Utilization Of Immunotherapy In Head And Neck Cancers Pre-Food And Drug Administration Approval Of Immune Checkpoint Inhibitors

Two novel immune checkpoint inhibitors were approved by Food & Drug Administration (FDA) in 2016 for head and neck cancer squamous cell carcinoma (HNSCC) patients who have progressed on standard chemotherapy. However, immunotherapy agents have been used in HNSCC before the approval of these new agents. We investigated the patterns of immunotherapy utilization in the pre-FDA approval era using the National Cancer Database (NCDB) as a benchmark in anticipation of paradigm changes in the coming years. We selected all patients with HNSCC in NCDB from 2004 to 2014. Patients were categorized into those who were recommended for immunotherapy and those who were not. The recommended group was further divided into patients who received immunotherapy and those who did not. Temporal patterns of immunotherapy recommendation, primary site of the tumor, stage of the disease and place of treatments were analyzed among others. We identified 366,662 patients with HNSCC during the study period. Only a small minority were recommended for immunotherapy (4788, 1.3%). Majority of patients who were recommended for immunotherapy, received treatment (4223, 88%). Majority of recommendations were from the academic centers and comprehensive cancer programs and made during 2013-2014 (76.3%). Majority of patients were stage IV (2585, 61.2%) The most common sites were tongue (1154, 27.3%) and tonsil (915, 21.7%). Patients with eye and orbit cancers (5032, 1.4% of total cohort) were more likely to be recommended and receive immunotherapy (198, 4.7% of all who received immunotherapy P