Attempt at Outpatient Chemotherapy with Nivolumab for Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma Utilizing the Services of a Part-time Surgeon

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  • Mizokami Daisuke
    Nishi Saitama Chuo National Hospital, Department of Otolaryngology-Head & Neck Surgery
  • Kogashiwa Yasunao
    Kamifukuoka Sogo Hospital, Department of Otolaryngology-Head & Neck Surgery
  • Kamide Daisuke
    Self Defense Forces Central Hospital, Department of Otolaryngology
  • Maeda Mayuka
    Self Defense Forces Central Hospital, Department of Otolaryngology
  • Nakamori Yurina
    Self Defense Forces Central Hospital, Department of Otolaryngology
  • Shiotani Akihiro
    National Defense Medical College, Department of Otolaryngology-Head & Neck Surgery

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  • 非常勤医師との分業制による再発転移頭頸部癌患者に対するニボルマブ外来化学療法の試み
  • ヒジョウキン イシ ト ノ ブンギョウセイ ニ ヨル サイハツ テンイ トウケイブガン カンジャ ニ タイスル ニボルマブ ガイライ カガク リョウホウ ノ ココロミ

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Abstract

<p>　Head and neck surgeons face many problems in their working conditions, including lengthy surgeries, overtime meetings, and increasing numbers of patients due to aging of the population. In recent years, with the advent of molecular-targeted drugs and immune checkpoint inhibitors, the treatment options for recurrent, metastatic head and neck squamous cell carcinoma (RMHNSCC) have expanded, while the working hours of surgeons are approaching the limit for the conventional single doctor system in Japan. Therefore, we have begun to manage cases of RMHNSCC by switching the doctors in charge, including to part-time doctors. Full-time physicians are responsible for inpatients initiated on chemotherapy and serious adverse events, while part-time physicians administer the anticancer drugs in the outpatient chemotherapy room, assess the treatment efficacy, and assess adverse events. The ER doctor on duty responds to sudden changes at night or on holidays. Treatment policies, such as switching of anti-cancer drugs, regular follow-up schedule for recurrence, and evaluation of adverse events are standardized as much as possible, based on evidence. Doctors share information about the medical care of individual patients via a chat application on their phones. Thirty-two patients with RMHNSCC were enrolled in our present study. The median overall survival was 5.9 months, the average survival was 7.8 months, and the 1-year overall survival rate was 19.1%. There were 3 long-term survivors (2 years or longer). Grade 3 or higher irAEs occurred in 15.6% of the patients. There were no deaths due to irAEs. Although not strictly comparable because of the different patient backgrounds, the overall survival and incidence of irAE in our patients treated with nivolumab appeared to be acceptable and consistent with those reported from previous clinical trials. Our strategy has the potential to revitalize retired surgeons and improve the working conditions of head and neck surgeons in Japan.</p>

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