Efficacy of first-line immune checkpoint inhibitors for recurrent/metastatic head and neck cancer: a systematic review and meta-analysis.

[INTRODUCTION] Immune checkpoint inhibitors (ICIs) have brought a paradigm shift in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC), but their first-line efficacy remains inconsistent. This meta-analysis compared the efficacy of ICIs versus the EXTREME regimen in R/M HNSCC patients.

[METHODS] Randomized controlled trials evaluating the efficacy of ICIs versus EXTREME in R/M HNSCC patients and reporting on programmed death-ligand 1 (PD-L1) expression, overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) were included. Kaplan-Meier curves of OS and PFS were reconstructed; ORR was presented as odds ratios.

[RESULTS] From an initial pool of 356 studies, three trials were included. In the total population, median OS was similar among ICI monotherapy (11.5 months), dual ICIs (12.5 months), and EXTREME (12.0 months). In the PD-L1 high expression population, ICI monotherapy and dual ICIs demonstrated a trend toward improved OS relative to EXTREME. EXTREME demonstrated better PFS and ORR than ICI monotherapy and dual ICIs in both the total and PD-L1 high expression populations.

[CONCLUSIONS] First-line ICI monotherapy and dual ICIs did not significantly improve OS, PFS, and ORR compared with EXTREME. However, a discernible trend suggested a potential survival benefit for ICIs in patients with high PD-L1 expression.