First-Line Therapy in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: A Retrospective, Multicenter, Real-World Study

Abstract

Background: In Europe, pembrolizumab with or without chemotherapy is the recommended first-line treatment for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC), with a combined positive score (CPS) ≥ 1. In France, the TPExtreme (TPEx) regimen is preferred for CPS < 1. These regimens were studied in selected populations, which may not reflect real-world patients. Methods: We reviewed all R/M HNSCC cases treated with first-line regimens between January 2021 and December 2023 in Nancy and Lille. Data on patient history, treatments, survival, response, and safety were collected. PFS and OS were analyzed using the Cox multivariable regression model, adjusting for the covariates age, Eastern Cooperative Oncology Group (ECOG) performance status, comorbidities, and nutritional status. Results: The analysis included 290 patients; 19% received pembrolizumab alone, 28% received pembrolizumab with chemotherapy, 19% received TPEx, and 20% received adapted regimens. PFS and OS differed significantly between groups. Median PFS and OS were respectively 2.9 and 9.4 months for pembrolizumab, 6 and 15.5 months for pembrolizumab-chemotherapy, 5.9 and 13.7 months for TPEx, and 4.3 and 10 months for adapted regimens. Pembrolizumab alone is the safest regimen. Conclusion: This retrospective study reflects real-world first-line therapy for R/M HNSCC in two French cancer institutes. Pembrolizumab combined with chemotherapy is the preferred treatment option.