There’s a Best Option for Patients With Head-and-Neck Cancer Who Can’t Take Cisplatin

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Cisplatin is the go-to chemotherapy for people battling head-and-neck cancers, but nearly a third of patients can’t tolerate its side effects and quit the drug.

A new trial offers surprising results on the best second-line drug to use in these cases. 

The monoclonal antibody cetuximab (Erbitux) was more effective than a newer drug, the immune checkpoint inhibitor medicine durvalumab (Imfinzi), in fighting head-and-neck tumors, the trial found. 

The difference in outcomes was so great that researchers discontinued the trial early so that all patients could switch to cetuximab. 

“Our study helps reinforce that radiation with cetuximab is a very good alternative for patients who cannot get standard cisplatin,” said study lead author Dr.  Loren Mell. He’s professor and vice chair of clinical and translational research at University of California San Diego School of Medicine.

The findings were published recently in The Lancet Oncology.

As the researchers noted, head-and-neck cancers are relatively common, ranking seventh worldwide in total cancer cases.  Smoking, drinking and HPV infection are all risk factors for these tumors, which can arise in tissues of the the mouth, nose, sinuses, salivary glands, throat and voice box.

For years cisplatin has been the recognized best treatment for these cancers. However, its side effects can be so difficult that about 30% of patients’ quit the chemotherapy.

Cetuximab has long been considered to be a good second choice, but in recent years durvalumab has also emerged as a therapeutic option. 

Many oncologists have thought durvalumab might be safer and more effective than cetuximab.

Putting that notion to the test, Mell’s team (including researchers from two dozen other cancer centers) pitted the two drugs against each other in a clinical trial involving 186 cisplatin-intolerant patients with advanced squamous cell carcinomas of the head or neck.  

All patients also received radiotherapy along with their chemotherapy. 

The result wasn’t the win for durvalumab that many had expected.

“We found that the probability of being alive and free of disease at two years was approximately 64% for cetuximab versus 51% for durvalumab, indicating no evidence of a benefit of durvalumab over cetuximab,” said Mell in a UCSD news release. “We had a lot of reasons to be optimistic about durvalumab, but it turned out to be potentially worse than the standard.”

The trial also found that cetuximab was effective regardless of whether or not a cancer was caused by HPV infection.

There’s still a possibility that durvalumab could be the better option for a small minority of patients, however.  

As the researchers explained, the two drugs work in very different ways. Cetuximab links up with proteins on the surface of cancer cells, curbing their growth. But durvalumab blocks a separate protein on the cell’s surface, which then renders the cell much more vulnerable to immune system destruction.

So, “there is some evidence that durvalumab could still have a place in treating a very specific subset of patients with highly immunoreactive tumors,” according to the UCSD news release.

Cetuximab did seem to be the clear winner overall, however, and the trial could boost its use as second-line therapy for folks unable to take cisplatin. 

“Historically, this has been an underserved group, so our trial sought to establish an evidence base for this rather unique population,” Mell said. Many patients who can’t tolerate cisplatin are of an advanced age and/or have other health issues, he noted.

More information

There’s more on head-and-neck cancers at the American Cancer Society.

SOURCE: University of California San Diego, news release, Nov. 21, 2024

Source: HealthDay

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