The document summarizes results from a study comparing pembrolizumab (Pem), a drug that enhances the immune system, to extreme chemotherapy (Extreme) in treating recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). It found that Pem combined with chemotherapy increased overall survival compared to Extreme, with a hazard ratio of 0.77 and median survival of 13.0 months versus 10.7 months. For PD-L1 positive tumors, Pem monotherapy also increased overall survival compared to Extreme. The authors concluded that Pem combined with chemotherapy or Pem monotherapy for PD-L1 positive tumors are appropriate first-line treatments for recurrent or metastatic HNSCC.

1. Dr. Rajib Bhattacharjee
MBBS, MD, DNBSS Trainee
Dept of Medical Oncology
Apollo Gleneagles Hospital

12. Patient Charecteristics

13. Overall Survival

15. Pem vs Extreme
CPS > 1
12.3 mo 10.3mo
HR – 0.78
(0.64-0.96)
P=0.0086

16. Pem vs Extreme
Total Population
11.6 mo 10.7 mo
HR 0.85
(0.71-1.03)
P=0.0456

17. Pem vs Extreme
Total Population- Final analysis
11.5 mo 10.7 mo
HR – 0.83
(0.7-0.99)
P=0.0199

18. Pem Chemo Vs Extreme
CPS>1
13.6 mo 10.4 mo
HR = 0.65
(0.53-0.80)
P<0.0001

19. Pem Chemo Vs Extreme
CPS>20
14.7 mo 11.0 mo
HR - 0.6
(0.45 – 0.82)
P = 0.0004

20. Pem Chemo Vs Extreme
Total population
13.0 mo 10.7 mo
HR – 0.77 P = 0.0033

21. PFS

22. Pem vs Extreme
CPS > 1
HR – 1.16 (0.96 – 1.39)

23. Pem vs Extreme
CPS > 20
HR = 0.99 (0.75-1.29) P=0.4565

24. Pem Vs Extreme
Total Population
HR =0.92
(0.77 -1.10)
P=0.1657

25. Pem Chemo Vs Extreme
CPS>1
HR = 0.82 (0.67 – 1.0)

26. Pem Chemo Vs Extreme
CPS>20
HR = 0.73
(0.55-0.93)
P=0.0162

27. Pem Chemo Vs Extreme
Total Population
HR = 1.34 (1.13 – 1.59)

29. Overall Response Rate
Pembro alone Pembro + chemo EXTREME
CPS > 20 26% 43% 36%
CPS > 1 19% 36% 35%
Total population 17% 36% 36%
Median Duration Of Response
Pembro alone Pembro + chemo EXTREME
CPS > 20 22.6 mo 7.1 mo 4.2 mo
CPS > 1 23.4 mo 6.7 mo 4.5 mo
Total population 22.6 mo 6.7 mo 4.5 mo

33. Conclusion of the Authors
Pembrolizumab combined with platinum and 5-
fluorouracil is an appropriate first-line
treatment for recurrent or metastatic HNSCC
and pembrolizumab monotherapy is an
appropriate first line treatment for PD-L1-
positive recurrent or metastatic HNSCC.

34. THANK YOU