Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 6:15:1645509.
doi: 10.3389/fonc.2025.1645509. eCollection 2025.

Health-related quality of life outcomes from KEYNOTE-412: chemoradiotherapy with or without pembrolizumab in participants with head and neck squamous cell carcinoma

Affiliations

Health-related quality of life outcomes from KEYNOTE-412: chemoradiotherapy with or without pembrolizumab in participants with head and neck squamous cell carcinoma

J-P Machiels et al. Front Oncol. .

Abstract

Background: The health-related quality of life (HRQoL) of patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC) is impacted by both disease- and treatment-related factors. Treatments that preserve and maximize HRQoL in this setting represent a substantial unmet need.

Methods: KEYNOTE-412 (NCT03040999) was a randomized, double-blind, placebo-controlled phase 3 study of pembrolizumab plus chemoradiotherapy (CRT) versus placebo plus CRT for maintenance therapy in participants with treatment-naïve LA HNSCC. Patient-reported outcomes (PROs) assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EORTC QLQ Head and Neck 35 (H&N35) were pre-specified secondary endpoints and administered at baseline and throughout the study. Least squares mean (LSM) change from baseline was assessed using a constrained longitudinal data analysis model. No formal statistical significance testing was performed.

Results: The PRO analysis population included 395 participants randomized to receive pembrolizumab plus CRT and 397 to receive placebo plus CRT. Completion rates for all assessed PROs were >95% at baseline and >66% at week 45. LSM change from baseline to week 45 was similar between groups across EORTC QLQ-C30 and QLQ-H&N35 subscale scores. There were no notable differences in empirical mean change or the proportion of participants with improvement, stability, or deterioration from baseline to week 45 between treatment groups.

Conclusion: The addition of pembrolizumab to CRT did not meaningfully impact HRQoL in participants with LA HNSCC.

Keywords: chemoradiotherapy; head and neck cancer; health-related quality of life; immunotherapy; patient reported outcomes; pembrolizumab.

