023, the US FDA approved toripalimab in combination with Gemcitabine-Cisplatin (GP) as first-line treatment for recurrent or metastatic (r/m) NPC based on the results of JUPITER-02 study (NCT03581786). Here we report the results of four-year overall survival (OS) follow-up and dynamic EBV DNA copy number and its correlation with clinical outcome. Methods: Patients with r/m NPC (n=289) were randomized (1:1) to receive toripalimab 240 mg (n=146) or placebo (n=143) in combination with GP once every 3 weeks (Q3W) for up to 6 cycles, followed by monotherapy with toripalimab or placebo until disease progression, intolerable toxicity, or completion of 2 years of treatment. Stratification factors were ECOG performance score (0 vs. 1) and extent of disease (recurrent vs.primary metastatic). The primary endpoint was progression free survival by an independent review committee. Secondary endpoints included OS and safety. Exploratory endpoints included dynamic blood EBV DNA copy number and its correlation with clinical efficacy. Results: By the cutoff date of January 9, 2024, 50 months after the last patient was enrolled, 150 deaths were recorded. Compared with the results from the final OS analysis, consistent survival improvement was observed for toripalimab over placebo: HR=0.61 (95% CI: 0.44-0.85), nominal p=0.0027. The median OS was not yet reached in the toripalimab arm and was 33.7 months in the placebo arm. The 5-year OS rates were 52.0% in the toripalimab arm, and 33.9% in the placebo arm. Among patients with detectable baseline EBV DNA copy number and at least one EBV result after study treatment, significantly more patients from the toripalimab arm had EBV DNA copy number decreased to undetectable level than those in the placebo arm, 96.3% vs. 84.5%, p= 0.004. In addition, significantly less patients experienced EBV DNA copy number rebound in the toripalimab arm than in the placebo arm after the initial reduction, 36.5% vs, 57.4%, p=0.002. The median time from the lowest EBV DNA copy number to the rebound was 20.5 vs. 6.0 months in the toripalimab and placebo arms respectively. The rebound also preceded investigator-assessed disease progression by a median of 1.9 months in the toripalimab arm. Conclusions: The combination of toripalimab and chemotherapy showed long term survival benefit than chemotherapy alone with a 5-year OS rate at 52%. EBV DNA copy number might be used to monitor clinical response and predict disease progression. Clinical trial information: NCT03581786 .
The effects of substituting cladribine for fludarabine on outcomes of a reduced intensity conditioning regimen.
Authors: Ugur Sahin, Selin Merih Urlu, Ayla Gokmen, Onder Arslan, Muhit Ozcan
Journal: Journal of Clinical Oncology (2024)

e18518 Background: Drug shortages may be encountered especially in times of pandemics and war. The extrapolation of data focusing on different diseases may provide clinical clues for substituting two chemotherapeutic drugs of the same class. The substitution of cladribine for fludarabine in a reduced intensity conditioning (RIC) regimen composed of fludarabine, melphalan and total body irradiation (TBI) may yield similar side effect profile and outcomes. Methods: Consecutive patients undergoing an allogeneic stem cell transplant in our center between November 2019 to December 2022 were included. Within this period cladribine had to be substituted for fludarabine during a drug shortage. All patients received intravenous melphalan 75 mg/m 2 /day on day -2, and 200 cGy TBI on day -1. The regimen included either subcutaneous cladribine 10 mg/m 2 /day on days -5 to -2, or intravenous fludarabine 40 mg/m 2 /day on days -5 to -2. Graft versus host disease (GvHD) prophylaxis included a calcineurin inhibitor (CNI) + mycophenolate mofetil (MMF) for matched related donor transplants; and post-transplant cyclophosphamide + CNI + MMF for matched unrelated (MUD) and haploidentical donors. The distributions and medians of studied parameters in two cohorts were compared with non-parametric methods. Overall survival (OS), progression-free survival (PFS) and transplant-related mortality (TRM) were estimated by the Kaplan-Meier Method. The cut-off for statistical significance was defined as p&lt;0.05. Results: A total of 70 patients (27 in cladribine and 43 in fludarabine cohort) were included. Median age was 59 (22 to 76) and 64.3% constituted males. Median follow-up was 10.2 months (0.1 to 44.7). Acute leukemia diagnosis, intermediate to high disease risk index (DRI) and intermediate to high Charlson comorbidity index (CCI) constituted 45.7%, 60.0% and 58.1% respectively. Haploidentical donors were used in 28.6%. The distribution of gender, diagnosis, DRI and CCI scores, donor type, total CD34 dose given, panel reactive antibody (PRA) positivity were similar. Median days to neutrophil engraftment was shorter with fludarabine (19 vs 16, p=0.01), however, median duration of in-unit stay was similar (27 vs 28 days, p=0.73). TRM, nausea and acute GvHD frequency was lower with cladribine (p=0.35, p=0.001 and p=0.02, respectively). Typhilitis and perianal infections were more common with cladribine (p=0.07 and p=0.04, respectively). OS and PFS were similar (p=0.81 and p=0.66, respectively). When cladribine was compared to fludarabine on day +90, OS was 78,0% (95% CI: 62.3-93.7) vs 65,0% (95% CI: 51.3-78.7); PFS was 70.0% (95% CI: 52.4-87.6) vs 65.0% (95% CI: 51.3-78.7); TRM was 19.0% (95% CI: 3.3-34.7) vs 24.0% (95% CI: 10.3-37.7). Conclusions: Cladribine may be safely constituted for cladribine in a RIC regimen and may yield similar, even some favorable, outcomes when compared to fludarabine.