Head and Neck Cancer
PV 02 - Poster Viewing Q&A - Session 2
MO_33_2965 - Non-Steroidal Anti-Inflammatory Drug Use Is Associated with Improved Survival in Head and Neck Cancer: A Retrospective Review
Monday, September 16
10:45 AM - 12:00 PM
Location: ASTRO Innovation Hub
Austin Iovoli, MD
Roswell Park Comprehensive Cancer Center
University at Buffalo, Jacobs School of Medicine and Biomedical Sciences
Non-Steroidal Anti-Inflammatory Drug Use Is Associated with Improved Survival in Head and Neck Cancer: A Retrospective Review
A. J. Iovoli1, G. M. Hermann2, A. Platek1, L. H. DeGraaff1, M. K. Farrugia2, E. Yau2, K. E. Wooten2, H. Arshad2, V. Gupta2, M. Kuriakose2, W. L. Hicks2, and A. K. Singh2; 1Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, 2Roswell Park Comprehensive Cancer Center, Buffalo, NY
Purpose/Objective(s): Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin are commonly prescribed medications with anti-inflammatory and anti-platelet properties used long-term to decrease the risk of cardiovascular events. A recent study showed that aspirin improves survival in patients with head and neck squamous cell carcinoma (HNSCC). In HNSCC patients treated with definitive chemoradiation (CRT) with we performed a retrospective review to examine whether patients on NSAIDs had improved outcomes. Hypothesis: Patients on NSAIDs during CRT for HNSCC will have improved survival.
Materials/Methods: Clinical characteristics of HNSCC patients treated between 2005 and 2017 with definitive CRT were abstracted from the medical records. Patients were stratified by NSAID use during treatment. Patient and tumor characteristics included age, race, smoking status, alcohol use, comorbidities, disease stage, and HPV status. The effect of NSAID use on patterns of failure, disease-specific survival (DSS) and overall survival (OS) were examined using multivariate cox proportional hazard regression models. The analyses for the association between clinical outcomes and each interested risk were conducted using backward selection analyses. All related factors that are significant at level α = 0.20 in the backward selection analyses are included in the final multiple analyses. Survival trends for OS and DSS were estimated using Kaplan-Meier (K-M) survival curves. Bonferroni correction was used for comparison between multiple groups. Data and decision management software was used for statistical analyses.
Results: A total of 460 patients were included in the analysis. Among these patients, 201 (44%) were taking NSAIDs during treatment. On univariate analysis, NSAIDs (0.015) were associated with better overall survival. The following were associated with worse overall survival: clinical T stage (0.006), overall clinical stage (0.022), current or former smoking status (<0.001) and oral cavity primary (0.02). On Cox regression analysis, after backwards selection adjustment for potentially confounding factors (age, smoking status, primary tumor site, HPV status, diabetes, stroke, hyperlipidemia), NSAID use remained significantly associated with better OS (0.018). NSAID use was associated with significantly better OS at 5 and 10 years compared to patients who did not take concurrent NSAIDs (64% vs 56% and 38% vs 30%, log rank p-value=0.032). NSAID use was not associated with better DSS on univariate (0.48) or multivariate analysis (p=0.47). NSAID use was not associated with better response to treatment (p=0.21) or distant failure (p=0.59). There was a trend towards less local failure with NSAID use (p=0.08).
Conclusion: This study demonstrates an overall survival advantage for patients taking NSAIDs during CRT for HNSCC. Implications for practice or research: NSAIDs may offer a survival advantage to patients treated for HNSCC. Further studies examining this effect are warranted.
Author Disclosure: A.J. Iovoli: None. G.M. Hermann: None. A. Platek: None. L.H. DeGraaff: None. E. Yau: None. V. Gupta: Employee; Northwell Health. W.L. Hicks: None.