PubMed Disclaimer

Conflict of interest statement

Authors CB, JN, AW, BG, and BB were employed by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA at the time of the study. J-PM has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; support for attending meetings and/or travel from Amgen, Bristol Myers Squibb, Pfizer, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Gilead, and Sanofi. YT has received research funding from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; consulting fees and travel support from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA and Merck KGaA, Darmstadt, Germany; honoraria from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and Seagen. LL has received research funding paid to institution from Adlai Nortye, AstraZeneca, Bristol Myers Squibb, Debiopharm International SA, Eisai, Eli Lilly and Company, Exelixis, Hoffman-La Roche Ltd, Isa Therapeutics, Kura Oncology, Merck Serono, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Nektar Therapeutics, Novartis, Regeneron, Roche, Sanofi, Syneos, Sun Pharmaceutica, Incyte Biosciences International Sàrl, Gilead Sciences, Inc., Genmab, and Merck Healthcare KGaA; and consulting fees from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Merck Serono Spa, Merck KGaA, GSK, F. Hoffman-La Roche Ltd, EMD Serono Research & Development Institute, Inc., Boehringer Ingelheim International GmbH, Simon-Kucher & Partners Strategy & Marketing Consultants, Rgenta Therapeutics, Inc, Alentis Therapeutics AG, MedImmune Limited, Simon-Kucher & Partners Italia Srl; honoraria from Merck Serono Spa, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Merck KGaA, Bristol Mayers Squibb, and ALTIS Omnia Pharma Service Srl; travel support from TAE Life Science; personal fees from advisory or data safety monitoring boards from Merck KGaA, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, EMD Serono Research & Development Institute, Inc., F. Hoffman-La Roche Ltd, Seagen International GmbH, Genmab US, Inc., AbbVie Srl, Simon-Kucher & Partners Strategy & Marketing Consultants, Purple Biotech, Ltd, Aveo Pharmaceuticals, Inc, Alx Oncology Inc., Medscape LLC, and Bicara Therapeutics Inc. BBu has received support for the present manuscript from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; research funding paid to institution from GlaxoSmithKline, Cue BioPharma, IO Biotech, Johnson and Johnson, and EMD Serono; royalties or licenses from Up-to-Date; consulting fees from GlaxoSmithKline, Astellas, Pfizer, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Merck KgAm Takeda, Johnson and Johnson, IO Biotech Vaccinex, Cue BioPharma, Coherus, AstraZeneca, and Genmab; honoraria from Coherus; payment for expert testimony from Cell Sci; travel support from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; data monitoring or advisory board participation from ALX Oncology, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and Kura; and receipt of equipment, materials, drugs, medical writing, gifts or other services from Cardiff Oncology and Vitrac Pharmaceuticals. MTah has received support for the present manuscript from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; consulting fees from Boehringer Ingelheim, Astellas, Janssen Pharmaceutical, Genmab, and AbbVie; honoraria from Ono Pharmaceutical, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Bayer, Rakuten Medical, Novartis, Bristol Myers Squibb, Merck Biopharma, Eisai, and Lilly; and participated on data monitoring or advisory boards for Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Bayer, Bristol Myers Squibb, Eisai, AstraZeneca, Merus, Merck Biopharma, Pfizer, Lilly, Boehringer Ingelheim, and GSK. DR has participated on advisory boards for Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Regeneron, Eisai, GSK, and Bicara Therapeutics. GA has received support for the present manuscript from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; research funding paid to institution from Roche, AstraZeneca, BMS, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Merck-Serono, Pfizer, Beigene, and Ipsen; consulting fees from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and AstraZeneca; honoraria from GSK, AstraZeneca, and Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. IL has received honoraria for Janssen; and travel support from Adium. BH has participated on a data safety monitoring or advisory board for Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Bristol Myers Squibb, AstraZeneca, Pfizer, Roche, Eisai, Sanofi, and Regeneron. YP reports personal financial interests for an advisory board with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Bristol Myers Squibb, and Merck Serono. SA has received honoraria AstraZeneca, Eli Lilly, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Novartis, Pfizer, Bristol Myers Squibb, Roche, Daiichi Sankyo, Menarini Türkiye, Astellas Pharma, Eczacıbaşı, Pierre Fabre, and Baxter. SL has received support for the present manuscript from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; consulting fees from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, GlaxoSmithKline, and Böhringer Ingelheim; honoraria from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; travel support from Merck Healthcare; has a pending patent for tumor-exclusive peptides for vaccine development; participation on a data safety monitoring or advisory board for Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and Bristol Myers Squibb. RG has received grants or contracts from Celgene, Novartis, Roche, Bristol Myers Squibb, Takeda, AstraZeneca, Agmen, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Sandoz, and Gilead; consulting fees from Celgene, Novartis, Roche, Bristol Myers Squibb, Takeda, AbbVie, AstraZeneca, Janssen, MSD, Merck, Gilead, Daiichi Sankyo; honoraria from Celgene, Roche, Merck, BMS, Takeda, AbbVie, AstraZeneca, Agmen, MSD, Sandoz, Merck, Gilead, Daiichi Sankyo, and Pfizer; and owns stock in Novo Nordisk, Lilly, Regeneron, and Vertex. MB has participated on advisory boards for and received travel support from MSD Austria. RM has received support for the present manuscript from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; honoraria from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and Merck KGaA. KH has received grants or contracts from Boehringer-Ingelheim and RepImmune. CB is an employee of and owns stock in Merck & Co., Inc., Rahway, NJ, USA. JN is an employee of and owns stock in Merck & Co., Inc., Rahway, NJ, USA. AW is an employee of and owns stock in Merck & Co., Inc., Rahway, NJ, USA. BG is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, owns stock and/or hold stock options in Merck & Co., Inc., Rahway, NJ, USA. BBi is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, owns stock and/or hold stock options in Merck & Co., Inc., Rahway, NJ, USA. LS has received support for the present manuscript from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; research grants paid to institution from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Bristol Myers Squibb, Roche/Genentech, GlaxoSmithKline, Novartis, Pfizer, AstraZeneca, Boehringer Ingelheim, Bayer, Amgen, Daiichi Sankyo, EMD Serono, Astellas, Gilead, Incyte, Legochem Biosciences, Loxo/Lilly, Takara Bio, Incyte, Marengo; consulting fees from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, AstraZeneca, Bristol Myers Squibb, Roche/Genentech, Voronoi, GlaxoSmithKline, Arvinas, Navire, Relay Therapeutics, Daiichi Sankyo, Tubulis, LTZ Therapeutics, Marengo, Nerviano, Amgen, Pangea, Incyte, Gilead and Velivago; and owns stock in Marengo. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declare that this study received funding from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. The funders contributed to study design, data collection, data analysis, data interpretation, and writing of the report in collaboration with the authors. Investigators and site personnel collected data, which were housed on the Merck & Co database.

