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  • 1
    In: Head & Neck, Wiley, Vol. 46, No. 5 ( 2024-05), p. 1063-1073
    Abstract: For R/M HNSCC, the differences in prognosis and treatment options between distant metastasis (DM) and locoregional recurrence, especially in the DM group, remain unclear. Methods From the Taiwan Head Neck Society registry database, patients who were diagnosed with R/M HNSCC and received cetuximab‐based frontline therapy were collected for analysis. Results Among the enrolled patients, 59.3% (491/827) belonged to the DM group. The DM group had less primary site of oral cavity, less betel nut chewing, higher lactate dehydrogenase (LDH) levels, and higher LDH/albumin ratio compared with the non‐DM group. For the patients with primary site of oral cavity and current smokers, DM coexisted with poorer outcomes. In the DM group, EXTREME‐like regimen was more suitable for older patients, those with elevated LDH, and those with higher LDH/albumin ratio than TPExtreme‐like regimen. Conclusion DM coexisted with poorer prognosis in certain groups. LDH‐associated biomarkers may aid treatment options for DM patients.
    Type of Medium: Online Resource
    ISSN: 1043-3074 , 1097-0347
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2024
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  • 2
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 16_suppl ( 2022-06-01), p. e18013-e18013
    Abstract: e18013 Background: Cetuximab significantly improved survival outcomes of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) when combined with chemotherapy. The aim of this study was to explore clinical outcomes, prognostic factors, and risk stratification model for R/M HNSCC patients who received cetuximab-containing regimens based on a real-world, multicenter Taiwanese patient cohort. Methods: This is a retrospective study involving 12 oncology institutions in Taiwan. All R/M HNSCC patients who received cetuximab-containing regimens from January 2017 to December 2020 were included in this study. Prognostic factors were evaluated by univariate/ multivariate analysis. The factors that showed significant differences (p 〈 0.05) were selected to establish the prediction model. The receiver operating characteristic (ROC) curve was obtained to select cut-off values as a reference for continuous variables. The risk score system incorporated both continuous and categorical factors. The score was determined according to hazard ratio. Results: A total of 818 R/M HNSCC patients were included in this study. Patient characteristics were as following: median age, 56 years; performance status (PS) 0/1/≧2, 16.0%/70.4%/13.3%; oral/ oropharynx/ hypopharynx/ larynx/ others, 51.5%/17.5%/19.7%/6.4%/5.0%; stage at initial diagnosis (AJCC8), 0/I/II/III/IVA/IVB/IVC/unknown, 0.2%/5.9%/8.1%/7.1%/ 35.5%/18.0%/6.7%/18.6%; locoregional recurrence/ distant metastasis/ unknown, 38.4%/ 56.0%/ 5.6%; site of distant metastasis, lung/ distant lymph node/ bone/ liver/ skin/ brain, 60.3%/ 37.1%/ 18.8%/ 6.3%/ 8.1%/ 3.3%; cetuximab-PF/ cetuximab-non-PF regimen, 56.6%/ 43.4%. The median overall survival (mOS) was 10.0 months (95% confidence interval [CI] 9.1-10.9 months). Multivariate analysis disclosed poor prognostic factors on OS, including poor PS, smoking history, R2 resection of primary surgery, present distant metastasis at bone, cetuximab combined with non-PF regimen. In addition, HB and neutrophil to lymphocyte ratio (NLR) were shown to have significant difference between treatment responders and non-responders (inc. SD pts). Risk-stratification model was established including factors: PS, smoking history, bone metastasis, hemoglobin level, and NLR. The mOS of the three risk groups stratified from the prediction model were 13.0/7.0/4.0 months (p 〈 0.001). Conclusions: Poor prognostic factors for R/M HNSCC treated with cetuximab-based regimens includes poor PS, smoking history, R2 resection of primary surgery, bone metastasis, and non-PF regimen. In this study, the risk-stratification model for cetuximab-based treatment was established using some of the identified prognostic factors help to predict the overall survival for R/M HNSCC patients.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
