Cetuximab performs better than durvalumab in treating head and neck cancers

Head and neck cancers are the seventh most common type of cancer worldwide, according to the 2020 World Cancer Report. Smokers and drinkers, as well as those with HPV infections, are disproportionately affected. The chemotherapy drug cisplatin, when administered alongside radiation therapy, is the gold standard for treating these malignancies. However, more than 30% of patients, including some older adults and those with pre-existing kidney disease or hearing loss, cannot take cisplatin due to severe side effects.

The monoclonal antibody cetuximab, while not as effective as cisplatin, is often used as an alternative in these patients. However, there is currently no consensus on the standard of care for this population. Durvalumab, an immune checkpoint inhibitor, has shown promise for treating a wide range of cancers, and has been proposed as a potentially safer and more effective option than cetuximab, according to Loren Mell, MD, professor and vice chair of clinical and translational research at University of California San Diego School of Medicine Department of Radiation Medicine and Applied Sciences, and co-leader of the UC San Diego Moores Cancer Center Head/Neck Disease Team.

In a clinical trial, Mell and cancer researchers from two dozen other institutions compared the effectiveness of durvalumab and cetuximab -; in combination with radiation therapy -; in 186 patients with advanced squamous cell carcinoma of the head or neck who were ineligible for cisplatin. They report in The Lancet Oncology that contrary to expectations, cetuximab performed better than durvalumab, with a similar rate of adverse events. As a result, the researchers discontinued the study early. The results were published on November 14, 2024.

We found that the probability of being alive and free of disease at two years was approximately 64% for cetuximab versus 51% for durvalumab, indicating no evidence of a benefit of durvalumab over cetuximab. We had a lot of reasons to be optimistic about durvalumab, but it turned out to be potentially worse than the standard."

Loren Mell, MD, professor and vice chair of clinical and translational research at University of California San Diego School of Medicine Department of Radiation Medicine and Applied Sciences

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