(A506) Allergy History and Steroid Use on Immune-Checkpoint Inhibitor Response in Metastatic Head and Neck Cancer

Monday, October 13, 2025

12:00 PM - 1:00 PM EDT

Location: OTO EXPO, Posters

Has Audio

Presenting Author(s)

Hannah Lee

MS2
Stanford University School of Medicine
Stanford, California, United States

Co-Author(s)

SR

Shahana R, N/A

National University of Singapore, United States

Co-Author(s)

AM

Ahmad Mahmoudi, MD

Stanford University, United States
CP

C. William Pike, MD

Director of Medical Informatics and Innovation
Atropos Health
New York, New York, United States
GH

Gavin Hui, MD

Atropos Health, United States
JM

Jananee Muralidharan, MD

Clinical Informatician
Atropos Health
Bengaluru, Karnataka, India
MR

Mandal Rajarsi, MD

Northwell, United States

Senior Author(s)

TT

Tristan Tham, MD

Assistant Professor
Stanford University
Palo Alto, California, United States

Disclosure(s):

Hannah Lee: No relevant relationships to disclose.

C. William Pike, MD: No relevant relationships to disclose.

Jananee Muralidharan, MD: No relevant relationships to disclose.

Tristan Tham, MD: No relevant relationships to disclose.

Introduction: Head and Neck Squamous Cell Carcinoma (HNSCC) represents 5% of cancer diagnoses and deaths. The prognosis for metastatic HNSCC (M-HNSCC) is poor, highlighting the need for treatments like immune checkpoint inhibitors (ICI). Given the variable response to ICI, identifying subgroups that benefit most is crucial. This study aims to examine the impact of allergy history and steroid use on survival in a large cohort of M-HNSCC patients receiving ICI.

Methods: This study used de-identified data from Stanford Health Care, covering over 3.2 million patients. Cohort selection and statistical analysis was performed using the Atropos database, identifying adults (18-89) with metastatic Head and Neck Squamous Cell Carcinoma (M-HNSCC) treated with immune checkpoint inhibitors (ICI) from 2010-2024, using ICD-10-CM codes. We compared patients with and without a documented allergy history, and within the allergy group, those who received steroids in the past 6 months were compared to those who did not. Overall survival was the primary outcome. High-dimensional propensity score matching and Cox Proportional Hazards Regression were used for statistical analysis.

Results: Patients with M-HNSCC starting ICI within 6 months of diagnosis were divided into two groups: allergy history (n=292) and no allergy history (n=2341). Of the 292 allergy patients, 210 received steroids and 82 did not within 6 months. After PS-matching, there were no survival differences between the allergy and no allergy groups (Hazard Ratio = 1.03; 95% CI: 0.77 - 1.37; p=0.84). Within the allergy subgroup, no survival difference was found between those who received steroids and those who did not after propensity score matching (HR = 1.29; 95% CI: 0.69 – 2.40; p=0.42).

Conclusions: We found similar survival outcomes between patients with and without a documented allergy history. Interestingly, recent steroid use did not impact survival in allergy patients. This study aims to inform clinical decision-making regarding immune checkpoint inhibitors (ICI) and steroids in M-HNSCC. Further prospective research is needed to validate these findings.