Effectiveness Outcomes in Patients With Recurrent or Refractory Head and Neck Cancers: Retrospective Analysis of Data From a Community Oncology Database

• Published in: Clinical therapeutics 2018-09, Vol.40 (9), p.1522-1537
• Main Authors: Fisher, Maxine D., Fernandes, Ancilla W., Olufade, Temitope O., Miller, Paul J., Walker, Mark S., Fenton, Moon
• Format: Article
• Language: English
• Subjects: Abuse; Age; Alcohol abuse; Alcohols; Cancer; Chemotherapy; Communities; Data processing; Drug abuse; Electronic health records; Electronic medical records; FDA approval; Head; Head & neck cancer; head and neck cancer; Human papillomavirus; Medical prognosis; Medical records; Metastases; Metastasis; Oncology; outcomes; Patients; PFS; Pharyngitis; Pharynx; PRO; Smoking; Statistical analysis; Surgery; Survival; Swallowing; Therapy; Tobacco
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2018.07.016

The purpose of this study was to provide an understanding of the effectiveness of existing therapies in patients with advanced head and neck cancer (HNC), particularly in clinical practice. Data from the electronic medical records of adult patients diagnosed with locally advanced or metastatic (Stage III-IVc) HNC between January 1, 2007, and October 1, 2015, were retrospectively collected from a network of community oncology practices in the United States. Eligible patients experienced disease progression despite having received prior systemic therapy. Kaplan-Meier and Cox regression analyses of progression-free survival (PFS) and overall survival (OS) were conducted. Patient-reported outcomes were also collected. The study included 462 patients (median age 61.0 years; 80.7% male; 77.1% white). Most patients had a history of tobacco use (41.8% current, 41.8% past), and human papillomavirus testing was infrequent overall (11.0%). The median overall duration of follow-up was 16.4 months (range, 2.3–85.2 months). Median PFS values were 8.45 months with first-line treatment and 5.33 months with second-line treatment. PFS with first-line treatment was significantly associated with primary tumor location, performance status, and tobacco use. Performance status was a predictor of PFS in second-line treatment. Median OS values were 21.04 and 9.53 months from the start of the first and second lines of therapy, respectively. Abuse/excessive use of alcohol, older age, and impaired performance status were associated with a significantly increased risk for death in outcomes analyses. Outcomes were worse among patients initially diagnosed with Stage IVc disease versus those who progressed to Stage IVc. Past tobacco use and alcohol abuse were associated with worse patient-reported symptoms such as dry mouth and sore throat (smoking) and trouble swallowing (alcohol). This study of data from clinical practice shows that there remains a large unmet need for effective therapeutic options in advanced HNC. Patients' characteristics such as alcohol use and performance status were statistically significant predictors of PFS and OS in Stage III-IVc HNC.