PD-L1 testing patterns in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) in the U.S
Oral Oncology, 2025
Background
Pembrolizumab with/without platinum + 5-FU is approved for the first-line (1L) treatment of R/M HNSCC, and its monotherapy use requires PD-L1 Combined Positive Score (CPS) ≥ 1. We aimed to understand PD-L1 testing patterns and associations with patient characteristics and treatment choice in R/M HNSCC.
Methods
Adults with R/M HNSCC initiating 1L systemic therapy were included from a U.S. nationwide database primarily compromised of community practices (07/01/2019-12/31/2023). PD-L1 testing patterns, treatment sequence, and time gaps related to testing and treatment initiation were summarized. Logistic regression was used to test associations between patient characteristics and PD-L1 testing patterns, and between CPS scores and 1L pembrolizumab monotherapy use.
Results
Of 2,207 patients, 32.7 % received PD-L1 testing before 1L therapy initiation, 17.4 % after 1L therapy initiation, and 50.0 % were never tested. Most patients (55.9 %) who tested positive before 1L therapy received pembrolizumab monotherapy while those who tested negative received pembrolizumab + platinum + 5-FU most commonly (31.6 %). Among patients untested before 1L therapy, the most common 1L treatment was pembrolizumab monotherapy (24.3 %). Patients with an ECOG ≥ 2 had higher odds of being tested before 1L therapy (OR: 1.42, p < 0.01). CPS scores were associated with higher odds of receiving 1L pembrolizumab monotherapy (OR: 4.11 and 4.96 for CPS 1-19 and ≥ 20, respectively; both p < 0.0001).
Conclusions
This study revealed low utilization of PD-L1 testing to guide treatment choice and impactful gaps between specimen collection, the receipt of results, and 1L therapy initiation. There is a need to improve clinician awareness of the importance of PD-L1 testing and an opportunity for updated guidelines on testing.
Authors
Hanna GJ, Zheng D, Gao W, Hair GM, Ai L, Song Y, Lerman N, Bidadi B, Zion A, Zou L, Tang Y, Wang L, Merchant S, Black CM