Survival after squamous recurrence may be unaffected by immune status

Patients who have recurrence of cutaneous squamous cell cancer of the head and neck (cSCC-HN) tend to have poor outcomes regardless of immune status, according to investigators.

Patients with surgically unsalvageable recurrent disease had the worst outcomes, reported lead author Lillian Sun, of the Cleveland Clinic, and her colleagues.

These findings support more intensive upfront therapy for patients with cSCC-HN, the investigators wrote in JAMA Dermatology. They noted that most patients with cSCC have good outcomes, with less than 5% experiencing recurrence or distant metastasis; however, “there is a subset of patients with adverse pathologic features and a more aggressive clinical course,” the investigators pointed out, “with substantially higher rates of locoregional recurrence (13%-41%) and distant metastasis (7%-16%) after surgical resection.”

According to the investigators, previous research has identified several patient factors that predict poor outcomes, such as invasiveness and differentiation, as well as chronic immunosuppression. To build on these data, and, in particular, to determine if immune suppression was linked with poor outcomes, the investigators conducted a retrospective analysis of 205 patients with cSCC-HN.

From this cohort, 72 patients had disease recurrence after surgery and radiotherapy. The average age of the patients was 71 years. About half were immunosuppressed (55.6%). On average, disease recurrence occurred slightly earlier in immunosuppressed patients (9.1 months) than in immunocompetent patients (10.1 months). Most patients had locoregional recurrence first, at rates of 65.6% and 77.5% among immunocompetent and immunosuppressed patients, respectively. Irrespective of immune status, median overall survival was 8.4 months and the 1-year overall survival rate was 43.2%. In contrast with previous findings, immune status was not statistically associated with median overall survival; immunocompetent patients did tend to live longer (12.9 months) than immunosuppressed patients (8.0 months), but this difference carried a P value of .90.

The investigators found that surgical candidacy after recurrence had the strongest impact on survival. Patients with surgically salvageable disease had a median overall survival of 26.1 months, compared with just 4.7 months for those who were not amenable to surgical salvage (P = .01). Among patients with unsalvageable disease, again, immune status did not have a significant impact on outcome.

“This study demonstrates that survival in this population is poor,” the investigators concluded. “Although we hypothesized that immunosuppressed status would be a significant contributor to outcomes in these patients, similar to findings in the upfront treatment setting, the current study suggests that this is not the case.”

The investigators reported clinical trial support from Genentech, Merck, and Bristol-Myers Squibb.

SOURCE: Sun et al. JAMA Derm. 27 Feb 2019. doi: 10.1001/jamadermatol.2018.5453.

Patients who have recurrence of cutaneous squamous cell cancer of the head and neck (cSCC-HN) tend to have poor outcomes regardless of immune status, according to investigators.

Patients with surgically unsalvageable recurrent disease had the worst outcomes, reported lead author Lillian Sun, of the Cleveland Clinic, and her colleagues.

These findings support more intensive upfront therapy for patients with cSCC-HN, the investigators wrote in JAMA Dermatology. They noted that most patients with cSCC have good outcomes, with less than 5% experiencing recurrence or distant metastasis; however, “there is a subset of patients with adverse pathologic features and a more aggressive clinical course,” the investigators pointed out, “with substantially higher rates of locoregional recurrence (13%-41%) and distant metastasis (7%-16%) after surgical resection.”

According to the investigators, previous research has identified several patient factors that predict poor outcomes, such as invasiveness and differentiation, as well as chronic immunosuppression. To build on these data, and, in particular, to determine if immune suppression was linked with poor outcomes, the investigators conducted a retrospective analysis of 205 patients with cSCC-HN.

From this cohort, 72 patients had disease recurrence after surgery and radiotherapy. The average age of the patients was 71 years. About half were immunosuppressed (55.6%). On average, disease recurrence occurred slightly earlier in immunosuppressed patients (9.1 months) than in immunocompetent patients (10.1 months). Most patients had locoregional recurrence first, at rates of 65.6% and 77.5% among immunocompetent and immunosuppressed patients, respectively. Irrespective of immune status, median overall survival was 8.4 months and the 1-year overall survival rate was 43.2%. In contrast with previous findings, immune status was not statistically associated with median overall survival; immunocompetent patients did tend to live longer (12.9 months) than immunosuppressed patients (8.0 months), but this difference carried a P value of .90.

The investigators found that surgical candidacy after recurrence had the strongest impact on survival. Patients with surgically salvageable disease had a median overall survival of 26.1 months, compared with just 4.7 months for those who were not amenable to surgical salvage (P = .01). Among patients with unsalvageable disease, again, immune status did not have a significant impact on outcome.

“This study demonstrates that survival in this population is poor,” the investigators concluded. “Although we hypothesized that immunosuppressed status would be a significant contributor to outcomes in these patients, similar to findings in the upfront treatment setting, the current study suggests that this is not the case.”

The investigators reported clinical trial support from Genentech, Merck, and Bristol-Myers Squibb.

SOURCE: Sun et al. JAMA Derm. 27 Feb 2019. doi: 10.1001/jamadermatol.2018.5453.

Patients who have recurrence of cutaneous squamous cell cancer of the head and neck (cSCC-HN) tend to have poor outcomes regardless of immune status, according to investigators.

Patients with surgically unsalvageable recurrent disease had the worst outcomes, reported lead author Lillian Sun, of the Cleveland Clinic, and her colleagues.

These findings support more intensive upfront therapy for patients with cSCC-HN, the investigators wrote in JAMA Dermatology. They noted that most patients with cSCC have good outcomes, with less than 5% experiencing recurrence or distant metastasis; however, “there is a subset of patients with adverse pathologic features and a more aggressive clinical course,” the investigators pointed out, “with substantially higher rates of locoregional recurrence (13%-41%) and distant metastasis (7%-16%) after surgical resection.”

According to the investigators, previous research has identified several patient factors that predict poor outcomes, such as invasiveness and differentiation, as well as chronic immunosuppression. To build on these data, and, in particular, to determine if immune suppression was linked with poor outcomes, the investigators conducted a retrospective analysis of 205 patients with cSCC-HN.

From this cohort, 72 patients had disease recurrence after surgery and radiotherapy. The average age of the patients was 71 years. About half were immunosuppressed (55.6%). On average, disease recurrence occurred slightly earlier in immunosuppressed patients (9.1 months) than in immunocompetent patients (10.1 months). Most patients had locoregional recurrence first, at rates of 65.6% and 77.5% among immunocompetent and immunosuppressed patients, respectively. Irrespective of immune status, median overall survival was 8.4 months and the 1-year overall survival rate was 43.2%. In contrast with previous findings, immune status was not statistically associated with median overall survival; immunocompetent patients did tend to live longer (12.9 months) than immunosuppressed patients (8.0 months), but this difference carried a P value of .90.

The investigators found that surgical candidacy after recurrence had the strongest impact on survival. Patients with surgically salvageable disease had a median overall survival of 26.1 months, compared with just 4.7 months for those who were not amenable to surgical salvage (P = .01). Among patients with unsalvageable disease, again, immune status did not have a significant impact on outcome.

“This study demonstrates that survival in this population is poor,” the investigators concluded. “Although we hypothesized that immunosuppressed status would be a significant contributor to outcomes in these patients, similar to findings in the upfront treatment setting, the current study suggests that this is not the case.”

The investigators reported clinical trial support from Genentech, Merck, and Bristol-Myers Squibb.

SOURCE: Sun et al. JAMA Derm. 27 Feb 2019. doi: 10.1001/jamadermatol.2018.5453.