Efficacy and safety of immune checkpoint inhibitors in recurrent or metastatic head and neck squamous cell carcinoma: A systematic review and meta‐analysis of randomized clinical trials

Abstract

Abstract Background Immune checkpoint inhibitors (ICIs) showed antitumor activity for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, the results from different studies were controversial. Methods Online databases were searched for randomized clinical trials (RCTs) evaluating ICIs for R/M HNSCC. The characteristics of the studies and the results of overall survival (OS), progression‐free survival (PFS), objective response rate (ORR), treatment‐related adverse events (TRAEs) were extracted. Results A total of 4936 patients from eight studies were included. Anti‐PD1/PDL1 monotherapy significantly improved OS in total population (hazard ratio, HR, 0.87, 95% CI, 0.79–0.95, p = 0.003) and PD‐L1 high expression patients (HR, 0.71, 95% CI, 0.55–0.90, p = 0.006) with significant lower incidence of any grade TRAEs (odds ratio, OR, 0.16, 95% CI, 0.07–0.37, p < 0.00001) and Grades 3–5 TRAEs (OR, 0.18, 95% CI, 0.10–0.33, p < 0.0001) compared with standard of care (SOC); however, the pooled results of PFS and ORR were not significant different. PD1/PDL1 inhibitors plus CTLA4 inhibitors did not improve OS, PFS, ORR compared with SOC or ICIs monotherapy; however, the incidence of Grades 3–5 TRAEs was significant higher compared with ICIs monotherapy (OR, 1.80, 95% CI, 1.34–2.41, p = 0.0001). Conclusions Anti‐PD1/PDL1 monotherapy could improve OS for R/M HNSCC with significant lower incidence of TRAEs compared with SOC. PD1/PDL1 inhibitors plus CTLA4 inhibitors showed no more benefit compared with both SOC and ICIs monotherapy, but the incidence of Grades 3–5 TRAEs was significant higher compared with ICIs monotherapy.

Keywords

• chemotherapy
• head and neck squamous cell carcinoma
• immune checkpoint inhibitors
• meta‐analysis
• systematic review