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Risk for OPSCC death halved among patients with HPV positive tumors

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Patients with HPV-positive oropharyngeal squamous cell carcinoma have twice the overall likelihood of survival than their HPV-negative counterparts, according to data presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium.

In the retrospective study, researchers evaluated 181 patients with stage III to IV oropharyngeal squamous cell carcinoma (OPSCC), 105 of whom were HPV-positive and 76 HPV-negative. All patients experienced cancer progression after completing primary cisplatin-based chemotherapy and radiation therapy, and the progression was local, regional or distant.

The study’s primary endpoint was defined as time from first recurrence to death or last follow-up. The researchers used the Kaplan-Meier method to approximate rates and compared them using log rank. Cox proportional hazards models stratified by treatment approach were utilized to calculate HRs.

According to study findings, between the HPV-positive and HPV-negative patients, the median time to cancer progression was similar (8.2 months for HPV-positive vs. 7.3 months for HPV-negative patients).

Univariate analysis revealed increased mortality risk to be associated with higher tumor stage at diagnosis (T4 vs. T2-T3), fewer on-protocol cycles of cisplatin treatment, and distant vs. local or regional recurrence (for all, HRs >2 and P<.05) Tobacco use increased risk for death after cancer progression by 1% per cigarette pack-year at diagnosis.

Conversely, tumor HPV positivity (HR=0.49; 95% CI, 0.34-0.7) and salvage surgery (HR=0.44; 95% CI, 0.28-0.68) were associated with a significantly decreased risk for death. This correlation became more significant, with risk for death reduced by half, after adjusting for tumor stage, recurrence type and cumulative tobacco use (HR=0.48; 95% CI, 0.31-0.74).

There also was a stronger association between salvage surgery and decreased mortality risk after adjusting for these factors (HR=0.48; 95% CI, 0.27-0.84).

According to study investigator Carole Fakhry, MD, assistant professor at the department of otolaryngology, head and neck surgery at Johns Hopkins Medicine, these findings may be useful in providing optimal and individualized treatment to patients with OPSCC.

“Our findings demonstrate that HPV-positive OPSCC patients have significantly improved survival after progression of disease when compared with HPV-negative patients,” Fakhry said in a press release. “Median survival after disease progression was strikingly longer for HPV-positive than HPV-negative patients. These findings provide us with valuable knowledge to better counsel and treat patients.”

For more information:

• Fakhry C. Abstract #3. Presented at: the Multidisciplinary Head and Neck Cancer Symposium; Feb. 20-22, 2014; Scottsdale, Ariz.

Disclosure: Researchers reported consulting relationships with Bristol-Myers Squibb and GlaxoSmithKline.