Improved outcomes in HPV+ versus HPV- locally advanced head and neck squamous cell carcinoma (LAH&NSCC) when treated with cetuximab and concurrent radiation.
2010; Lippincott Williams & Wilkins; Volume: 28; Issue: 15_suppl Linguagem: Inglês
10.1200/jco.2010.28.15_suppl.e16023
ISSN1527-7755
AutoresM. Howard, Rebecca Slack, D. P. Hartmann, W Harter, Kenneth Newkirk, Benny Davidson, Frank E. Berkowitz, Kathryn J. Steadman, D. Lockard, John F. Deeken,
Tópico(s)Cancer Diagnosis and Treatment
Resumoe16023 Background: Patients with LAH&NSCC caused by the human papillomavirus (HPV) have higher survival rates when treated with induction chemotherapy or concurrent cisplatin chemoradiotherapy. No previous report has shown whether these findings apply to patients treated with concurrent cetuximab (C) and radiation (XRT). Past research has found no difference in epidermal growth factor receptor (EGFR) expression in HPV+ tumors, but none have investigated differences in EGFR pathway activation by HPV status. Methods: Tumors from sequential patients treated with C and XRT were analyzed for HPV status using PCR for the E6/E7 gene sequence unique to HPV 16 or 18. Differences in overall survival (OS) and progression-free survival (PFS) were assessed by HPV status, stage, tumor (T) and nodal (N) status, primary site, and duration of XRT using the log rank test. Expression of pEGFR, pAkt, pPI3K, and pERK were measured and correlated with HPV status. Results: Between 1/07 and 11/09, 20 patients were treated with C + IMRT XRT. Primary sites included oral cavity (1), oropharynx (12), hypopharynx (1), larynx (5), and unknown (1). Six patients had stage III disease and 14 had IVa disease. Median age was 63 yrs (range 31 – 78). Median duration of XRT was 59 days (49-73). Median cycles of C was 7 (range 4 – 8). Six patients were HPV+, all were HPV16, all had oropharynx primaries, with a median age of 64 yrs. After a 19.0 mos. median follow up, 4 patients have died and 12 patients had disease progression. No correlation was found between OS or PFS and stage, T or N status, primary site, or XRT duration. For OS, 1-year and 2-year rates were 100% vs. 81% and 100% vs. 71% for HPV+ vs. HPV- tumors, respectively (p=0.11). For PFS, 1-year and 2-year rates were 100% vs. 31% and 60% vs. 31% (p=0.07). Differences in EGFR pathway activation and updated outcomes will be presented. Conclusions: Trends in improved OS and PFS by HPV status were seen in this small patient population treated with C. These findings are consistent with previous reports that HPV+ disease has a better prognosis no matter the treatment modality. Optimizing and personalizing therapy by HPV status remains the pivotal clinical research question in LAH&NSCC. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Bristol-Myers Squibb
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