Barbara Burtness, MD, the Anthony N. Brady Professor of Medicine and Chief Translational Research Officer at Yale Cancer Center, New Haven, featured the CONTINUUM study at the head and neck cancer session on Highlights of the Day during the 2023 ASCO Annual Meeting. She noted the study’s premise starts with the recognition that for locally advanced nasopharyngeal cancer, gemcitabine/cisplatin induction chemotherapy is now accepted as a standard of care.1 In addition, she added, gemcitabine/cisplatin is an appropriate backbone for treatment with PD-1 inhibition, as recently shown by the overall survival advantage seen with toripalimab in the JUPITER-02 study, also presented at this ASCO meeting.2
“So, the question of induction achemotherapy with gemcitabine/cisplatin had been previously answered, as had the question of immunotherapy plus gemcitabine/cisplatin. But how do those two things fit together?” Dr. Burtness asked.
Barbara Burtness, MD
The CONTINUUM trial sought to answer that question by assessing 425 patients with advanced-stage disease who were randomly assigned between induction chemotherapy followed by chemoradiation or the same plus the incorporation of the PD-1 inhibitor sintilimab, with sintilimab continued for a total of 12 cycles. The groups were well matched, and adherence to treatment was acceptable for chemotherapy, radiotherapy, and sintilimab. However, in the sintilimab arm, fewer patients completed concurrent chemortherapy, and the cumulative cisplatin dose was slightly lower. More than 70% of patients randomly assigned to receive sintilimab received all 12 cycles, she pointed out.
“The primary endpoint of event-free survival was significantly improved by the inclusion of sintilimab (hazard ratio = 0.59; P = .019). This benefit resulted both from the impact of sintilimab on distant metastasis–free survival as well as on locoregional recurrence–free survival,” stated Dr. Burtness. “As expected in nasopharyngeal cancer, where subsequent lines of therapy are effective and the natural history is a bit slower than in other types of head and neck cancer, there is yet no difference observed in overall survival, and that is not surprising. For this reason, I don’t think the findings are practice-changing now. We should wait for the mature overall survival data,” she added.
DISCLOSURE: Dr. Burtness has served as a consultant or advisor to AbbVie, ALX Oncology, Arvinas, Coherus Biosciences, CUE Biopharma, Genentech/Roche, IO Biotech, Kura Oncology, MacroGenics, Merck, Merck KGaA, and Vaccinex.
1. Zhang Y, Chen L, Hu GQ, et al: Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma. N Engl J Med 381:1124-1135, 2019.
2. Mai HQ, Chen QY, Chen DP, et al: Final overall survival analysis of JUPITER-02. 2023 ASCO Annual Meeting. Abstract 6009. Presented June 5, 2023.
The addition of the PD-1 inhibitor sintilimab to standard induction chemotherapy and chemoradiotherapy resulted in a significant improvement in 3-year event-free survival, a manageable safety profile, and comparable quality of life in high-risk, locally advanced nasopharyngeal carcinoma vs standard ...