Clinical Benefits of Cetuximab Versus Cisplatin in HPV-Positive Oropharyngeal Cancer
Posted: Monday, December 10, 2018
The NRG Oncology RTOG 1016 trial found that there were no clinical benefits related to treating patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma with cetuximab compared with cisplatin. Based on the results, published in The Lancet, the study authors suggested that radiotherapy plus cisplatin should remain the standard of care for this patient population.
“Although one prior study suggested that cetuximab may provide survival benefits of similar magnitude as cisplatin when combined with radiation but with fewer long-term side effects, these two regimens have not been compared head to head in such a large study before. The result of our study showed that this is not the case,” explained senior study author Quynh-Thu Le, MD, of Stanford University, in an institutional press release. “Unfortunately, this means we are back to square one. We have to figure out a better way to reduce toxicity for these patients.”
Nearly 1,000 patients with HPV-positive oropharyngeal carcinoma were enrolled. Of them, 849 were randomly assigned to receive radiotherapy plus cetuximab (n = 425) or radiotherapy plus cisplatin (n = 424). The radiotherapy regimen remained the same between the two groups.
Of those treated with cetuximab, the 5-year progression free survival was 67.3% versus 74.8% among the cisplatin group (P = .0002). The estimated 5-year overall survival was also better in the cisplatin group (84.6% vs. 77.9%). Locoregional tumor failure was higher among those treated with cetuximab (17.3%) than with cisplatin (9.9%). In addition, there was no difference in the proportions of acute moderate to severe toxicities (P = .16) or late moderate to severe toxicities (P = .19) between the two treatment groups.