Top Takeaways from ASCO: HPV-associated head and neck cancer
A lower-dose radiation-cisplatin regimen warrants further research.
CHICAGO — De-intensified chemoradiation was efficacious in patients with low-risk, HPV-associated oropharyngeal squamous cell carcinoma, according to findings presented at the ASCO 2015 Annual Meeting. Barbara Ann Burtness, MD, professor of medicine (medical oncology), clinical research program leader, Head and Neck Cancers Program, and co-director, Developmental Therapeutics Research Program, Yale University, discussed the results with Healio.com.
De-intensified chemoradiation in oropharyngeal squamous cell carcinoma
The results of treatment with 60 Gray intensity-modulated radiation and concurrent, weekly doses of 30 mg/m2 cisplatin may result in very high cancer control, according to findings from Bhishamjit S. Chera, MD, assistant professor of radiation oncology, clinical division, at the University of North Carolina Chapel Hill, and colleagues.
“We’ve been aware for a few years now that, among patients with oropharynx cancer, some who have a virally-associated cancer that arises because of HPV infection, are much more treatment-responsive than others who don’t have that viral association,” said Burtness, HemOnc Today section editor of head and neck cancer and editorial board member. “The question has arisen whether the treatment paradigms that we’ve been using, which were developed in people with HPV-negative cancer, actually represent over-treatment for some patients with HPV-positive cancer.”
Barbara Ann Burtness
In the study conducted by Cherah and colleagues, participants had locally advanced, HPV-associated head and neck cancer.
“Dr. Cherah and his colleagues treated a population who they felt were at lower risk for recurrence – or more likely to do well,” Burtness told Healio.com. Participants had a smoking history of 10-pack years or less and did not have T4 cancers or N2C or N3 neck disease. Treatment involved 60 Gray of radiation in place of standard therapy with 70 Gray of radiation, according to Burtness, and cisplatin at a lower dose of 30 milligrams per meter squared weekly rather than 100 milligrams per meter squared every 3 weeks.
The primary endpoint was pathologic complete response rate, based on biopsy of the primary site and dissection of pretreatment-positive lymph node regions, regardless of radiographic response. Secondary endpoints included physician-reported toxicity, patient-reported symptoms, quality of life and penetration aspiration scale scores for modified barium swallow studies. Cherah and colleagues followed 43 patients for a median of 15 months.
All patients were alive at the time of the study’s completion, with no evidence of disease, according to the researchers. The pathologic complete response rate was 86% (37 out of 43 patients), with a median time to biopsy/neck dissection of 9 weeks. The six cases that did not achieve the pathologic CRR were limited to microscopic foci of residual cancer, with one case at the primary site and five nodal cases, according to the study results.
Physician-reported, acute grade 3/4 toxicities and patient-reported severe or very severe symptoms included mucositis (34%/45%), pain (5%/48%), nausea (18%/52%), vomiting (5%/34%), dysphagia (39%/55%) and xerostomia (2%/75%). According to the abstract presented at the meeting, Grade 3/4 hematological toxicities were 11%. Mean pre- and post-chemoradiation quality-of-life scores were: global 80/69 (lower worse, P < 0.01), pain 15/20 (higher worse, P = NS), swallowing 11/18 (P = 0.04), dry mouth 16/64 (P < 0.001) and sticky saliva 6/49 (P < 0.001). The P value for coughing was not significant.
“The results were quite striking,” Burtness told Healio.com. “The pathologic complete response rate at the primary site was 98%. In the nodes, it was 86%.”
In addition, at the 20-month follow-up point, 44 of 45 patients were alive and free of disease; one patient died of a stroke, according to Burtness.
“I don’t think this is enough to say that we’re going to start treating all of our HPV-positive patients with 60 gray [chemoradiation] and weekly cisplatin, but it’s certainly very encouraging that this is a regimen that could be tested in future trials,” she said. – by Julia Ernst, MS
Chera BS, et al. Abstract 6004. Presented at: ASCO Annual Meeting; May 29-June 2, 2015; Chicago.
Disclosure: Burtness reports no relevant financial disclosures.