Turn on cookies to sign in
Signing in saves your progress to your Curie account. We can only do that with cookies on — turn them on to continue.
A new combo therapy for head and neck cancer shows promise — with a catch. The phase 1b/2 RADIAN trial found that adding niraparib and dostarlimab to chemoradiotherapy (CRT) hit its 1-year survival target in cisplatin-fit patients with locally advanced HNSCC. But significant toxicity led to frequent dose reductions and treatment discontinuations, raising questions about tolerability.
A new combination therapy for locally advanced head and neck squamous cell carcinoma (HNSCC) is showing early promise — but comes with a significant toxicity burden. The phase 1b/2 RADIAN trial tested adding niraparib (a PARP inhibitor) and dostarlimab (a PD-1 inhibitor) to definitive chemoradiotherapy (CRT) in 34 patients split into two groups: those fit for cisplatin (Cohort A) and those who weren't (Cohort B).
Cohort A hit its efficacy target with an impressive 1-year progression-free survival (PFS) rate of 88.2%, well above the historical benchmark of 65%. Cohort B, however, fell short at 60.6% vs. a 55% historical control. The overall response rate 12 weeks post-radiotherapy was 88.2% in both groups — a bright spot in the data.
The downside? Toxicity was substantial across the board, with high rates of dose reductions, interruptions, and permanent discontinuations — especially in Cohort B, where 59% of patients stopped treatment early. Five deaths occurred in Cohort B (3 treatment-related), and only 8% completed maintenance therapy.
Key Takeaways:
Why it matters: HNSCC is a tough cancer to treat, and new combination strategies are urgently needed. While this trial signals that niraparib + dostarlimab could enhance CRT outcomes in the right patients, the toxicity profile — particularly in older, frailer patients — will need to be addressed before this approach can move forward confidently.
