Dr. Cohen on the Era Before Immunotherapy in Head and Neck Cancer

Ezra Cohen, MD, associate director, Moores Cancer Center at the University of California, San Diego, discusses the treatment era before immunotherapy in head and neck cancer.

Before PD-1/PD-L1 inhibitors came into the mix, there were very limited options in the treatment of patients with head and neck cancer. In the frontline setting, patients typically received the EXTREME regimen of 6 cycles of platinum, 5-fluorouracil, and cetuximab (Erbitux). This was an effective regimen compared with single-agent chemotherapy, with response rates in the low- to mid-30% range and median overall survival (OS) of about 10 months, Cohen says.

For patients who progressed on frontline therapy, they generally received single-agent chemotherapy or cetuximab. In this setting, the outlook decreased dramatically with median OS dropping to around 6 months and response rates falling to single digits. Notably, Cohen adds, this poor outlook did not come from lack of trying—researchers tested numerous targeted therapies and novel approaches but only saw negative trials until immunotherapy emerged.