Phase 2 trial of neoadjuvant chemotherapy and transoral endoscopic surgery with risk‐adapted adjuvant therapy for squamous cell carcinoma of the head and neck

Abstract

The study met both its primary efficacy endpoint and the secondary feasibility endpoint. Neoadjuvant, systemic therapy and surgical resection followed by risk-adapted adjuvant therapy resulted in high response rates and excellent long-term outcomes and should be further studied. Cancer 2018;124:2986-92. © 2018 American Cancer Society.

Novel Strategies to Effectively De-escalate Curative-Intent Therapy for Patients With HPV-Associated Oropharyngeal Cancer: Current and Future Directions

“…The use of neoadjuvant therapy before TOS has also been a topic of increasing interest. [49][50][51] The NECTORS study, using neoadjuvant cisplatin and docetaxel before TOS in patients with HPV-OPC, found high pathologic CR rates (72% and 57% at the primary and nodal disease sites, respectively) and 3-year disease-specific survival of 94%. 51,52 OPTIMAII is a phase II trial (NCT03107182) incorporating induction chemoimmunotherapy (carboplatin, nab-paclitaxel, and nivolumab) followed by risk-and responseadapted locoregional treatment (TOS, RT, or CRT).…”

Treatment outcomes of neoadjuvant chemotherapy and transoral robotic surgery in locoregionally advanced laryngopharyngeal carcinoma

“…Despite all of these available treatment types, the disease ultimately recurs in 40% of patients with HNSCC, and radiotherapy cannot be used a second time to treat recurrent disease. Thus, if radiotherapy can be avoided during the initial treatment of patients with HNSCC, the morbidity associated with radiotherapy could potentially be significantly reduced, and it could be saved for use in recurrent disease or a second primary cancer that occurs later 4,5 …”

“…Although the same indications for adjuvant treatment are still being used in patients with HPV-related OPC, the long-term side effects of radiotherapy could be more problematic in patients with HPV-related OPC, as life expectancy of patients with HPV-related OPC is relatively longer than that of patients with traditional HNSCC. 4,5 We have developed a new treatment protocol using neoadjuvant chemotherapy and transoral robotic surgery (TORS) for patients with locoregionally advanced (T3-4 or N2-3) HNSCC and have reported initial treatment results. 8,9 In selected cases of advanced HNSCC, patients did not need to receive adjuvant therapy (radiotherapy or concurrent chemoradiotherapy) after neoadjuvant chemotherapy and TORS, since there was no residual disease or minimal disease without adverse pathologic features on pathologic examination of surgical specimens.…”

“…Thus, adjuvant radiotherapy was omitted [Color figure can be viewed at wileyonlinelibrary.com] patients with HNSCC, the morbidity associated with radiotherapy could potentially be significantly reduced, and it could be saved for use in recurrent disease or a second primary cancer that occurs later. 4,5 There have been significant changes in the epidemiology of HNSCC in recent years: The incidence of HNSCC related to smoking and alcohol consumption has decreased, while the incidence of oropharyngeal cancer (OPC) related to human papilloma virus (HPV) has increased rapidly. 6 HPV-related OPC is known to be prevalent in relatively young men and to be highly responsive to treatment.…”

Surgery alone for transorally resected human papillomavirus–driven head and neck cancer—can we de‐intensify adjuvant therapy to 0 Gy and 0 mg/m2?

“…Several studies have de‐escalated radiation therapy after successful induction, 9‐11 but there has been little prospective study after surgery. The Lineberger Comprehensive Cancer Center 1125 study administered induction carboplatin, paclitaxel, and lapatinib, which were followed by transoral surgery and then risk‐adapted adjuvant therapy, to 40 patients eligible for transoral surgery, regardless of site or HPV status 12,13 . All patients were projected to require adjuvant therapy on initiation on the basis of clinical staging, and 77% were able to avoid it with no recurrences.…”