Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Nutritional needs in patients with recurrent/metastatic Head & Neck Cancer (R/M HNSCC) receiving immune checkpoint inhibitors (ICI) (#228)

Teresa Brown 1 2 , Belinda Camilleri 1 , Judy Bauer 3 , Michelle Nottage 1 , Brett G.M. Hughes 1 4
  1. Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
  2. School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
  3. Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
  4. School of Medicine, University of Queensland, Brisbane, Queensland, Australia

Aims

Although ICI have significantly improved outcomes for patients with R/M HNSCC1,2, the impact on patients’ nutritional status and the role of the dietitian and nutrition intervention in the era of ICI remains unclear. The aim of this study was to increase understanding of nutrition outcomes of patients undergoing immunotherapy.

Methods

Patients with a diagnosis R/M HNSCC treated with ICI between 2015 – 2023 at RBWH were included in this retrospective cohort study. Data collection occurred for the first three cycles of treatment and included weight change, nutritional status, presence of nutrition impact symptoms and dietary referrals and nutrition interventions.

Results

89 patients (74 males (83%); mean age 64.5+/-10) received ICI. Most common primary tumour diagnosis was oral cavity (n=40, 45%) or oropharynx (n=37, 42%).

Patients were treated with Nivolumab (n=46, 52%), Pembrolizumab (n=30, 34%) or Pembrolizumab-Carboplatin-5FU (n=13, 14%), with 83 patients (93%) completing two cycles, and 64 (72%) completing three cycles. Ten patients were malnourished at commencement of treatment, and 21 had a feeding tube in-situ (67% G tube; 33% NGT). Nearly half were already under the care of a dietitian (n=41, 46%).

Ten additional patients were referred at Cycle 1 (C1), with the most common nutrition impact symptoms; fatigue (n=40, 45%), constipation (n=22, 25%), nausea (n=14, 16%), and anorexia (n=13, 15%). Symptoms remained similar at C2 and C3, although fatigue increased (68% and 61% respectively), and nausea increased by C3 (22%). Median weight change from baseline to C3 was -1.2% but varied considerably from -15% to +10%. Referrals to the dietitian continued throughout treatment (C2 n=12; C3 n=5).

Conclusions

Dietetic support remains important during palliative ICI due to presence of malnutrition, ongoing nutrition impact symptoms and requirement for tube feeding. Further co-design of optimal models of care are recommended to ensure appropriate patient support during this time.

  1. Burtness, B., Harrington, K.J., Greil, R., Soulières, D., Tahara, M., de Castro Jr, G., et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. The Lancet (2019), 394, (10212), p1915-1928. DOI:https://doi.org/10.1016/S0140-6736(19)32591-7
  2. Ferris, R.L., Blumenschein, Jr., G., Fayette, J., Guigay, J., Colevas, D., Licitra, L., et al. Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck. N Engl J Med 2016; 375 (19):1856-1867. DOI: 10.1056/NEJMoa1602252