# Real‐World Outcomes of Immune Checkpoint Inhibitors in Head and Neck Squamous Cell Carcinoma: Analyzing Patient‐Specific Factors Influencing Survival and Response Rate

## TL;DR

This study examines how immune checkpoint inhibitors affect survival and response rates in head and neck cancer patients, identifying factors like PD-L1 levels and lifestyle habits that influence outcomes.

## Contribution

The study identifies patient-specific factors influencing ICI outcomes in HNSCC using real-world data, highlighting TPS, lifestyle, and biomarkers like NLR.

## Key findings

- Median overall survival was 10.4 months and progression-free survival was 7.4 months with an objective response rate of 22%.
- TPS ≥ 50% and absence of smoking or alcohol abuse significantly improved response rates.
- Female sex, high NLR, and elevated leukocyte counts were linked to worse survival outcomes.

## Abstract

Head and neck squamous cell carcinoma (HNSCC) is a globally significant disease with poor survival outcomes. Immune checkpoint inhibitors (ICIs) such as pembrolizumab and nivolumab have improved treatment paradigms, yet their real‐world efficacy and the factors influencing treatment outcomes remain underexplored.

This study aimed to evaluate real‐world outcomes of pembrolizumab and nivolumab therapy in patients with HNSCC and to identify clinical and laboratory factors associated with overall survival (OS), progression‐free survival (PFS), and objective response rate (ORR).

We conducted a retrospective analysis of 45 HNSCC patients treated with pembrolizumab or nivolumab at the University Medical Center Mannheim. Patient‐specific factors, including tumor characteristics, PD‐L1 expression, and laboratory parameters, were assessed using Kaplan–Meier estimation, log‐rank tests, and multivariate regression models. The median OS and PFS were 10.4 months and 7.4 months, respectively, with an ORR of 22%. A tumor proportion score (TPS) ≥ 50% and absence of smoking or alcohol abuse significantly improved ORR, while female sex, high neutrophil‐to‐lymphocyte ratio (NLR), and elevated leukocyte counts were associated with inferior OS and PFS. Real‐world outcomes largely aligned with the pivotal trials Keynote‐048 and CheckMate 141.

This study underscores the predictive value of TPS and patient lifestyle factors in ICI treatment for HNSCC. The findings also highlight sex‐specific differences, as well as NLR and leukocyte count as potential prognostic factors. Larger, more diverse cohorts are needed to confirm these results and refine patient selection strategies.