HPV+ oropharynx cancer: aggressive ART de-escalation shows benefit

  • Ma DJ & al.
  • J Clin Oncol
  • 4 Jun 2019

  • curated by Brian Richardson, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Dose de-escalation of adjuvant radiotherapy (ART) from 60-66 Gy to 30-36 Gy is associated with similar locoregional control rates as historically reported for patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC).

Why this matters

  • Aggressive ART de-escalation is a strategy for reducing toxicity while maintaining cure rates.

Key results

  • The 2-year locoregional control (LRC) rate was 96.2%.
  • 2-year distant metastasis-free survival was 94.9%, 2-year PFS was 91.1%, and 2-year OS was 98.7%.
  • Rates of grade 3+ toxicity were 2.5% at pre-RT, 0.0% at 1 year, and 0.0% at 2 years.
  • At 1-year posttreatment, QoL improved compared with pre-RT (FACT-HN, EORTC-QLQ HN35, and EQ-5D-3L; P<.001 for all>
  • At 1-year posttreatment, swallowing function improved compared with pre-RT (pharyngeal total modified barium swallow impairment profile and diet normalcy, as measured by the Functional Oral Intake Scale; P=.01 for both).

Study design

  • Phase 2 trial of 80 patients with HPV-associated OPSCC and negative margins.
  • Intermediate-risk patients received 1.5-Gy fractions twice daily over the course of 2 weeks+15 mg/m2 docetaxel once weekly; patients with extranodal extension also received a simultaneous integrated boost to 36 Gy in 1.8-Gy fractions twice daily.
  • Funding: NIH; Braillier Family Research Fund; Matteson Research Fund.

Limitations

  • Singe-group trial.
  • Small patient sample size.