7th ICHNO Abstract book

page 24 7 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 14 – 16 March 2019 Barcelona, Spain __________________________________________________________________________________________ 7th ICHNO

into account differences in: sub-sites, stage at diagnosis and HPV-status in order correctly to estimate and monitor socioeconomic inequality in HNSCC survival.

treatment, comorbidity and tobacco-use. All models were adjusted for age, gender and period of diagnosis. Results For all cancer sub-sites the adjusted HRs were increased for patients, particularly men, with shorter education, lower income, and those living alone or in rural areas (Forest plot 1). The largest effect was found among oropharynx patients with low income who had more than double the hazard of dying during follow-up, compared to those with high income (HR: 2.18 (95 % CI 1.26-1.71)). The ORs for: advanced stage at diagnosis, not having a HPV- positive oropharynx cancer, not being curatively intended treated, having more than one comorbid disease, or being a smoker at diagnosis were significantly increased among patients with shorter education (Forest plot 2), lower income, and those living alone or in rural areas. The largest effect was likewise found among oropharynx cancer patients, where those with short education had double the odds for not having a HPV-positive oropharynx cancer (OR: 2.23 (95 % CI 1.88-2.65)) and three times higher odds for being a smoker at diagnosis (OR: 3.27 (2.81-3.80)), compared to those with high education.

Debate: Debate 2: This house believes that immunotherapy is going to replace chemotherapy

SP-046 For the motion: This house believes that immunotherapy is going to replace chemotherapy K. Harrington 1 1 The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Division of Radiotherapy and Imaging, Sutton, United Kingdom Abstract text We are already beginning to see the first evidence from studies in which immunotherapy is demonstrating equivalence or even superiority over standard-of- care chemotherapy regimens across a range of tumour types. In the context of relapsed/metastatic head and neck cancer, we have data from randomised phase III trials definitively proving the benefits of immunotherapy - initially in the second-line setting, and now in patients receiving first-line therapy. A host of new studies will address questions relating to the potential roles of immunotherapies in neoadjuvant, concomitant and adjuvant contexts - and data from these trials will be reported in the next few years. It is clear that the reign of chemotherapy is nearing an end and that novel immunotherapies - as single agents or in combinations - will sweep away the poisonous, non-specific chemotherapy drugs that have yielded such little benefit and so much toxicity over the last five decades. SP-047 Against the motion S. Faivre 1 1 Hôpital Beaujon, Medical Oncology, Clichy, France Abstract text Immunotherapy (nivolumab, pembrolizumab) has been demonstrated to be superior to various regimen of non- platinum chemotherapy in second line for patients with recurrent or metastatic head and neck squamous cell carcinoma. This approach is currently tested against platinum-based chemotherapy as first line therapy. Recent data shows that pembrolizumab improves overall survival in comparison to platinum-5FU-cetuximab (EXTREME) but this is only reported in selected subgroups of patients with tumors expressing PD-L1 by combined positive score (CPS) ≥ 20 or ≥ 1, restricted to 40% and 85% of the general population respectively. Moreover, there is no benefit in PFS for pembrolizumab and the response rate ranging 19-23% is lower than that obtained with EXTREME (34-36%). Finally, physicians will have to detect and manage the high rate of primary progression observed under PD-1 inhibitors (32-44%, including sometime hyper- progression where disease is worsening, this being not observed with chemotherapy) that could explain, at least in part, why the benefit of immunotherapy appears rather limited in the overall intent-to-treat population. Immunotherapy (nivolumab, pembrolizumab) has been demonstrated to be superior to various regimen of non- platinum chemotherapy in second line for patients with recurrent or metastatic head and neck squamous cell carcinoma. This approach is currently tested against platinum-based chemotherapy as first line therapy.

Conclusion This large, population-based study reveals significant socioeconomic differences in the most important determinants for HNSCC survival, possibly explaining a considerable part of the excess burden of HNSCC deaths among deprived patients. We have defined a high risk group being: men, above 60, living alone, who have a - hort education or low income who could be the target for early interventions and improved surveillance. Finally, this study stresses that it is of major importance to take