Immunooncology in Head Neck Cancer Dr Robert Metcalf

Immuno-oncology in Head & Neck Cancer Dr Robert Metcalf Consultant Medical Oncologist, The Christie NHS Foundation Trust, University of Manchester © Copyright Greater Manchester Cancer. All rights reserved.

Disclosures • Research/Travel Grants Astra. Zeneca, Bristol Myers Squibb • Speaking/Consultancy/Advisory MSD, Bristol Myers Squibb, Merck • I will be discussing off label use of: • Pembrolizuab, nivolumab, ipilimumab, durvalumab, tremelimumab @GMCEducation I #GMCHead. And. Neck 2019

Overview 1. Background to immuno-oncology 2. Current Licensed Immunotherapies: recurrent/metastatic, postplatinum • Pembrolizumab monotherapy • Nivolumab monotherapy 3. Horizon scanning: recurrent/metastatic, first line • Pembrolizumab monotherapy or pembrolizumab/platinum/5 FU @GMCEducation I #GMCHead. And. Neck 2019

Background: Where Melanoma goes …. HNSCC follows Immunotherapy KEYNOTE-001 (phase I) Pembrolizumab monotherapy associated with ORR of 19% and median DOR of 12. 5 months CA 184 -002 (phase III) Ipilimumab and/or gp 100 vaccine: Ipilimumab monotherapy equivalent to combination therapy and superior to gp 100 vaccine monotherapy 2011 CA 209 -003 (phase I) Nivolumab associated with ORR of 28%, with durable responses 2012 @GMCEducation I #GMCHead. And. Neck 2019 CA 209 -004 (phase I) Ipilimumab + nivolumab: Concurrent treatment at different doses was associated with an overall ORR of 40% 2013 KEYNOTE-002 (phase II) Pembrolizumab superior to chemotherapy after ipilimumab Check. Mate 037 (phase III) Nivolumab superior to chemotherapy after progression on ipilimumab Check. Mate 066 (phase III) Nivolumab superior to frontline dacarbazine 2014 KEYNOTE-006 (phase III) Pembrolizumab superior to ipilimumab in frontline setting Check. Mate 067 (phase III) Ipilimumab + nivolumab AND nivolumab alone superior in terms of progression-free survival to frontline ipilimumab; combination numerically superior to nivolumab alone, although with substantially increased toxicity 2015

Immuno-oncology therapies are transforming systemic management of head and neck cancer 51 -year-old male diagnosed with T 4 N 1 SCC oropharynx Multiple lung metastases 2015 Radical radiotherapy Pretreatment @GMCEducation I #GMCHead. And. Neck 2019 2016 KESTREL Complete radiologic response ongoing at month 18 2016 Week 8 2017 Year 3

Immuno-oncology therapies are transforming systemic management of head and neck cancer 67 year-old male diagnosed with T 3 N 1 SCC floor or mouth 2016 Local recurrence Complete radiologic response ongoing at month 26 2017 Check. Mate 651 2017 2018 2019 Surgery - Radiotherapy September 2017 @GMCEducation I #GMCHead. And. Neck 2019 November 2017 June 2018 May 2019

Pembrolizumab monotherapy post-platinum Cohen ESMO 2017 @GMCEducation I #GMCHead. And. Neck 2019

Pembrolizumab monotherapy post-platinum Cohen Lancet 2019 @GMCEducation I #GMCHead. And. Neck 2019

Pembrolizumab monotherapy post-platinum @GMCEducation I #GMCHead. And. Neck 2019

Nivolumab monotherapy post-platinum @GMCEducation I #GMCHead. And. Neck 2019

Ferris Oral Oncol June 2019 @GMCEducation I #GMCHead. And. Neck 2019

PDL 1 expression Ferris Oral Oncol June 2019 @GMCEducation I #GMCHead. And. Neck 2019

HPV P 16 Ferris Oral Oncol June 2019 @GMCEducation I #GMCHead. And. Neck 2019

Prior cetuximab Ferris Clin Can Res Sep 2019 @GMCEducation I #GMCHead. And. Neck 2019

Pembrolizumab monotherapy or pembrochemo first-line ASCO 2019 @GMCEducation I #GMCHead. And. Neck 2019

ASCO 2019 @GMCEducation I #GMCHead. And. Neck 2019

Pembro (blue) versus cetux-chemo (red) CPS>20 Pembro-chemo (blue) versus cetux-chemo (red) CPS >20 CPS>1 CPS any Burtness Lancet 2019 @GMCEducation I #GMCHead. And. Neck 2019

ASCO 2019 @GMCEducation I #GMCHead. And. Neck 2019