    detail.hit.zdb_id: 2005181-5
    detail.hit.zdb_id: 604914-X
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  • 3
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2023
    In:  Journal of Clinical Oncology Vol. 41, No. 16_suppl ( 2023-06-01), p. e18080-e18080
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. e18080-e18080
    Abstract: e18080 Background: The treatment of HNSCC in Taiwan is still very challenging and might be related to betel-nuts use. Betel nut chewing might contribute to strong angiogenesis/invasion and treatment refractoriness. In western countries where HPV+ oropharyngeal cancer prevalence is high, induction TPF (TAX323/324) response rate in locally advanced HNSCC is around 70%; Erbitux and TP (Argiris in JCO2008) induction response rate is 86%. In the analysis from KGMH in Taiwan, induction chemotherapy response for locally advanced HNSCC was 55% in betel-nuts chewers compared with 75% in non-users ( p=0.038; From Su in World Journal of Surgical Oncology 2016). In further studies from Taiwan, Avastin-PF induction benefit (ORR 80%) was also prominent from NTUH (Huang in ESMO Asia2016); Erbitux-TPF induction response rate was 88% from VGH by Lu in Head & Neck2019. Neoadjuvant biochemotherapy seemed to bring more benefits in betel-nuts related HNSCC. In the era of incorporating immunotherapy to neoadjuvant setting of HNSCC, triple therapy of bio-chemoimmunotherapy deserves more attention. Methods: From 2012 to 2022, 111 unresectable stage IVA & IVB betal-nuts related HNSCC patients (OSCC 69, Hypopharynx 26, OPC 13) had ever received induction Bio-chemotherapy or triple therapy (Bio-chemoimmunotherapy) in Yun-lin Branch of National Taiwan University Hospital. We have reviewed basic characteristics, therapeutic regimens, induction response, and final outcomes of these patients. Results: See table. Conclusions: Induction TPF response in locally advanced betel-nuts related HNSCC in Taiwan was not so prominent. Flexible chemotherapy backbones, such as TP/DP-HDFL(weekly docetaxel or paclitaxel with cisplatin and 24-hr high dose 5-fluorouracil/leucovorin infusion), might produce acceptable response rates with less toxicity. Bio(EGFR or VEGFR-targeting)-chemotherapy or Bio-chemoimmunotherapy has brought encouraging induction response with favorable toxicity profiles to conversion surgery or definite CCRT. Further investigation and clinical trials will be urgently warranted. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
    detail.hit.zdb_id: 2005181-5
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  • 4
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 42, No. 16_suppl ( 2024-06-01), p. e16059-e16059
    Abstract: e16059 Background: ESCC is still a health burden in Taiwan; besides, double cancers easily occur in Taiwan, like HypoCa & ESCC or OSCC and ESCC. ESCC is still an immunogenic cancer type. Nivolumab with chemotherapy or nivolumab with ipilimumab in CM648 study and pembrolizumab with chemotherapy in KN590 study have also won survival benefits compared with chemotherapy alone in frontline treatment for R/M ESCC, esp. for PDL1+ patients. In our previous study, EGFR TKI, such as afatinib, have multiple immuno-modulatory effects and may help to increase immunotherapy benefits in the 1 st line(67% ORR) of CT-unfit advanced ESCC. Following KN590 or chemotherapy failure, good rescue efficacy(70% ORR) was also seen in subsequent afatinib with anti-PD1.(ASCO-GI2022). Methods: We try to analyze the treatment options and final survivals of 72 patients with stage IV ESCC from 2010 to 2019 in my institution from National Taiwan University Hospital, Yun-lin Branch. Results: See Table. Conclusions: In this 10-year experience in one institution, we suggested induction Immuno-chemotherapy, Bio-immunochemotherapy, & Bio-immunotherapy may lead to coversion chemoradiation, even to final surgery for stage IV ESCC with well systemic control in selected fit patients to boost further survival. Maintenance metronomic UFUR with anti-PD1 may also be beneficial. Afatinib with anti-PD1 could be a good option for (1)frontline treatment for double cancers or CT-unfit patients; (2)salvage treatment in later lines, even failing KN590 or CM648. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2024
