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European Archives of Oto-Rhino-Laryngology

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23-12-2022 | Lymphopenia | Head and Neck

Impact of lymphopenia on efficacy of nivolumab in head and neck cancer patients

Authors: Mathieu Césaire, Audrey Rambeau, Florian Clatot, Alisson Johnson, Natacha Heutte, Juliette Thariat

Published in: European Archives of Oto-Rhino-Laryngology | Issue 5/2023

Abstract

Introduction

Lymphopenia has been correlated with poorer survival in patients with metastatic cancers treated with anti-PD-1 immunotherapy. Treatments such as chemotherapy, surgery or radiotherapy can induce lymphopenia. Radiation-induced lymphopenia is common and prolonged in head and neck cancer (HNSCC) patients. We evaluated the impact of lymphopenia, on efficacy of anti PD-1 nivolumab immunotherapy in HNSCC patients.

Methods

a multicenter retrospective study included consecutive patients treated with nivolumab for recurrent/metastatic (R/M) HNSCC between January 2017 and June 2019. Lymphopenia was defined as lymphocyte counts below 1000 cells/mm³ upon initiation of nivolumab. Logistical regression was performed on factors associated with lymphopenia and ROC analyses assessed association between lymphopenia and survival.

Results

median age was 65. Of the 100 included patients, 60% had been treated by surgery, 67% had had first-line chemotherapy, and 89% loco-regional radiotherapy, 65% had concurrent chemotherapy with radiotherapy. Lymphopenia occurred in 56 (56%) patients upon initiation of nivolumab, with 29 (29%) patients having radiation-related lymphopenia. Prior locoregional radiotherapy was the only factor associated with lymphopenia upon initiation of nivolumab by logistical regression (OR 0.144 [0.029–0.706], p − 0.017). Lymphopenia upon initiation of nivolumab did not affect progression-free survival (PFS) (p − 0.815), overall survival (OS) (p − 0.783) or disease control rate (DCR) (p − 0.125). Locoregional symptomatology (HR − 2.37 [1.24–4.54], p − 0.009), metastatic symptomatology (HR − 4.74 [2.21–10.15], and persistent lymphopenia under nivolumab (HR 3.96 [1.19–13.17] p − 0.034) were associated with poorer OS in multivariate analysis.

Conclusions

Lymphopenia upon initiation of nivolumab was not associated with poorer survival in R/M HNSCC patients, but persistence of lymphopenia during immunotherapy might be a prognostic marker of patient survival.

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Title: Impact of lymphopenia on efficacy of nivolumab in head and neck cancer patients
Authors: Mathieu Césaire
Audrey Rambeau
Florian Clatot
Alisson Johnson
Natacha Heutte
Juliette Thariat
Publication date: 23-12-2022
Publisher: Springer Berlin Heidelberg
Keywords: Lymphopenia
Radiotherapy
Cytostatic Therapy
Published in: European Archives of Oto-Rhino-Laryngology / Issue 5/2023
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-022-07800-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of lymphopenia on efficacy of nivolumab in head and neck cancer patients

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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