Figures

Figure 1
Figure 1
Difference in least squares mean from baseline to week 45 by primary tumor site location in (A) EORTC QLQ-C30 GHS/QoL, (B) EORTC QLQ-C30 PF, (C) EORTC QLQ-H&N35 pain, (D) EORTC QLQ-H&N35 swallowing, and (E) EORTC QLQ-H&N35 speech scores. C30, Core 30; CI, confidence interval; CRT, chemoradiotherapy; EORTC QLQ, European Organisation for Research and Treatment of Cancer Quality of Life questionnaire; GHS/QoL, Global Health Score/quality of life; H&N35, Head and Neck 35; PF, physical functioning, PRO FAS, patient-reported outcomes full analysis set.
Figure 2
Figure 2
Difference in least squares mean from baseline to week 45 by PD-L1 CPS ≥1 in (A) EORTC QLQ-C30 GHS/QoL and PF and (B) EORTC QLQ-H&N35 pain, swallowing, and speech scores. C30, Core 30; CI, confidence interval; CPS, combined positive score; CRT, chemoradiotherapy; EORTC QLQ, European Organisation for Research and Treatment of Cancer Quality of Life questionnaire; GHS/QoL, Global Health Score/quality of life; H&N35, Head and Neck 35; LSM, least squares mean; PD-L1, programmed cell death ligand 1; PF, physical functioning, PRO FAS, patient-reported outcomes full analysis set.
Figure 3
Figure 3
Difference in least squares mean from baseline to week 45 by cancer stage in (A) EORTC QLQ-C30 GHS/QoL (B) EORTC QLQ-C30 PF (C) EORTC QLQ-H&N35 pain (D) EORTC QLQ-H&N35 swallowing and (E) EORTC QLQ-H&N35 speech. C30, Core 30; CI, confidence interval; CRT, chemoradiotherapy; EORTC QLQ, European Organisation for Research and Treatment of Cancer Quality of Life questionnaire; GHS/QoL, Global Health Score/quality of life; H&N35, Head and Neck 35; LSM, least squares mean; PF, physical functioning, PRO FAS, patient-reported outcomes full analysis set.
Figure 4
Figure 4
Empirical mean change from baseline to week 45 in (A) EORTC QLQ-C30 GHS/QoL, (B) EORTC QLQ-C30 PF, (C) EORTC QLQ-H&N35 pain, (D) EORTC QLQ-H&N35 swallowing, and (E) EORTC QLQ-H&N35 speech scores. C30, Core 30; CI, confidence interval; CRT, chemoradiotherapy; EORTC QLQ, European Organisation for Research and Treatment of Cancer Quality of Life questionnaire; GHS/QoL, Global Health Score/quality of life; H&N35, Head and Neck 35; PF, physical functioning.
Figure 5
Figure 5
Proportion of participants with improved, stable, or deteriorated scores from baseline to week 45 in (A) EORTC QLQ-C30 GHS/QoL and PF, and (B) EORTC QLQ-H&N35 pain, swallowing, and speech. C30, Core 30; CRT, chemoradiotherapy; EORTC QLQ, European Organisation for Research and Treatment of Cancer Quality of Life questionnaire; GHS/QoL, Global Health Score/quality of life; H&N35, Head and Neck 35; PF, physical functioning; PRO, patient-reported outcome.

References

    1. Chow LQM. Head and neck cancer. N Engl J Med. (2020) 382:60–72. doi: 10.1056/NEJMra1715715, PMID: - DOI - PubMed
    1. Saddawi-Konefka R, Simon AB, Sumner W, Sharabi A, Mell LK, Cohen EEW. Defining the role of immunotherapy in the curative treatment of locoregionally advanced head and neck cancer: Promises, challenges, and opportunities. Front Oncol. (2021) 11:738626. doi: 10.3389/fonc.2021.738626, PMID: - DOI - PMC - PubMed
    1. Johnson DE, Burtness B, Leemans CR, Lui VWY, Bauman JE, Grandis JR. Head and neck squamous cell carcinoma. Nat Rev Dis Primers. (2020) 6:92. doi: 10.1038/s41572-020-00224-3, PMID: - DOI - PMC - PubMed
    1. Okamoto I, Okada T, Tokashiki K, Tsukahara K. Quality-of-life evaluation of patients with unresectable locally advanced or locally recurrent head and neck carcinoma treated with head and neck photoimmunotherapy. Cancers (Basel). (2022) 14:4413. doi: 10.3390/cancers14184413, PMID: - DOI - PMC - PubMed
    1. Rathod S, Livergant J, Klein J, Witterick I, Ringash J. A systematic review of quality of life in head and neck cancer treated with surgery with or without adjuvant treatment. Oral Oncol. (2015) 51:888–900. doi: 10.1016/j.oraloncology.2015.07.002, PMID: - DOI - PubMed

LinkOut - more resources