    detail.hit.zdb_id: 2005181-5
    detail.hit.zdb_id: 604914-X
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  • 5
    In: The Oncologist, Oxford University Press (OUP), Vol. 29, No. 4 ( 2024-04-04), p. e498-e506
    Abstract: Reports of tuberculosis (TB) during anticancer treatment with immune checkpoint inhibitors (ICIs) are increasing. However, it is not clear whether the use of ICIs is a significant risk factor for TB, including reactivation or latent TB infection (LTBI). Methods To determine the risk of TB reactivation in patients with lung cancer who use ICIs or tyrosine kinase inhibitors (TKIs), we conducted a retrospective study using a hospital-based cancer registry. In addition, we monitored patients with cancer using ICI or TKI in a multicenter prospective study to check the incidence of LTBI. Results In the retrospective study, several demographic factors were imbalanced between the ICI and TKI groups: the ICI group was younger, had more males, exhibited more squamous cell carcinoma in histology rather than adenocarcinoma, had fewer EGFR mutations, and received more chemotherapy. Propensity score matching was used to control for confounding factors, and we found that the incidence of TB was higher among patients with lung cancer who received ICIs than among those who received TKIs (2298 vs 412 per 100 000 person-years, P = .0165). Through multivariable analysis, group (ICI vs TKI) was the independent risk factor for TB development (adjusted hazard ratio (aHR): 6.29, 95% CI, 1.23-32.09, P = .0269). In the prospective cohort, which included 72 patients receiving ICIs and 50 receiving TKIs, we found that the incidence of positive seroconversion of LTBI by interferon gamma release assay (IGRA) was significantly higher in patients receiving ICIs (18% vs 0%, aHR: 9.88, P = 0.035) under multivariable Cox regression. Conclusion The use of ICIs may be linked to a higher likelihood of TB reactivation and LTBI than individuals solely receiving TKIs as anticancer therapy. Consequently, the implementation of a screening program for TB reactivation and LTBI among patients undergoing ICI treatment could prove advantageous by enabling early detection and prompt treatment of the infection.
    Type of Medium: Online Resource
    ISSN: 1083-7159 , 1549-490X
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2024
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  • 6
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2021
    In:  Journal of Clinical Oncology Vol. 39, No. 15_suppl ( 2021-05-20), p. e16190-e16190
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 39, No. 15_suppl ( 2021-05-20), p. e16190-e16190
    Abstract: e16190 Background: Metronomic oral cyclophosphamide would suppress Treg and low dose nivolumab(0.1 mg/kg biweekly) might be still effective for immunogenic cancers. We try to introduce this regimen for immunogenic advanced HCC. Methods: From 2016 to 2021, 65 advanced HCC patients receiving ICIs in Yun-lin Branch of National Taiwan University Hospital were reviewed. Results: In these patients, 46 failed sorafenib; 35 (54%) HBV infected, 23 (35%) HCV infected, 7 (11%) alcoholism. The objective response rate was 48% (31/65) and disease control rate was 74% (48/65), with favorable toxicity profiles. In 43 nivolumab users, dosage from 0.3 to 3 mg/kg biweekly with 58% in 3 mg/kg; 15 receiving second-line low dose biweekly 20 mg nivolumab with oral metronomic cyclophosphamide 50 mg per day produced response rate 53% (8/15) & clinical benefit 73% (11/15). For this special regimen, in 10 HCV-infected patients, ORR was 70% & DCR was 90%; in 4 HBV-infected patients, ORR was 25%. In 10 with lung/LN metas only, ORR was 80%. 7 receiving bevacizumab, nivolumab, & cisplatin had 57% (4/7) response rate. In 7 atezolizumab users, combined with low dose bevacizumab (100 to 200 mg per 3 weeks) for first-line use, 6 were responders (86%). 19 front-line immunotherapy users had 68% (13/19) response rate (5 bevacizumab & atezolizumab; 4 lenvatinib & pembrolizumab; 2 bevacizumab, cisplatin, & nivolumab; 2 nivolumab with SBRT on MPV); 47 later line users had 38% (18/47) response rate (some receiving nivolumab combined with CT; bevacizumab with nivolumab & CT; sorafenib or regorafenib). 