Clinical outcomes and prognostic factors in cisplatin versus cetuximab chemoradiation for locally advanced p16 positive oropharyngeal carcinoma
| Autor: | Aashish D. Bhatt, V.M. Diavolitsis, John C. Grecula, Theodoros N. Teknos, E. Healy, Matthew O. Old, Enver Ozer, Ricardo L. Carrau, Amit Agrawal, R. Rupert, Steve Walston, Nicole Nolan, Dukagjin Blakaj, C. Barney, James W. Rocco, Stephen Y. Kang, Panayiotis Savvides, Pedro Zamora, Jessica Wobb, Anterpreet Neki, D.L. Mitchell |
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| Rok vydání: | 2017 |
| Předmět: |
Oncology
Adult Male Cancer Research medicine.medical_specialty medicine.medical_treatment Cetuximab Antineoplastic Agents Kaplan-Meier Estimate 03 medical and health sciences Young Adult 0302 clinical medicine Internal medicine medicine Humans 030223 otorhinolaryngology Aged Cisplatin Aged 80 and over business.industry Proportional hazards model Genes p16 Head and neck cancer Dose fractionation Cancer Chemoradiotherapy Middle Aged medicine.disease Prognosis Radiation therapy Oropharyngeal Neoplasms Treatment Outcome 030220 oncology & carcinogenesis Female Oral Surgery business medicine.drug |
| Zdroj: | Oral oncology. 79 |
| ISSN: | 1879-0593 |
| Popis: | Randomized trials evaluating cisplatin versus cetuximab chemoradiation (CRT) for p16+ oropharyngeal cancer (OPC) have yet to report preliminary data. Meanwhile, as a preemptive step toward morbidity reduction, the off-trial use of cetuximab in p16+ patients is increasing, even in those who could potentially tolerate cisplatin. The purpose of this study was to compare the efficacy of cisplatin versus cetuximab CRT in the treatment of p16+ OPC and to identify prognostic factors and predictors of tumor response.Cases of p16+ OPC treated with cisplatin or cetuximab CRT at our institution from 2010 to 2014 were identified. Recursive partitioning analysis (RPA) classification was used to determine low-risk (LR-RPA) and intermediate-risk (IR-RPA) groups. Log-rank/Kaplan-Meier and Cox Regression methods were used to compare groups.We identified 205 patients who received cisplatin (n = 137) or cetuximab (n = 68) CRT in the definitive (n = 178) or postoperative (n = 27) setting. Median follow-up was 3 years. Cisplatin improved 3-year locoregional control (LRC) [92.7 vs 65.4%], distant metastasis-free survival (DMFS) [88.3 vs 71.2%], recurrence-free survival (RFS) [86.6 vs 50.6%], and overall survival (OS) [92.6 vs 72.2%] compared to cetuximab [all p .001]. Concurrent cisplatin improved 3-year OS for LR-RPA (97.1 vs 80.3%, p .001) and IR-RPA (97.1 vs 80.3%, p .001) groupings.When treating p16+ OPC with CRT, the threshold for substitution of cisplatin with cetuximab should be maintained appropriately high in order to prolong survival times and optimize locoregional and distant tumor control. When cetuximab is used in cisplatin-ineligible patients, altered fractionation RT should be considered in an effort to improve LRC. |
| Databáze: | OpenAIRE |
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