NSAIDs During CRT Tied to Improved OS in Patients With HNSCC

Findings from a cohort study suggest that patients with head and neck squamous cell carcinoma (HNSCC) who take nonsteroidal anti-inflammatory drugs (NSAIDs) during chemoradiation may achieve an overall survival (OS) advantage (JAMA Netw Open. 2020;3[6]:e207199).

“A recent study showed that aspirin was associated with improved survival in patients with [HNSCC] who were treated with surgery,” wrote Austin J. Iovoli, MD, Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, and colleagues.

Thus, Dr Iovoli et al sought to assess whether NSAIDs used during definitive chemoradiation therapy (CRT) could improve outcomes in patients with HNSCC.

Overall, 460 patients (median age, 60 years) with HNSCC who were treated with CRT at a single institution between January 2005 and August 2017 were included in the analysis.

“Patient and tumor characteristics included age, race/ethnicity, smoking status, alcohol use, comorbidities (respiratory, cardiovascular, immune, renal, endocrine), disease stage, human papillomavirus status, and treatment duration,” the investigators remarked.

The main outcome of the study was the link between NSAID use and patterns of failure, disease-specific survival (DSS), and OS, which was evaluated using multivariate Cox proportional hazard regression models. Kaplan-Meier survival curves were used to create survival estimates for OS and DSS. 

Dr Iovoli and co-investigators analyzed these data from May 1, 2019, to March 17, 2020.

A total of 201 (43.7%) patients were taking NSAIDs during CRT. According to a univariate analysis, NSAID use (hazard ratio [HR], 0.63; 95% CI, 0.43-0.92; P = .02) was linked to better OS.

Furthermore, after backward selection adjustment for potentially confounding factors (ie, age, smoking status, primary tumor site, human papillomavirus status, diabetes, stroke, hyperlipidemia), Cox regression analysis maintained that NSAID use was significantly tied to better OS (HR, 0.59; 95% CI, 0.38-0.90; P = .02).

The use of NSAIDs was associated with a significantly better 5-year OS compared with that of patients who did not take concurrent NSAIDs during CRT (63.6% [56 of 88 patients]; 95% CI, 58%-73% vs 56.1% [83 of 148 patients]; 95% CI, 50%-63%; P = .03).

Of note, the investigators did not find a link between NSAID use and better DSS in univariate (HR, 0.82; 95% CI, 0.48-1.41; P = .47) or multivariate (HR, 0.98; 95% CI, 0.57-1.70; P = .44) analysis.

In addition, NSAID use was not linked to better response to treatment (HR, 1.44; 95% CI, 0.91-2.27; P = .12) or distant failure (HR, 1.12; 95% CI, 0.68-1.84; P = .65), and a change in local control with NSAID use did not yield a statistical significance (HR, 0.59; 95% CI, 0.31-1.10; P = .10).

“This cohort study suggests a possible OS advantage for patients taking NSAIDs during chemoradiation for HNSCC. Further studies examining this association are warranted,” Dr Iovoli and colleagues concluded.—Hina M. Porcelli