13 patients had MPV involvement (7 responders to immunotherapy-54%): 3 patients, using nivolumab after sorafenib failure, all suffered from rapid progression; 3 patients, receiving front-line SBRT over portal vein tumors and nivolumab, had response rate in 67% (2/3) and 100% clinical benefit; 2 responders to front-line lenvatinib & pembrolizumab (ORR 2/2-100%); 1 responder to front-line bevacizumab & atezolizumab (ORR 1/2-100%; another patient responded to second-line lenvatinb & pembrolizumab); 1 responder to front-line bevacizumab, cisplatin, & nivolumab. Conclusions: In our institution, ICIs combined with metronomic chemotherapy, low dose bevacizumab, multi-targeted VEGFR2 TKI, CT(platinum, anthracycline, and 5-fluorouracil), & SBRT could produce favorable response rates(first line 68%; later line 38%)/clinical benefits and toxicity profiles in advanced HCCs, even in heavily-treated patients, MPV involvement, and fulminant spreading status. Metronomic oral cyclophosphamide & low dose nivolumab, all failing sorafenib, seemed feasible and effective with lower toxicity/cost. Patients with HCV infection or lung/lymph nodes metastasis only seemed to respond better. Immune-modulation mechanisms of metronomic oral cyclophosphamide, nivolumab biologically-effective dose, clinical trial design, & biomarkers research are warranted.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2021
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  • 7
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2022
    In:  Journal of Clinical Oncology Vol. 40, No. 4_suppl ( 2022-02-01), p. 328-328
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 4_suppl ( 2022-02-01), p. 328-328
    Abstract: 328 Background: ESCC is a health burden in Taiwan due to smoking and drinking habits. In R/M setting, the prognosis is worse. In 2021, KN590 study(pembrolizumab with chemotherapy in CPS≥10%), CM648 study(nivolumab with chemotherapy or nivolumab with ipilimumab in TPS≥1%), and ESCORt-1st study(camrelizumab with chemotherapy in TPS≥1%) have all been shown to get survival benefits compared with chemotherapy alone in front-line setting. Further immunotherapy combinations with targeted therapies and subsequent therapy options after anti-PD1 failure deserve more investigation. Methods: From early 2016 to late 2021, 26 advanced ESCC patients had ever received immunotherapy-containing regimens in Yun-lin Branch of National Taiwan University Hospital. We have reviewed basic characters, ICIs regimens, and treatment response of these patients. Results: 3 patients under progression during front-line KN590 got PR by subsequent afatinib(2) or lenvatinib(1) use. So, the overall response rate of advanced ESCC to immunotherapy-containing regimens was 59%(17/29) and disease control rate was 72%(21/29). Conclusions: Afatinib has multiple immuno-modulatory effects. AP or NA is an effective regimen in Taiwan, where double cancers, like HNSCC and ESCC, are popular due to smoking, drinking, and bêtel-nuts chewing. Following KN590 good efficacy was also seen in our institution and afatinib with anti-PD1 could be introduced in CT-unfit patients. In unresectable and/or oligometastatic ESCC, induction triple therapy may lead to conversion chemoradiation, even to final surgery. EGFR or VEGFR TKI with immunotherapy might also be a subsequent recue regimen after front-line anti-PD1 failure.[Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
    detail.hit.zdb_id: 2005181-5
    detail.hit.zdb_id: 604914-X
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  • 8
    In: Targeted Oncology, Springer Science and Business Media LLC, Vol. 19, No. 1 ( 2024-01), p. 51-58
    Type of Medium: Online Resource
    ISSN: 1776-2596 , 1776-260X
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2024
    detail.hit.zdb_id: 2222136-0
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  • 9
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2020
    In:  Journal of Clinical Oncology Vol. 38, No. 15_suppl ( 2020-05-20), p. e18502-e18502
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 38, No. 15_suppl ( 2020-05-20), p. e18502-e18502
