Efficacy and toxicity of PD-1 inhibitor combined with induction chemotherapy for locally advanced laryngeal and hypopharyngeal cancers

Abstract

Objective: To evaluate the efficacy, toxicity, and voice rehabilitation outcomes of PD-1 inhibitors combined with induction chemotherapy (PCIC) compared to induction chemotherapy (IC) alone.

Methods: A retrospective analysis was conducted on 250 patients with stage III/IVA squamous cell carcinoma of the larynx/hypopharynx treated between June 2021 and December 2023. After 1:1 propensity score matching, 216 patients (108 per group) were analyzed. Both groups received platinum-based induction chemotherapy, with the PCIC group receiving an additional PD-1 inhibitor, toripalimab. Efficacy was evaluated based on response rates and survival outcomes, while toxicity profiles and voice rehabilitation were assessed.

Results: The PCIC group had significantly higher complete remission rates (81.48% vs. 65.74%; P = 0.021) and improved 1-year overall survival (62.96% vs. 49.07%; P = 0.040). The incidence of neutropenia and nausea was higher in the PCIC group (P < 0.05). Voice quality assessments showed worse objective vocal grade but better patient-perceived vocal quality in the PCIC group (both P < 0.05).

Conclusion: The combination of PD-1 inhibitors with induction chemotherapy improve remission rates and survival in patients with locally advanced laryngeal and hypopharyngeal cancers. However, increased toxicity and voice rehabilitation challenges highlight the need for comprehensive patient support during treatment.

Keywords: PD-1 inhibitors; hypopharyngeal cancer; induction chemotherapy; laryngeal cancer; survival outcomes; toxicity profiles.

Figure 1

Flowchart of patient selection.

Figure 2

Comparison of auditory-perceptual voice between the two groups. A: Grade; B: Roughness; C: Breathiness; D: Asthenia; E: Strain; ns: No significant difference; *: P < 0.05.