(A556) Immunotherapy monotherapy for patients with recurrent nonmetastatic larynx cancer who refuse salvage total laryngectomy

Introduction: Total laryngectomy has traditionally been recommended for patients with recurrent larynx cancer after radiation or chemoradiation, but some patients refuse salvage surgery. Historically, these patients have been placed on hospice or palliative chemotherapy, but immunotherapy has recently added another treatment modality to our armamentarium.

Methods: 8 patients with recurrent larynx cancer declined salvage laryngectomy. They were started on immunotherapy alone. We recorded their demographics, initial cancer stage, initial cancer treatment, CPS values, need for tracheostomy, addition of chemotherapy to their immunotherapy, and response to therapy.

Results: 67% were African American, while 33% were Caucasian. Most had early (stage 1 or 2 disease) at the time of initial diagnosis. 75% had radiation alone as their initial treatment, while 25% had chemoradiation. All of these patients had high CPS scores. 33% progressed on 4 rounds of immunotherapy and are deceased. Chemotherapy was added to the regimen of 50% of the patients after poor response to immunotherapy. These patients are all still alive after 1 year of treatment. 75% needed tracheostomy while on salvage treatment. One patient (13%) has had a long-lasting positive response to immunotherapy alone.

Conclusions: Our patients with nonmetastatic recurrent larynx cancer were found to have high CPS scores, which suggests favorable response to immunotherapy. Most patients with recurrent larynx cancer on immunotherapy required a tracheostomy. These patients had poor response on immunotherapy alone, but had prolonged survival with added chemotherapy.