An immunotherapy drug on its own is better than aggressive chemotherapy as a first-line treatment for advanced head and neck cancer, data from a trial suggests.
Patients lived for longer and had far lower rates of side-effects if they took pembrolizumab than those who received an “extreme” combination of two chemotherapies and a targeted drug, according to the trial led by a team at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust.
People with an immune hallmark called PD-L1 in their tumours did particularly well on pembrolizumab – living for around 40% longer.
And while only around a fifth of patients overall responded to pembrolizumab, those who did so often did well – with a median length of response of 20.9 months compared with only 4.2 months with aggressive chemotherapy.
The trial’s findings could see immunotherapy become a standard first-line treatment for advanced head and neck cancer, and spare many patients the side-effects associated with combination chemotherapy.
Patients would normally be given aggressive chemotherapy if diagnosed at an advanced stage when the cancer has begun to spread to try to get rid of all the cancer cells as quickly as possible.
But the new trial sought to see if immunotherapy, in combination with chemotherapy or on its own, could be a more effective and kinder option.
The researchers randomly assigned 882 patients in equal numbers to one of three treatment groups – receiving the “extreme” chemotherapy combination, and the immunotherapy pembrolizumab with platinum chemotherapy or on its own.
Some 17% of patient experienced serious side-effects with pembrolizumab, compared with 69% of those taking the extreme therapy.
A downside to pembrolizumab on its own was that fewer people in total responded.
Even in the group with high levels of PD-L1, 23% of patients who received the treatment responded, compared with 36% for chemotherapy.
Professor Kevin Harrington, professor of biological cancer therapies at The Institute of Cancer Research, London – and consultant clinical oncologist at The Royal Marsden Foundation Trust, said: “Our study has shown that the immunotherapy pembrolizumab on its own is better than an aggressive triple-whammy of two types of chemotherapy plus a targeted drug as first-line treatment for advanced head and neck cancer.
“We couldn’t believe it when we saw the results. None of us expected pembrolizumab on its own to work so well in some of these patients – and it raises the prospect that we could spare some people chemotherapy altogether.
“The study could have major implications for the treatment of advanced head and neck cancers – taking immunotherapy from a last resort to the treatment we turn to first for some patients.
“The trial is still ongoing, but we expect some patients to go on to live for years longer than they would have done had they received standard chemotherapy.”