Prognostic factors and overall survival for recurrent and metastatic head and neck squamous cell carcinoma: a multicenter retrospective analysis.

Background: Immune checkpoint inhibitors (ICIs) improve outcomes in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, some patients remain unresponsive to treatment, necessitating further investigation into optimal therapeutic strategies and prognostic biomarkers. This study aimed to evaluate the efficacy of various therapies and identify factors influencing overall survival (OS) in these patients.

Methods: We retrospectively analyzed 606 patients (517 men, 89 women; median age 68 years) treated at 13 head and neck cancer specialty facilities in Japan between January 2018 and December 2022. Associations between OS and variables, including age, sex, primary site, Eastern Cooperative Oncology Group performance status, estimated glomerular filtration rate, therapeutic target lesion, history of drug use in systemic chemotherapy, number of treatment lines, nondrug treatments, de novo metastasis, programmed death-ligand 1 combined positive score, and platinum resistance were statistically examined.

Results: Median OS was 14.2 months, and median progression-free survival was 5.0 months. Multivariate analysis identified poor OS in patients with oral cavity tumors and performance status 2-3, whereas ICI therapy and nondrug salvage interventions were associated with improved OS. ICI/non-ICI subgroup analysis revealed that ICI may have a limited effect on oral cancer. Additionally, our results indicated that a history of platinum therapy for R/M HNSCC may not affect the therapeutic efficacy of ICIs.

Conclusion: For patients with R/M HNSCC, further OS improvement may be achieved using ICIs or aggressive nondrug salvage therapy and by considering the use of chemotherapy other than ICI for patients with oral cancer or poor PS.