Adjuvant chemotherapy ‘may be unnecessary’ for HPV-related OPSCC patients
medwireNews: US researchers question the addition of chemotherapy to the adjuvant treatment regimen in surgically managed patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (OPSCC).
Among 178 patients with HPV-related OPSCC, as indicated by positivity for p16, the 5-year disease-free survival (DFS) rate was 79% for the 90 patients who received adjuvant chemoradiotherapy and also for the 88 given adjuvant radiotherapy. The corresponding 5-year overall survival rates were 82% and 84%.
After weighting patients by the inverse probability of receiving adjuvant chemotherapy and adjusting for factors such as age and smoking, the researchers found that receipt of adjuvant chemotherapy was not associated with improved DFS (adjusted hazard ratio [HR]=0.91), but was linked to a “statistically insignificant but clinically meaningful” increased risk of death from any cause (adjusted HR=1.46).
Thus, addition of adjuvant chemotherapy “may be unnecessary” in this patient population, say Jay Piccirillo, from the Washington University School of Medicine in St Louis, Missouri, USA, and colleagues in JAMA Otolaryngology–Head & Neck Surgery.
They add that given the “markedly improved prognosis” of HPV-positive compared with HPV-negative OPSCC, “treatment de-escalation for p16-positive OPSCC is now being considered with the goal of decreasing treatment-associated morbidity without compromising tumor control.”
In the absence of randomized trials, the study authors believe that their findings “provide evidence that surgically managed, p16-positive OPSCC may be adequately treated with adjuvant radiotherapy alone.”
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