The De-ESCALaTE HPV trial has reported complete two-year survival rates with cisplatin vs cetuximab in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC).
The trial has already published data showing the dominance of cisplatin over cetuximab for tumour control in patients with HPV-positive OPSCC. This new paper presents an analysis of health-related quality of life (HRQoL), resource use, and healthcare costs, as well as complete 2-year survival and recurrence.
In the study, 334 patients were randomised to cisplatin (n=166) or cetuximab (n=168).
At two years, overall survival rates favoured cisplatin over cetuximab (97.5% vs 90.0%; HR 3.268; 95% CI 1.451-7.359]; P=0.0251). Recurrence rates similarly were lower with cisplatin (6.4% vs 16.0%; HR 2.67; 95% CI 1.38-5.15; P=0.0024).
There were no significant differences in EQ-5D-5L utility scores between the groups. Two years post treatment, the mean difference was 0.107 QALYs in favour of cisplatin (95% CI 0.186-0.029; P=0.007). The authors say this was driven by the mortality difference.
Healthcare costs were similar across all categories except the procurement cost and delivery of the systemic agent, with cetuximab being significantly more expensive than cisplatin (£7779; P<0.001). Consequently, the average cost of two years of treatment was £13,517 per patient for cisplatin and £21,064 for cetuximab (mean difference £7547; 95% CI £6512-£8582).
Reporting the findings in the European Journal of Cancer, the authors conclude that, given the high QALYs and lower cost, cisplatin should remain the standard of care for nonsurgical treatment of HPV-positive OPSCC.
