A clinical trial has found a cisplatin alternative for head and neck cancer


(HealthDay News) — Cisplatin is the chemotherapy of choice for people battling head and neck cancer, but nearly a third of patients cannot tolerate the side effects and stop taking the drug.


A new study provides surprising results about 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 durvalumab (Imfinzi), in the fight against head and neck tumors, the study showed.


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


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


The findings were recently published in The Lancet Oncology.


Black Americans with some form of head or neck cancer are twice as likely to die of the disease compared to white patients.


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


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


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


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


To put that idea to the test, Mell’s team (including researchers from 20 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 in addition to chemotherapy.


The result was not the victory for durvalumab that many expected.


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


The study also found that cetuximab was effective regardless of whether or not the cancer was caused by an HPV infection.


However, there is still a possibility that durvalumab could be the better option for a small minority of patients.


As the researchers explained, the two drugs work in very different ways. Cetuximab binds to proteins on the surface of cancer cells, slowing their growth. But durvalumab blocks a separate protein on the cell surface, making the cell much more vulnerable to immune system destruction.


Thus, there are indications that durvalumab may still have a place in the treatment of a very specific subgroup of patients with highly immunoreactive tumors, according to the UCSD press release.


However, cetuximab appeared to be the clear winner overall, and the trial could boost its use as a second-line therapy for people who cannot take cisplatin.


“Historically, this has been an underserved group, so our process sought to establish an evidence base for this rather unique population,” Mell said. Many patients who cannot tolerate cisplatin are elderly and/or have other health problems, he noted.


More information


You can find more about head and neck cancer on the website American Cancer Society.


SOURCE: University of California, San Diego, press release, November 21, 2024



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