This article is more than 5 years old. Information may no longer be current.
HPV status predicted OS after progression in oropharyngeal cancer
Click Here to Manage Email Alerts
Patients with progressive oropharyngeal squamous cell carcinoma who had p16-positive tumors experienced longer OS than those who had p16-negative tumors, according to results of a retrospective analysis.
Carole Fakhry, MD, assistant professor of otolaryngology — head and neck surgery at The Johns Hopkins Medical Institutions, and colleagues evaluated data from 181 patients with stage III to IV oropharyngeal cancer enrolled on the RTOG 0129 or RTOG 0522 trials.
Carole Fakhry
All patients had experienced local, regional and/or distant progression after platinum-based chemoradiotherapy. The median age of patients was 56 years, and 87.8% were male. Researchers reported a median 23.8 pack-year history of cigarette smoking in the cohort (interquartile range, 4.5-45).
Fifty-eight percent of patients (n=105) had p16–positive tumors and 42% (n=76) had p16–negative tumors. Patients with p16-positive tumors were younger (P=.01), more likely to be non-Hispanic white (P=.002), reported less cumulative cigarette exposure (P˂.001) and presented with smaller tumors at enrollment (P=.02).
Researchers reported comparable median time to progression (8.2 months for p16-positive vs. 7.3 months for p16-negative; P=.67) and rate of distant metastases development (45.7% for p16-positive vs. 43.4% for p16-negative; P=.76) between cohorts.
Median follow-up after disease progression was 4 years.
Researchers reported a higher rate of 2-year OS (54.6% vs. 27.6%) and significantly longer median OS (2.6 years vs. 0.8 years; P<.001) among patients with p16-positive tumors.
Results demonstrated a reduced risk for death after progression among patients with p16–positive disease (HR=0.48; 95% CI, 0.31-0.74), as well as among all patients who underwent salvage surgery (HR=0.48; 95% CI, 0.27-0.84).
An analysis adjusted for tumor stage and cigarette smoking history at enrollment indicated distant progression increased the risk for death compared with locoregional progression (HR=1.99; 95% CI, 1.28-3.09).
“Our data highlight previously unappreciated prognostic differences after disease progression between HPV–positive and HPV–negative oropharynx cancer and underscore the need to identify biomarkers for risk of progression,” Fakhry and colleagues concluded.
Disclosure: One researcher reports consultant/advisory roles with, as well as honoraria or other remuneration from, Bristol-Myers Squibb, GlaxoSmithKline and Merck Serono.
Perspective
Back to Top
Neal E. Ready, MD, PhD
Oropharyngeal squamous cell carcinoma (OPC) is often caused by the same strains of HPV that cause cervical cancer. In RTOG 0129, more than 60% of OPC was caused by HPV, and the proportion of OPC that is caused by HPV has been increasing. OPC treated for cure with chemoradiotherapy on RTOG 0129 had markedly improved outcomes for HPV-positive vs. -negative cancer, with 3-year OS rates of 82% in the HPV-positive cohort vs. 57% in the HPV-negative cohort. Ongoing clinical trials are studying whether lower-dose radiation, or cetuximab vs. cisplatin combined with radiotherapy, are optimal in HPV-related OPC.This report by Fakhry et al extends our knowledge for the differential outcomes for HPV-positive vs. -negative recurrent OPC. The newly reported data shows that patterns of locoregional and distant failure are similar for HPV-positive and -negative OPC. The data also showed that, after progression, survival was improved for HPV-positive vs. HPV-negative OPC. Two-year OS was 54.6% in the HPV-positive cohort vs. 27.6% in the HPV-negative cohort (P<.001).
As the authors suggest, it now makes sense to use HPV status as a stratification factor in clinical trials for recurrent and metastatic OPC. It will be important to prospectively study differential benefit for cytotoxic, molecular and immunologic therapy for HPV-negative and -positive OPC. The analysis reported in this manuscript is a significant contribution to the effort to better understand how to evaluate and treat HPV-related OPC, an important and growing subset of head and neck cancers.
Click Here to Manage Email Alerts