    Abstract: e18502 Background: The treatment of HNSCC in Taiwan is still very challenging. Betel nut chewing might contribute to (1)strong invasion; (2)easy recurrence; (3)poor response to traditional therapies. In our retrospective analysis for 75 patients receiving front-line EPF, patients, with rapid progression within 3 months after previous CCRT, had significantly worse survival with only 2.6 months; however, the survival increased significantly to 7.5 months in the same population if under later-line immunotherapy. Methods: From 2016 to early 2020, 46 R/M HNSCC patients receiving immunotherapy-containing regimens in Yun-lin Branch of National Taiwan University Hospital were reviewed. Results: These patients consisted of 2 HPV and 44 non-HPV; 24 pembrolizumab and 22 nivolumab; 18 with afatinib(11 pembrolizumab & 7 nivolumab); 7 with bevacizumab; 9 with chemotherapy. The objective response rate was 48%(22/46) and clinical benefit was 80%(37/46). 20 patients were still under use(8 afatinib with pembrolizumab; 4 afatinib with nivolumab). 1 patient under afatinib and pembrolizumab had hyperprogression but then got pCR after bevacizumab & strong CT. 1 patient had rapid skin metastasis over previous radiation fields after pembrolizumab, bevacizumab, and CT. 5 patients under afatinib & pembrolizumab developed autoimmune cholestasis(3 also with pneumonitis). Afatinib with nivolumab had similar efficacy but less toxicity. 18 patients receiving afatinib combined with anti-PD1(11 failing EPF, 14 with pleural/pericardial/skin metastases, 13 rapid progression within 3 months after CCRT) had 67% response rate(12/18) and 89% clinical benefit(16/18). 11 patients under afatinib & anti-PD1, who had failed EPF, had the response rate in 55%(6/11). 7 patients under front-line afatinib & anti-PD1 had the response rate in 86%(6/7). Post-progression use of anti-PD1 with other treatments were seen in 12 patients(esp. 1 with nivolumab & ipilimumab; 3 with Avastin, taxane, cisplatin). 7 patients got benefits and had longer survivals. Conclusions: Novel immunotherapy-containing combinations are of clinical significance in refractory betel-nuts related HNSCC in Taiwan. Afatinib has several immuno-modulatory effects in high risk patients(pleural/pericardial/skin metastases failing EPF, rapid progression within 3 months after definite CCRT). Afatinib with anti-PD1 may be a good option to avoid hyperprogression for more immunotherapy efficacy. Adding on CTLA4 blockage to previous afatinib/anti-PD1 after progression seemed potential for further studies.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2020
    detail.hit.zdb_id: 2005181-5
    detail.hit.zdb_id: 604914-X
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  • 10
    In: Head & Neck, Wiley, Vol. 41, No. 9 ( 2019-09), p. 3201-3210
    Abstract: We hypothesized that patients with head and neck squamous cell carcinoma (HNSCC) with smoking cessation during curative chemoradiotherapy (CRT) had fewer complications and lower tumor progression risks. Methods Sixty‐three patients with nonmetastatic HNSCC who were smokers at diagnosis (carbon monoxide [CO] breath concentrations ≥3 ppm) and underwent curative CRT were prospectively enrolled. Successful smoking cessation throughout CRT was confirmed by CO breath concentrations 〈 3 ppm at CRT completion. Results Forty‐one patients (65%) successfully discontinued smoking throughout CRT. With a median 33‐month follow‐up, patients with successful smoking cessation during CRT had significantly fewer, greater, and lower probabilities of grade ≥3 acute toxicities ( P  = .01), progression‐free survival ( P  = .03), and permanent gastrostomy or tracheostomy ( P  = .04), respectively, than those continuing smoking throughout CRT. In multivariate analysis, successful smoking cessation during CRT significantly reduced tumor progression risks (hazard ratio: 0.4, P  = .05). Conclusion Smoking cessation during curative CRT reduced treatment‐related toxicities and tumor progression risks in patients with HNSCC.
    Type of Medium: Online Resource
    ISSN: 1043-3074 , 1097-0347
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2001440-5
    detail.hit.zdb_id: 645165-2
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