TOPLINE:

Among US patients diagnosed with head and neck cancer (HNC) before age 65, immunotherapy uptake has been slow, inching up from 2.3% of patients in 2017 to 2.8% in 2022. Immune-related adverse events with the therapies are common, but severe events are relatively rare.

METHODOLOGY:

• The immune checkpoint inhibitors pembrolizumab and nivolumab were approved by the FDA for patients with recurrent or metastatic HNC in 2016. They have since become part of the gold standard for those patients, with approval of first-line pembrolizumab in 2019. But national prescribing patterns of immunotherapy for patients with HNC are largely unknown.
• To investigate, researchers conducted a retrospective cohort study using MarketScan Commercial and Medicaid databases for January 1, 2016, through December 31, 2022. A total of 47,365 US patients aged 18-64 years with HNC were included.
• Primary outcome measures were prescribing rates of immunotherapies overall and per year, as well as relative use of individual agents. Secondary outcomes included incidence of overall and severe immune-related adverse events.

TAKEAWAY:

• The rate of immunotherapy prescriptions increased slightly over time, from 2.3% of patients in 2017 to 2.8% in 2022. Uptake was slower than expected, the authors wrote, noting that a recent study found that among HNC patients older than 65, over 11% had received immunotherapy.
• Pembrolizumab has dominated prescriptions since its 2019 first-line approval, rising from 49% of market share in 2017 to 87% in 2022, representing a 38% increase.
• The 90-day immune-related adverse event rate was 41.2%, with an attributable risk of 20.4% to immunotherapy. Endocrine adverse events, primarily hypothyroidism, were most frequent, at 28.7%. Severe immune-related events were reported in 2.7% of patients.
• Baseline hypothyroidism was independently associated with the risk of immune-related side effects (adjusted odds ratio [OR], 6.7; 95% CI, 5.0-9.0), as was liver disease (adjusted OR, 1.7; 95% CI, 1.1-2.7). Comorbidity score was associated with severe immune-related adverse events at 90 days (OR, 1.02; 95% CI, 1.02-1.03), indicating a 2%-3% increased risk with each point increase in the comorbidity index score.

IN PRACTICE:

Overall, the authors wrote, “relative use of immunotherapy has minimally increased in patients younger than 65 years since FDA approval,” adding that while immune-related side effects are common, severe ones requiring hospitalization are rare. “Otolaryngologists can use these data to counsel patients, particularly because immunotherapy has now expanded into the neoadjuvant setting as the standard of care for locally advanced HNC,” they concluded.

SOURCE:

The study, led by Andrew M. Peterson, MD, Washington University School of Medicine in St Louis, St Louis, Missouri, was published in JAMA Otolaryngology-Head & Neck Surgery.

LIMITATIONS:

The study lacked staging data, making it difficult to determine disease severity in the non-immunotherapy cohort, though most patients receiving immunotherapy are assumed to have recurrent/metastatic HNC. The database excludes patients aged 65 years or older, which may underestimate the rate of adverse events in the general patient population. Previous treatments including surgery, chemotherapy, and radiotherapy could not be controlled for within the 90-day adverse event multivariate logistic regression model.

DISCLOSURES:

The research received support from the US Department of Veterans Affairs Biomedical Laboratory Research & Development Service. Several co-authors disclosed financial ties to commercial sources. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.