ICHNO-ECHNO 2022 - Abstract Book

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ICHNO-ECHNO 2022

Purpose or Objective To assess efficacy and tollerability data with Nivolumab monotherapy in elderly and frail patients affected by locally advanced or recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) and evaluate their correlation with selected frailty scores. Materials and Methods Overall Survival (OS), Progression Free Survival (PFS), Immune-related adverse events (irAEs), Overall Response Rate (ORR), Duration of Response (DoR) data were retrospectively collected from a cohort of HNSCC patients treated at our institution with Nivolumab monotherapy. Charleson Comorbidity Index (CCI), Geriatric-8 score (G-8) and Adult Comorbidity Evaluation- 27 (ACE-27) score were extrapolated from medical records. Subgroups analysis between patients with different ECOG-PS and frailty scores was conducted using Student's t-test or Mann-Whitney U test for continuous variables, and the Chi-square test or Fisher's exact test for categorical variables. Results We analyzed data from 26 HNSCC patients aged over 70 years (median 77,8 years) and treated from April 2018 to October 2021. At baseline, six patients had ECOG PS 0, thirteen patients had PS 1 and seven patients had PS 2. All patients had G8 score ≤ 14, while CCI was 0 for eleven patients, 1 for nine patients and ≥ 2 for six patients. Most common primitive tumor location was oral cavity (57,7%). At data cutoff 19 th October 2021, mOS was 8,4 months (range 0-27) and mPFS was 6 months (range 0-27), with median nivolumab cycles administered being 11. ORR was 43,5% with 10 partial responses as best response and median DoR among patients having at best a stable disease of 7,7 months. IrAEs of any grade were observed in 42,3% of patients and there were only two irAEs of grade 3, being one pneumonitis and one cutaneous rash. PS and selected frailty scores did not show any significant difference with respect of outcome data or incidence of irAEs at univariate analysis. Conclusion Nivolumab in elderly HNSCC patients demonstrated good efficacy and safety profile, in substantial accordance with data available for general HNSCC population, regardless of PS or frailty as assessed. Further data is needed. 1 San Raffaele Scientific Institute, Otorhinolaryngology - Head and Neck Surgery, Milan, Italy; 2 San Raffaele Scientific Institute, Radiology and Experimental Imaging Center, Milan, Italy Purpose or Objective Skeletal muscle mass (SMM) depletion has been validated in many surgical fields as independent predictor of postoperative major complications through cross-sectional imaging. We evaluated SMM depletion in a stage III-IV head and neck cancer cohort comparing the accuracy of CT/MRI at C3 level with ultrasound (US) of rectus femoris muscle (RF) in terms of prediction of major complications Materials and Methods Patients submitted to radical surgery for stage III-IV head and neck cancer were recruited (2016-2021). SMM was estimated on CT/MRI by calculating the sum of the cross-sectional area (CSA) of the sternocleidomastoid and paravertebral muscles at C3 level and its height-indexed value (cervical skeletal muscle index, CSMI) and on US by computing the CSA of RF. Specific thresholds were defined for both US and CT/MRI according to ROC curve in terms of best prediction of 30-day major complications (the main clinical endpoint) to detect sarcopenic subjects. Results Sixty-five patients completed the study. Thirty-day major postoperative complication rate was 35.4%. According to the mentioned ROC curves, Youden test was used to define the cut-offs for the definition of low SMM, as surrogate marker of sarcopenia: · - US-defined rectus femoris CSA: 1.32 cm 2 (sensitivity 81.8%, specificity 63.4%; prevalence of low SMM: 53.8%, 35/65); - CT/MRI-defined cervical SMM: 34.91 cm 2 (sensitivity 68.2%, specificity 65.9%; prevalence of low SMM: 47.7%, 31/65); - CT/MRI-defined CSMI: 11.25 cm 2 /m 2 (sensitivity 54.5%, specificity 70.7%; prevalence of low SMM: 40.0%, 26/65). At univariate analysis, major complications were associated to lower RF CSA (OR 7.72, p =0.001), lower CSA at C3 level (OR 4.11, p =0.009) and lower CSMI (OR 2.90, p =0.044), together with previous radiotherapy (OR 4.16, p = 0.038), higher ASA score (OR 2.60, p = 0.061) and higher modified frailty index (mFI, OR 3.75, p = 0.013). At multivariate analysis, RF CSA (OR 7.07, p =0.004), CSA at C3 level (OR 6.74, p =0.005) and CSMI (OR 4.02, p =0.025) were confirmed as independent predictors in three different models including radiotherapy, ASA score and mFI. Conclusion SMM depletion and sarcopenia are considered an independent risk factor for postoperative major complications in many oncological scenarios, even in the field of head and neck. A huge of portion of stage III-IV head and neck cancer develop sarcopenia during the natural history of their disease, for both cancer-related and treatment-related reasons. In this subset of patients, SMM depletion either defined through US (as CSA of rectus femoris muscle) or neck cross-sectional imaging (as CSA at C3 level or CSMI) was proved to significantly predict 30-day major postoperative complications better than any other clinical of functional parameter, providing a fundamental tool for on-going re-assessment of patients with regards to any pre-habilitation strategy aimed at reducing surgical morbidity. PO-0184 Skeletal muscle depletion and major postoperative complications in advanced head and neck cancer A. Galli 1 , M. Colombo 2 , C. Prizio 1 , F. Lira Luce 1 , P.L. Paesano 2 , F. De Cobelli 2 , M. Bussi 1