Real-world effectiveness and healthcare utilization of nivolumab for advanced head and neck cancer: a real-world population-based descriptive study

Introduction — Nivolumab was the first immunotherapy to have shown efficacy in platinum-resistant recurrent and/or metastatic squamous cell carcinoma of head and neck (R/M SCCHNC) in the CheckMate-141 trial. We conducted a population-based retrospective study to examine the survival outcomes and resource utilization of patients with R/M SCCHNC who were treated with nivolumab.

Method — Patients with R/M SCCHNC were included in the study if they received nivolumab between January 17th 2018 to August 31st 2022 in Ontario, Canada. The primary outcomes, including overall survival (OS) and time-to-treatment discontinuation (TTD), were assessed using Kaplan-Meier. Cox proportional hazard model was used to explore the association between baseline patient characteristics and all-cause death. The incidence of healthcare utilization was estimated using the cumulative incidence function, taking death as a competing event.

Results — A total of 498 R/M SCCHNC patients received nivolumab (Mean age 62.9, 78.7 % male). The median OS was 6.0 months (95 % CI: 5.0–7.3) and median time-to-treatment discontinuation was 2.6 months (95 % CI: 2.3–3.0). There is no significant OS difference between older patients (age > 75 years old) and younger patients (p-value 0.73). At 1-year post-nivolumab initiation, the cumulative incidence of emergency department visits is 50.6 % (95 % CI: 46.1–55.0 %) and direct hospitalization is 22.7 % (19.0–26.6 %).

Conclusion — In this real-world study, the survival outcomes of nivolumab were similar to those observed in CheckMate-141 trial. We demonstrated that there is no survival difference between older and younger patients. Furthermore, more than half of patients exaperienced an hospital encounter with the healthcare system, suggesting significant healthcare resource utilization.