Hypoalbuminemia and hypercalcemia are independently associated with poor treatment outcomes of anti-PD-1 immune checkpoint inhibitors in patients with recurrent or metastatic head and neck squamous cell carcinoma.

Publisher: BioMed Central Country of Publication: England NLM ID: 101170544 Publication Model: Electronic Cited Medium: Internet ISSN: 1477-7819 (Electronic) Linking ISSN: 14777819 NLM ISO Abbreviation: World J Surg Oncol Subsets: MEDLINE

Original Publication: London : BioMed Central, 2003-

Immune Checkpoint Inhibitors*/therapeutic use ; Squamous Cell Carcinoma of Head and Neck*/drug therapy ; Squamous Cell Carcinoma of Head and Neck*/blood ; Squamous Cell Carcinoma of Head and Neck*/pathology ; Squamous Cell Carcinoma of Head and Neck*/immunology ; Head and Neck Neoplasms*/drug therapy ; Head and Neck Neoplasms*/pathology ; Head and Neck Neoplasms*/blood ; Head and Neck Neoplasms*/complications ; Head and Neck Neoplasms*/immunology ; Hypercalcemia*/drug therapy ; Hypercalcemia*/blood ; Hypercalcemia*/etiology ; Neoplasm Recurrence, Local*/drug therapy ; Neoplasm Recurrence, Local*/pathology ; Hypoalbuminemia*/complications ; Hypoalbuminemia*/etiology; Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Prognosis ; Survival Rate ; Adult ; Follow-Up Studies ; Aged, 80 and over ; Programmed Cell Death 1 Receptor/antagonists & inhibitors ; Biomarkers, Tumor/blood

Background: Recent randomized phase III trials have demonstrated the efficacy of anti-programmed cell death 1 (PD-1) immune checkpoint inhibitors (ICIs) in treating patients with recurrent or metastatic head and neck squamous cell carcinoma (RMHNSCC). However, a large proportion of such patients still have poor response. This study aimed to identify biomarkers for predicting anti-PD-1 ICI treatment outcomes .
Methods: We retrospectively analyzed 144 patients with RMHNSCC who received anti-PD-1 ICIs after progression to platinum-based chemotherapy between January 2017 and December 2022 at Kaohsiung Chang Gung Memorial Hospital. Data on clinicopathological parameters, albumin levels, calcium levels, and other pretreatment peripheral blood biomarkers, including total lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and prognostic nutritional index (PNI) were collected and correlated with the treatment outcome of anti-PD-1 ICIs.
Results: Low tumor proportion score (TPS), low combined positive score (CPS), NLR ≥ 5, PLR ≥ 300, hypercalcemia, hypoalbuminemia, and PNI < 45 were significantly correlated with poor response of ICIs. The overall response rates were 25% and 3% in patients with calcium < 10 mg/dL and calcium ≥ 10 mg/dL, respectively (P = 0.007). The overall response rates were 6% and 33% in patients with albumin < 4 g/dL and albumin ≥ 4 g/dL, respectively (P < 0.001). Univariate survival analysis showed that low TPS, low CPS, NLR ≥ 5,, hypercalcemia, hypoalbuminemia, and PNI < 45 were significantly associated with worse progression-free survival (PFS) and inferior overall survival (OS). Multivariate analysis revealed that calcium ≥ 10 mg/dL and albumin < 4 g/dL were independent poor prognosticators for worse PFS and inferior OS. The two-year OS rates were 26% and 9% in patients with calcium < 10 mg/dL and ≥ 10 mg/dL, respectively (P < 0.001). The two-year OS rates were 10% and 33% in patients with albumin < 4 g/dL and ≥ 4 g/dL, respectively (P < 0.001).
Conclusions: Hypercalcemia and hypoalbuminemia can potentially predict poor treatment outcomes of anti-PD-1 ICIs in patients with RMHNSCC. Blood calcium and albumin levels may be helpful in individualizing treatment strategies for patients with RMHNSCC.
(© 2024. The Author(s).)

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CMRPG8N0802 and CORPG8M0461 Chang Gung Memorial Hospital; CMRPG8N0802 and CORPG8M0461 Chang Gung Memorial Hospital; NSTC 112-2314-B-182A-029-MY3 National Science Council, Taiwan

Keywords: Albumin; Calcium; Head and neck cancer; Immune checkpoint inhibitors; Squamous cell carcinoma

0 (Immune Checkpoint Inhibitors)
0 (Programmed Cell Death 1 Receptor)
0 (Biomarkers, Tumor)

Date Created: 20240910 Date Completed: 20240911 Latest Revision: 20240914

20240914

PMC11389424

10.1186/s12957-024-03522-2

39256833