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Reduced-Intensity Chemoradiotherapy for HPV-Associated Oropharyngeal Cancer

By: Cordi Craig
Posted: Monday, November 4, 2019

De-intensified chemoradiotherapy may improve clinical outcomes among patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma, according to a report published in the Journal of Clinical Oncology. Bhishamjit S. Chera, MD, of the University of North Carolina, Chapel Hill, and colleagues concluded that neither routine surgery nor neoadjuvant chemotherapy is necessary for favorable results with this treatment approach.

The phase II trial included 114 patients with HPV-associated oropharyngeal squamous cell carcinoma. Overall, 80% of the patient population had 10 or fewer tobacco pack-years. Treatment was limited to 60-Gy intensity-modulated radiotherapy with concurrent low-dose cisplatin.

After a median follow-up of 31.8 months, the post-treatment CT complete response rate was 93% at the primary site and 80% in the neck. Of the 11 patients who underwent neck dissection, all remained alive without evidence of disease at the time of analysis; however, 4 patients had pathologic residual disease. The rates of 2-year distant metastasis–free survival, progression-free survival, and overall survival were 91%, 86%, and 95%, respectively. The 2-year locoregional control rate was 95%. 

The most common acute adverse events of grade 3 or higher were mucositis (33%), decreased appetite (25%), dysphagia (21%), and pain (12%). Patient-reported adverse events that were severe and very severe included xerostomia (60%), decreased appetite (59%), dysphagia (50%), and pain (45%). About one-third of patients required a feeding tube for a median of 10.5 weeks, and one patient died of neutropenic sepsis. There were no grade 3 or higher clinician-reported late adverse events.

“Additional efforts are warranted to evaluate novel biomarkers to better optimize the selection of patients for de-intensification,” the authors concluded.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

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