Identifying an oligometastatic phenotype in HPV-associated oropharyngeal squamous cell cancer: Implications for clinical trial design.

Autor: Fleming CW; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States. Electronic address: fleminc@ccf.org., Ward MC; Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States., Woody NM; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States., Joshi NP; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States., Greskovich JF Jr; Department of Radiation Oncology, Cleveland Clinic Florida, Weston, FL, United States., Rybicki L; Department of Quantitative Health Sciences, Cleveland Clinic Learner Research Institute, Cleveland, OH, United States., Xiong D; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States., Contrera K; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States., Chute DJ; Department of Pathology, Cleveland Clinic, Cleveland, OH, United States., Milas ZL; Department of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States., Frenkel CH; Department of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States., Brickman DS; Department of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States., Carrizosa DR; Department of Medical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States., Ku J; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States., Prendes B; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States., Lamarre E; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States., Lorenz RR; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States., Scharpf J; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States., Burkey BB; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States., Schwartzman L; Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States., Geiger JL; Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States., Adelstein DJ; Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States., Koyfman SA; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States.
Jazyk: angličtina
Zdroj: Oral oncology [Oral Oncol] 2021 Jan; Vol. 112, pp. 105046. Date of Electronic Publication: 2020 Oct 28.
DOI: 10.1016/j.oraloncology.2020.105046
Abstrakt: Objectives: Patients with human papillomavirus (HPV) associated squamous cell carcinoma of the oropharynx (SCC-OP) have improved overall survival (OS) after distant metastasis (DM) compared to HPV negative patients. These patients may be appropriate candidates for enrollment on clinical trials evaluating the efficacy of metastasis-directed therapy (MDT). This study seeks to identify prognostic factors associated with OS after DM, which could serve as enrollment criteria for such trials.
Materials and Methods: From an IRB approved multi-institutional database, we retrospectively identified patients with HPV/p16 positive SCC-OP diagnosed between 2001 and 2018. Patterns of distant failure were assessed, including number of lesions at diagnosis and sites of involvement. The primary outcome was OS after DM. Prognostic factors for OS after DM were identified with Cox proportional hazards. Stepwise approach was used for multivariable analysis.
Results: We identified 621 patients with HPV-associated SCC-OP, of whom 82 (13.2%) were diagnosed with DM. Median OS after DM was 14.6 months. On multivariable analysis, smoking history and number of lesions were significantly associated with prolonged OS. Median OS after DM by smoking (never vs ever) was 37.6 vs 11.2 months (p = 0.006), and by lesion number (1 vs 2-4 vs 5 or more) was 41.2 vs 17.2 vs 10.8 months (p = 0.007).
Conclusion: Among patients with newly diagnosed metastatic HPV-associated SCC-OP, lesion number and smoking status were associated with significantly prolonged overall survival. These factors should be incorporated into the design of clinical trials investigating the utility of MDT, with or without systemic therapy, in this population.
(Copyright © 2020 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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