Impact of Tobacco, Marijuana, and Alcohol Use on Overall Survival in Recurrent Metastatic Head and Neck Cancer Patients Treated With Immune Checkpoint Inhibitors

Mohammad Bilal Alsavaf; Majd Issa; Brett G Klamer; Marium Husain; Khaled Dibs; Xueliang Pan; John C Grecula; Matthew O Old; David Konieczkowski; Darrion L Mitchell; Sujith Baliga; Ricardo L Carrau; James W Rocco; Marcelo Bonomi; Dukagjin M Blakaj; Priyanka Bhateja

doi:10.1111/ajco.14135

Impact of Tobacco, Marijuana, and Alcohol Use on Overall Survival in Recurrent Metastatic Head and Neck Cancer Patients Treated With Immune Checkpoint Inhibitors

Asia Pac J Clin Oncol. 2024 Dec 20. doi: 10.1111/ajco.14135. Online ahead of print.

Authors

Mohammad Bilal Alsavaf¹, Majd Issa², Brett G Klamer³, Marium Husain², Khaled Dibs⁴, Xueliang Pan³, John C Grecula⁴, Matthew O Old¹, David Konieczkowski⁴, Darrion L Mitchell⁴, Sujith Baliga⁴, Ricardo L Carrau¹, James W Rocco¹, Marcelo Bonomi², Dukagjin M Blakaj⁴, Priyanka Bhateja²

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
² Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
³ Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA.
⁴ Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

PMID: 39704258
DOI: 10.1111/ajco.14135

Abstract

Aim: The response rates to immune checkpoint inhibitors (ICI) remain low (13%-20%) in metastatic head and neck cancer patients, indicating an urgent need to better understand factors predictive of response to these agents. This study explored the impact of smoking status, marijuana use, and alcohol consumption on treatment outcomes in recurrent-metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients treated with ICI.

Methods: A retrospective analysis was performed on 201 R/M HNSCC patients treated with ICI between January 15th 2016 and April 9th 2020 at a single institution.

Results: Gender: 154 male (77%), 47 female (23%). Median age 61 (IQR: 55-68). ICI drug: pembrolizumab 100 (50%), nivolumab 91 (45%), nivolumab + ipilimumab 10 (5%). Line of therapy: first: 98 (49%), second and beyond: 103 (51%). Tumor site: oropharynx 84 (42%), oral cavity 45 (22%), larynx 26 (13%), other sites 46 (23%). p16 tumor status: negative 132 (66%), positive 69 (34%). Smoking status: former 111 (55%), never 54 (27%), current 36 (18%), median pack-year 18 (IQR: 0-37). Alcohol use: yes 110 (55%), no 91 (54%). Marijuana use: yes 47 (23%), no 154 (77%). Overall response rate: 36 (18%). Median OS: 12 months (95% CI: 9.4-14.8). Tobacco: former (HR: 0.75, 95% CI: 0.50, 1.11), current (HR: 0.58, 95% CI: 0.33, 1.02). Marijuana: yes (HR: 0.93, 95% CI: 0.58, 1.49). Alcohol: yes (HR: 1.04, 95% CI: 0.72, 1.49).

Conclusion: In our cohort, smoking status, marijuana use, and alcohol consumption did not have a statistically significant impact on OS in patients with R/M HNSCC treated with ICI.

Keywords: head and neck; immune checkpoint inhibitor; immunotherapy; marijuana; survival; tobacco.