Standard of care vs reduced-dose chemoradiation after induction chemotherapy in HPV+ oropharyngeal carcinoma patients: The Quarterback trial
| Autor: | Nadia Camille, Peter M. Som, Elizabeth Roy, Marcelo Bonomi, David Y. Zhang, Isaiah Selkridge, Fei Ye, Rachel Jia, Vishal Gupta, M. Hwang, Marshall R. Posner, J.T. Surgeon, Richard L. Bakst, Eric M. Genden, Hope Rainey, Brett A. Miles, Krzysztof Misiukiewicz, Erin Moshier |
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| Rok vydání: | 2019 |
| Předmět: |
Oncology
Adult Male Cancer Research medicine.medical_specialty 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Median follow-up Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans 030223 otorhinolaryngology Aged Human papillomavirus 16 business.industry Squamous Cell Carcinoma of Head and Neck Patient Selection Papillomavirus Infections Induction chemotherapy Dose-Response Relationship Radiation Radiotherapy Dosage Standard of Care Chemoradiotherapy Induction Chemotherapy Middle Aged Acute toxicity Carboplatin Progression-Free Survival Clinical trial Oropharyngeal Neoplasms Docetaxel chemistry Fluorouracil 030220 oncology & carcinogenesis Quality of Life Female Oral Surgery business medicine.drug |
| Zdroj: | Oral oncology. 95 |
| ISSN: | 1879-0593 |
| Popis: | Background Human Papillomavirus oropharyngeal carcinoma (HPVOPC) has better progression free (PFS) and overall survival (OS) than non-HPVOPC. Standard-dose chemoradiotherapy (sdCRT) results in significant acute toxicity and late morbidity. We hypothesized that after induction chemotherapy (IC), reduced dose chemoradiation (rdCRT) would result in equivalent PFS and OS compared to sdCRT plus IC in HPVOPC and would reduce toxicity. Methods Patients with p16+, previously untreated, locally advanced HPVOPC and ≤20 pack years smoking history received 3 cycles of IC with docetaxel, cisplatin and fluorouracil (TPF). Clinical responders who were HPV positive by type-specific PCR were randomized 1:2 to sdCRT (7000 cGy) or rdCRT (5600 cGy) with weekly carboplatin. The endpoints of the study were 3 year PFS and OS. Results 23 patients were enrolled, 22 were evaluable for TPF toxicity and 20 were randomized, 8 to sdCRT and 12 to rdCRT. Sixteen (80%) were HPV 16+ and 4 (20%) were other high risk (HR) variants. Fourteen (70%) had high risk features: T4, N2c, or N3. Median follow up was 56 months (range 42–70). Three-year PFS/OS for sdCRT and rdCRT are 87.5% vs 83.3% (log-rank test p = 0.85), respectively. All 3 failures are locoregional within 4 months of completion of CRT; 2 were in HR variants (50%). Conclusions rdCRT after IC resulted in similar PFS/OS compared sdCRT. These data support Phase 3 clinical trials of radiation dose reduction after IC as a treatment strategy in HPVOPC. Molecular HPV with variant testing and smoking history are necessary for de-escalation trials. |
| Databáze: | OpenAIRE |
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