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A randomised trial at Tata Memorial added nivolumab at 20 mg every three weeks, about one-twelfth of the standard dose, to cheap metronomic chemotherapy for head and neck cancer patients who could not afford full-dose immunotherapy, and they lived longer. Checkpoint inhibitors saturate their target far below approved doses, so publicly funded trials should test low doses in common cancers.
Patil et al. (JCO 2023) randomised 151 patients with advanced head and neck cancer to triple metronomic chemotherapy with or without nivolumab 20 mg flat dose every three weeks, about one-twelfth of the standard dose. One-year overall survival was 43.4% versus 16.3%. Checkpoint inhibitors saturate their target at doses far below those approved, which were chosen for development convenience rather than minimum effective exposure. Publicly funded non-inferiority trials of low-dose pembrolizumab and nivolumab in common indications would establish whether the finding generalises.
Patients with head and neck squamous cell cancer that has recurred or spread should be treated first with pembrolizumab: alone if their tumour is strongly PD-L1 positive and they can wait for a slower response, or with chemotherapy if the tumour is bulky or PD-L1 low. Cetuximab-based chemotherapy is no longer the default. Long-term follow-up shows a small but real group of patients alive at four to five years, which was almost unheard of before.
One of the most cited papers Europe PMC returns for Jean-Pascal Machiels at King Albert II Cancer Institute, Cliniques universitaires Saint-Luc, so it is a natural starting point for reading their work. The record was linked automatically from the author list and affiliation; read the abstract above and the paper itself before relying on any figure.
One of the most cited trial reports Europe PMC returns for Pembrolizumab in Head and neck squamous cell carcinoma, so it is a natural first reading for anyone weighing the idea it is linked from. The record was linked automatically by title and abstract; read the abstract above and the paper itself before relying on any figure.
Shares Pembrolizumab for Platinum- and Cetuximab-Refractory Head and Neck Cancer: Results From a Single-Arm, Phase II Study, Pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma (KEYNOTE-040): a randomised, open-label, phase 3 study, KEYNOTE-412, KEYNOTE-689.
Shares KEYNOTE-048, KEYNOTE-048: pembrolizumab, alone or with chemotherapy, as first treatment for recurrent or metastatic head and neck cancer, Head and neck squamous cell carcinoma, Pembrolizumab.
Shares Project Optimus, Tata Memorial Centre, Wrong doses, Prices and value.
Shares Pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma (KEYNOTE-040): a randomised, open-label, phase 3 study, KEYNOTE-412, Head and neck squamous cell carcinoma.
Shares Prices and value, Most of the world has almost no cancer care, Nivolumab, Pembrolizumab.
Shares Wrong doses, Prices and value, Nivolumab, Pembrolizumab.
Shares Tata Memorial Centre, Wrong doses, Prices and value, Nivolumab.
Shares Tata Memorial Centre, Wrong doses, Prices and value, Most of the world has almost no cancer care.