Adjuvant chemoradiation therapy with high-dose versus weekly cisplatin for resected, locally-advanced HPV/p16-positive and negative head and neck squamous cell carcinoma

Data indicate a better prognosis for human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC). HPV and p16 detection are established markers for HPV-related HNSCC. Both are accepted as survival-independent predictors. Previous studies investigating the survival in HNSCC patients depending on HPV(+/-) and p16(+/-) status consistently found discordant results with p16(-)/HPV(+) and p16(+)/HPV(-). However, no meta-analysis regarding the survival according to combined HPV/p16 status has been performed yet. The objective of this study was to discriminate the impact of combined HPV(+/-) and p16(+/-) status on survival. Data sources were identification and review of publications assessing survival of the distinct subgroups with both p16 and HPV investigated in HNSCC until February, 2015. A meta-analysis was performed to classify survival and clinical outcomes. 18 out of 397 articles (4424 patients) were eligible for the meta-analysis. The percent proportion of the subgroups was 25 % for HPV(+)/p16(+), 61.2 % for HPV(-)/p16(-), 7.1 % for HPV(-)/p16(+) and 6.8 % for HPV(+)/P16(-). The meta-analysis showed a significantly improved 5-year overall survival (OS), 5-year disease-free survival and their corresponding hazard ratio for HPV(+)/p16(+) HNSCC in comparison to HPV(-)/p16(-), HPV(+)/p16(-) and HPV(-)/p16(+). The 5-year OS of the HPV(-)/p16(+) subgroup was intermediate while HPV(+)/p16(-) and HPV(-)/p16(-) HNSCC had the shortest survival. With current therapeutic strategies, survival of patients with HNSCC is better if associated with HPV(+)/p16(+) or HPV(-)/p16(+). Clinical trials are needed to confirm the distinct survival pattern and to investigate possible differences in survival for HPV(+)/p16(-) and HPV(-)/p16(+) HNSCC. To further differentiate p16(+) HNSCC, HPV testing may be advisable.

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“…indicated that HPV-related HNSCC have a distinct biology [52], and are more responsive to treatment by radio-and chemotherapy [16,17,19].…”

Section: Discussionmentioning

confidence: 99%

“…Evidence-based clinical guidelines recommend HPV testing in HNSCC, especially for those arising in the oropharynx. HPV status may provide prognostic information and in future, it may also guide specific treatment decisions [17,19]. However, a standardized procedure for HPV testing remains to be established [6,9,38].…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of survival in patients with HNSCC discriminates risk depending on combined HPV and p16 status

Coordes

Lenz

Qian

et al. 2015

Eur Arch Otorhinolaryngol

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“…44,53,[61][62][63][64] For example, a study of 220 patients with p16-positive oropharyngeal cancer who received surgical resection with or without adjuvant treatment showed that the presence of ≥5 metastatic nodes is associated with disease recurrence and survival, but extracapsular spread was not significantly associated with outcomes in this sample. 63 Recent studies of patients with p16-positive oropharyngeal cancer treated with surgery show that soft tissue metastasis may be associated with poor survival outcomes, especially in patients with T3-T4 disease.…”

Section: Hpv and Treatment Of Oropharyngeal Cancermentioning

confidence: 94%

NCCN Guidelines Insights: Head and Neck Cancers, Version 2.2017

Adelstein¹,

Gillison²,

Pfister³

et al. 2017

J Natl Compr Canc Netw

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280

241

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The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers provide treatment recommendations for cancers of the lip, oral cavity, pharynx, larynx, ethmoid and maxillary sinuses, and salivary glands. Recommendations are also provided for occult primary of the head and neck (H&N), and separate algorithms have been developed by the panel for very advanced H&N cancers. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding the increase in human papillomavirus-associated oropharyngeal cancer and the availability of immunotherapy agents for treatment of patients with recurrent or metastatic H&N cancer.

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“…In a retrospective review by Geiger et al on 104 patients with Stage III /IV HNSCC who had surgery followed by adjuvant chemoradiation therapy determining whether weekly cisplatin could be a safe and effective alternative as compared to standard 3-weekly chemotherapy. The authors concluded that there was no significant survival difference with high-dose or weekly cisplatin and weekly cisplatin in the adjuvant setting may be a better treatment for patients with HPV-positive oropharynx cancer to preserve survival and minimize toxicity (Geiger et al, 2014). In a report of 50 patients which included majority of patients with advanced laryngeal cancer, compared administration of bolus cisplatin at 100 mg/m 2 every 3 weeks in younger patients with more favourable performance status (PS) to a schedule of weekly cisplatin at 40 mg/m 2 given to older patients with less favourable PS, combined with conventionally fractionated RT to 70…”

Section: Overall Survival and Response Ratesmentioning

confidence: 99%

Three Weekly Versus Weekly Cisplatin as Radiosensitizer in Head and Neck Cancer: a Decision Dilemma

Negi¹,

Kingsley²,

Srivastava³

et al. 2016

Asian Pacific Journal of Cancer Prevention

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Cisplatin-based concurrent chemoradiation plays an undisputed key role as definitive treatment in unresectable patients with locally advanced squamous cell carcinoma head and neck or as an organ preservation strategy. Treatment with 100 mg/m2 3-weekly cisplatin is considered the standard of care but is often associated with several adverse events. The optimum drug schedule of administration remains to be defined and presently, there is insufficient data limiting conclusions about the relative tolerability of one regimen over the other. This review addresses regarding the optimal dose schedule of cisplatin focusing mainly on three-weekly and weekly dose of cisplatin based concurrent chemoradiotherapy in locally advanced head and neck cancer with an emphasis on mucositis, dermatitis, systemic toxicity, compliance, and treatment interruptions. To derive a definitive conclusion, large prospective randomized trials are needed directly comparing standard 3-weekly cisplatin (100 mg/m 2 ) with weekly schedule (30 -40 mg/m 2 ) of concurrent cisplatin based chemoradiotherapy in locally advanced squamous cell carcinoma head and neck.

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Adjuvant chemoradiation therapy with high-dose versus weekly cisplatin for resected, locally-advanced HPV/p16-positive and negative head and neck squamous cell carcinoma

Cited by 56 publications

References 26 publications

Meta-analysis of survival in patients with HNSCC discriminates risk depending on combined HPV and p16 status

Meta-analysis of survival in patients with HNSCC discriminates risk depending on combined HPV and p16 status

NCCN Guidelines Insights: Head and Neck Cancers, Version 2.2017

Three Weekly Versus Weekly Cisplatin as Radiosensitizer in Head and Neck Cancer: a Decision Dilemma

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