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Open Access 21-08-2023 | Biomarkers | Research

Early on-treatment C-reactive protein and its kinetics predict survival and response in recurrent and/or metastatic head and neck cancer patients receiving first-line pembrolizumab

Authors: Markus Haas, Alexander Lein, Thorsten Fuereder, Julia Schnoell, Faris F. Brkic, David T. Liu, Lorenz Kadletz-Wanke, Gregor Heiduschka, Bernhard J. Jank

Published in: Investigational New Drugs | Issue 5/2023

Abstract

Purpose: First-line immune checkpoint blockade has improved the prognosis of recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC), but response rates remain low. In this study, we aimed to investigate the prognostic value of CRP and its early kinetics to predict response and survival in R/M HNSCC. Methods: A total of 87 patients who received first-line pembrolizumab for R/M HNSCC were analyzed. Three-fold cross-validation was used to estimate cut-off points of CRP at baseline and on-treatment (day 40 ± 10). Treatment response and survival were analyzed according to early CRP kinetics. The neutrophil-to-lymphocyte ratio (NLR) was used as a benchmark for the prognostic performance of CRP. Results: On-treatment CRP below 2 mg/dl, 4x the upper limit of normal (ULN), was associated with increased overall survival (OS), while on-treatment CRP below 3 mg/dl (6x ULN) was correlated with a higher disease control rate (DCR) and increased progression-free survival (PFS). CRP flare-responders and CRP responders showed a higher DCR and longer PFS than CRP non-responders. An NLR above 6 was a negative prognosticator for progression. In multivariable analysis, on-treatment CRP prevailed as the only significant prognosticator for OS (HR: 4.97, CI95%: 2.18–11.32, p < 0.001) and PFS (HR: 2.07, CI95%: 1.07–3.99, p = 0.030). Conclusion: On-treatment CRP was identified as a prognostic biomarker for objective response and survival in R/M HNSCC patients receiving first-line pembrolizumab and could be easily incorporated into clinical practice as a widely available and cost-effective biomarker.

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Title: Early on-treatment C-reactive protein and its kinetics predict survival and response in recurrent and/or metastatic head and neck cancer patients receiving first-line pembrolizumab
Authors: Markus Haas
Alexander Lein
Thorsten Fuereder
Julia Schnoell
Faris F. Brkic
David T. Liu
Lorenz Kadletz-Wanke
Gregor Heiduschka
Bernhard J. Jank
Publication date: 21-08-2023
Publisher: Springer US
Keyword: Biomarkers
Published in: Investigational New Drugs / Issue 5/2023
Print ISSN: 0167-6997
Electronic ISSN: 1573-0646
DOI: https://doi.org/10.1007/s10637-023-01388-x

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