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Immune protein key to head and neck cancer treatment

Monday March 28th 2022

Treatment for head and neck cancer could be personalised more easily if patients' needs were matched to their levels of a key immune protein, according to a new UK study.

Researchers at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust say measuring levels of the protein PD-L1 in tumours and on surrounding cells should enable medical teams to personalise treatment by selecting immunotherapy, chemotherapy or a combination of the two.

Writing in Clinical Oncology, the team describe analysing new data from the major KEYNOTE-048 trial to assess if patients should be treated with a combination of the immunotherapy pembrolizumab and chemotherapy.

Of the 882 trial participants, 373 had a moderate PD-L1 score between 1 and 19 and pembrolizumab on its own or with chemotherapy stopped tumour growth in many of these patients.

However, combining pembrolizumab-chemotherapy resulted in longer overall survival – 12.7 months, compared with 9.9 months for cetuximab plus chemotherapy.

The authors say these results, with previous findings from the trial, suggest three different approaches to treatment should be considered, depending on PD-L1 levels.

They say patients with low levels of PD-L1 are highly unlikely to benefit from pembrolizumab alone, and should receive chemotherapy alone or chemotherapy plus cetuximab, while individuals with moderate levels of PD-L1 may benefit most from a pembrolizumab and chemotherapy combination. Those with high levels of PD-L1 may benefit most from pembrolizumab alone.

Previous KEYNOTE-048 analysis showed it was possible to predict who is more likely to benefit from pembrolizumab by testing for PD-L1, which led to differing regulatory approvals of pembrolizumab across the globe as a first-line treatment for patients with relapsed head and neck cancer, based on a PD-L1 scoring system.

But the new findings suggest patients with moderate levels of PD-L1 may have better outcomes if they also receive chemotherapy.

However, the team say some of the results should be interpreted carefully because of the small number of participants with a PD-L1 score of less than 1, and that additional biomarkers are needed to further select patients who could benefit from pembrolizumab.

Study leader Professor Kevin Harrington, professor of biological cancer therapies at The Institute of Cancer Research, London, and consultant clinical oncologist at The Royal Marsden NHS Foundation Trust, said: “We have found that patients with head and neck cancer benefit from different approaches to treatment depending on the levels of a key immune protein in the tumour and among the surrounding cells.

“This new, more refined interpretation of the PD-L1 test should give clinicians a much clearer indication of which patients are most likely to benefit from immunotherapy alone and who should be considered for immunotherapy in combination with chemotherapy.

“Our new findings suggest people with a moderate PD-L1 score would benefit more from a combination of pembrolizumab plus chemotherapy.

“Currently, NICE has only recommended pembrolizumab on its own for this group of people, so I hope our new evidence will be taken into account and potentially change care for people in England and Wales.”

Professor Kristian Helin, chief executive of The Institute of Cancer Research, London, added: “Tests like these can help improve outcomes for patients and make sure we don’t subject people who are unlikely to respond to treatments that won’t benefit them. I hope our new study can improve care for patients with head and neck cancer by helping to optimise treatment depending on test results.”

Clinical Oncology 25 March 2022

Tags: Cancer | Pharmaceuticals | UK News

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