2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Oral Oncology 79 (2018) 9–14

C.L. Barney et al.

Fig. 1. Kaplan Meier plots with log-rank p-values of (A) overall survival, (B) recurrence-free survival, (C) locoregional control, and (D) distant metastasis-free survival (DMFS) in patients with p16 positive oropharyngeal carcinoma treated with radiotherapy plus concurrent cisplatin (blue) versus cetuximab (yellow). (For interpretation of the references to colour in this fi gure legend, the reader is referred to the web version of this article.)

comparable (83.0 vs 87.0%) to those from IMCL-9815. Multiple past randomized control trials have also associated AFRT with improved LRC in the treatment of head and neck squamous cell carcinoma [8,11,12] . These trials demonstrate up to 12% improvement in LRC with AFRT, which is not dissimilar to the 20% improvement we reported in our cetuximab cohort. This improvement in LRC should not be overlooked given the results of recently reported studies. For ex- ample, the CONCERT-2 study showed that in non-nasopharynx locally advanced head and neck cancers cisplatin was superior to panitu- mumab (anti-EGFR) when combined with SFRT; however, the HN.6 trial recently reported similar progression-free and overall survival between groups when AFRT was used in only the panitumumab arm, though non-inferiority was not proven [13,14] . These results and our own data suggest that AFRT may play a key role in bridging the gap in LRC between concurrent cisplatin and anti-EFGR agents. Furthermore, improved LRC not only reduces the necessity for morbid salvage treatments, but this study is the fi rst to suggest that it may reduce the rate of distant failure in p16+ OPC, which has been reported pre- viously for other head and neck cancer populations [15 – 17] . In this way, our data serves as a reminder that the outcomes of pending clin- ical trials are inseparable from the interventions that are currently being tested. For example, most current trials comparing the e ffi cacy of concurrent cetuximab to that of cisplatin in this population require AFRT. However, when patients are treated o ff trial, oncologists are often hesitant to give AFRT due to perceived increased rates of high- grade oral mucositis and dermatitis when concurrent cetuximab is

Table 2 Univariate analysis of prognostic factors for clinical outcomes (all patients).

Variable

Clinical outcome

LRC

DMFS

RFS

OS

p-value

.05 .06

.04 .02

ECOG PS (1 vs. 0)

.49 .96

.18 .39

Smoking (packyrs. >10 vs. ≤ 10)

N-Stage ICON-S (N2-3 vs. N0-N1)

.04 .49

.02 .14 .02 .09

.05 .24

.01 .09 .01 .34

AJCC 7th Ed. (N2b-N3 vs. N0-N2a)

.007

.004

T-Stage (T3-4 vs. T1-T2)

Age( ≥ 60 vs. <60)

.13

.05

< .001 < .001 < .001 < . 001

Cetuximab

Standard Fractionation

.67

.12

.28

.30

the increased frequency of advanced nodal disease (76.5 vs 55%) and SFRT (67 vs 2%) in our population. The results of our cetuximab sub- group analysis support this hypothesis. In our cetuximab cohort, ad- vanced nodal stage was the only factor prognostic for decreased OS, RFS, and DMFS, while AFRT was shown to improve LRC compared to SFRT. Furthermore, our rates of LRC with the use of AFRT were Abbreviations : LRC= locoregional control; DMFS = distant metastasis-free survival; RFS = recurrence-free survival; OS = overall survival; ECOG PS =Eastern Cooperative Oncology Group performance status; AJCC =America Joint Committee on Cancer; ICON- S = International Collaboration on Oropharyngeal cancer Network for Staging.

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