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Deeskalationsstrategien für die Radiochemotherapie HPV-positiver Oropharynxkarzinome: Pro und Kontra

De-escalation concepts for chemoradiotherapy of HPV-positive oropharyngeal carcinomas: pros and cons

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Zusammenfassung

Hintergrund

Die Inzidenz von humanen Papillomaviren (HPV)-assoziierten Oropharynxkarzinome nimmt stetig zu und betrifft im Gegensatz zu den durch Alkohol- und Nikotinkonsum induzierten Kopf-Hals-Tumoren vorwiegend jüngere Patienten. Aufgrund der deutlich besseren Prognose HPV-positiver Oropharynxkarzinome werden aktuell verschiedene Therapie-Deeskalationsstrategien in Studien mit dem Ziel untersucht, therapiebedingte Toxizitäten zu vermindern, ohne die guten Überlebensraten dieser Patienten zu verschlechtern.

Fragestellung

Ist die Therapiedeeskalation beim HPV-induzierten Oropharynxkarzinom in der klinischen Routine sinnvoll?

Material und Methoden

Es erfolgte eine entsprechende Literatursuche, die Ergebnisse relevanter Studien wurden erörtert.

Ergebnisse

Deeskalationsstrategien, bei denen eine Induktionschemotherapie verwendet oder die Radiotherapiedosis verringert wurde, zeigten – verglichen mit historischen Kontrollen – in Phase-II-Studien relativ gute onkologische Ergebnisse bei verminderten Toxizitätsraten für HPV-assoziierte Oropharynxkarzinome. Jedoch ergaben die beiden ersten veröffentlichten Phase-III-Studien, die eine Deeskalation der begleitenden Chemotherapie prüften, eine signifikante Unterlegenheit der experimentellen Arme, ohne die Toxizitätsraten signifikant zu verbessern. Weitere Phase-III-Studien zu anderen Deeskalationsstrategien liegen bisher nicht vor.

Schlussfolgerung

Eine Therapie-Deeskalation sollte lediglich im Rahmen von prospektiven Studien erfolgen und kann zum aktuellen Zeitpunkt nicht für die klinische Routine empfohlen werden.

Abstract

Background

In contrast to alcohol- and nicotine-induced head and neck tumors, human papillomavirus (HPV)-positive oropharyngeal carcinoma rather affects younger patients, and the incidence of this entity is continuously increasing. Due to the significantly better prognosis of HPV-positive oropharyngeal carcinoma, various treatment de-escalation strategies are currently being investigated, with the aim of reducing toxicity without affecting the good survival rates of these patients.

Objective

This study aims to evaluate the evidence for treatment de-escalation in HPV-positive oropharyngeal carcinoma.

Materials and methods

A literature search was performed and relevant studies are critically discussed.

Results

De-escalation strategies for HPV-associated oropharyngeal carcinoma using induction chemotherapy or radiation dose reduction have demonstrated good oncological results in phase II trials, with lower toxicity rates compared to historical controls. However, both of the first published phase III trials investigating de-escalation of concomitant chemotherapy regimens demonstrated inferior outcomes for the deescalated treatment strategies without improvements in treatment-associated toxicities. Additional phase-III trials investigating other de-escalation strategies have not yet been published.

Conclusion

Treatment de-escalation should be performed exclusively in prospective studies and can currently not be recommended in clinical routine.

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Authors and Affiliations

  1. Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Deutschland

    A. Rühle &  N. H. Nicolay

  2. Deutsches Krebsforschungszentrum (dkfz), Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partnerstandort Freiburg, Freiburg, Deutschland

    A. Rühle &  N. H. Nicolay

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  1. A. Rühle
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Correspondence to N. H. Nicolay.

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Interessenkonflikt

A. Rühle und N. H. Nicolay geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rühle, A., Nicolay, N.H. Deeskalationsstrategien für die Radiochemotherapie HPV-positiver Oropharynxkarzinome: Pro und Kontra. HNO 69, 278–284 (2021). https://doi.org/10.1007/s00106-020-00955-5

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  • DOI: https://doi.org/10.1007/s00106-020-00955-5

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