Immunotherapy improves efficacy and safety of patients with HPV positive and negative head and neck cancer: A systematic review and meta-analysis

Marisol Miranda Galvis; Gabriel Alvares Borges; Thiago Bueno de Oliveira; Isabela Porto de Toledo; Rogerio Moraes Castilho; Eliete Neves Silva Guerra; Luiz Paulo Kowalski; Cristiane Helena Squarize

doi:10.1016/j.critrevonc.2020.102966

Immunotherapy improves efficacy and safety of patients with HPV positive and negative head and neck cancer: A systematic review and meta-analysis

Crit Rev Oncol Hematol. 2020 Jun:150:102966. doi: 10.1016/j.critrevonc.2020.102966. Epub 2020 Apr 22.

Authors

Marisol Miranda Galvis¹, Gabriel Alvares Borges², Thiago Bueno de Oliveira³, Isabela Porto de Toledo⁴, Rogerio Moraes Castilho⁵, Eliete Neves Silva Guerra², Luiz Paulo Kowalski⁶, Cristiane Helena Squarize⁷

Affiliations

¹ Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil; Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
² Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA; Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasilia, Brasilia, Brazil.
³ Clinical Oncology Department, A.C. Camargo Cancer Center, São Paulo, Brazil.
⁴ Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasilia, Brasilia, Brazil.
⁵ Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
⁶ Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil; Head and Neck Surgery Department, Medical School, University of São Paulo, São Paulo, Brazil.
⁷ Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA. Electronic address: csquariz@umich.edu.

PMID: 32371338
DOI: 10.1016/j.critrevonc.2020.102966

Abstract

Background: Despite multiple modalities used to management of head and neck squamous cell carcinoma (HNSCC), disease control remains unsatisfactory. Immunotherapy is emerging as a novel therapeutic approach. This systematic review assesses clinical data regarding immunotherapy efficacy and safety.

Methods: Data from 11 clinical trials testing immunotherapy in HNSCC were assessed. We performed the meta-analysis to correlate the overall survival (OS), response rate (RR), adverse effects, HPV status, and PD-L1 expression.

Results: Immunotherapy extended OS (hazard ratio = 0.77, p < 0.0001) and RR significantly (risk ratio = 1.41, p = 0.02). Patients with HPV-positive HNSCC exhibited a better RR (risk ratio = 1.29, p = 0.24) and OS (11.5 vs. 6.3 months). PD-L1 positive tumors showed a higher OS (9.9 vs. 6.5 months). Moreover, immunotherapy caused less adverse effects than standard therapy.

Conclusion: Our results indicate the benefit of immunotherapy for improving RR and OS of HNSCC patients. The benefit is higher in patients with HPV and PD-L1 positive tumors.

Keywords: Head and neck squamous cell carcinoma; Human papillomavirus; Immunotherapy; Meta-analysis; Programmed death-ligand 1; Toxicity.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Head and Neck Neoplasms / pathology
Head and Neck Neoplasms / therapy*
Head and Neck Neoplasms / virology
Humans
Immunohistochemistry
Immunologic Factors
Immunotherapy / methods*
Molecular Targeted Therapy
Papillomaviridae
Papillomavirus Infections / immunology
Papillomavirus Infections / therapy
Papillomavirus Infections / virology*
Squamous Cell Carcinoma of Head and Neck / pathology
Squamous Cell Carcinoma of Head and Neck / therapy*
Squamous Cell Carcinoma of Head and Neck / virology
Treatment Outcome

Substances

Immunologic Factors