Skip to main content
SpringerLink
Log in

Should We De-escalate Treatment for HPV Positive Oropharyngeal Head and Neck Cancer?

  • Chapter
  • First Online:
Critical Issues in Head and Neck Oncology

  • 430 Accesses

Abstract

Due to the rising incidence and relative sensitivity of HPV positive head and neck tumours, a number of groups worldwide have begun clinical trials investigating whether therapy should be de-escalated in these patients. Approaches for reducing treatment intensity include reducing or replacing chemotherapeutic agents, reducing (chemo)radiotherapy, or eliminating systemic therapy with or without the substitution of surgery. Within the coming 5 years, multiple studies are due to publish their clinical findings, which could aid in reducing the need of toxic treatments in these individuals, whilst maintaining positive outcomes. Currently, treatment regimens should not be altered due to HPV status, unless as part of a clinical trial.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Louie KS, Mehanna H, Sasieni P. Trends in head and neck cancers in England from 1995 to 2011 and projections up to 2025. Oral Oncol. 2015;51(4):341–8.

    Article  Google Scholar 

  2. Mehanna H, Beech T, Nicholson T, El-Hariry I, McConkey C, Paleri V, et al. Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer--systematic review and meta-analysis of trends by time and region. Head Neck. 2013;35(5):747–55.

    Article  Google Scholar 

  3. Castellsague X, Alemany L, Quer M, Halec G, Quiros B, Tous S, et al. HPV involvement in head and neck cancers: comprehensive assessment of biomarkers in 3680 patients. J Natl Cancer Inst. 2016;108(6):djv403.

    Article  Google Scholar 

  4. Machtay M, Moughan J, Trotti A, Garden AS, Weber RS, Cooper JS, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26(21):3582–9.

    Article  CAS  Google Scholar 

  5. Trotti A, Pajak TF, Gwede CK, Paulus R, Cooper J, Forastiere A, et al. TAME: development of a new method for summarising adverse events of cancer treatment by the Radiation Therapy Oncology Group. Lancet Oncol. 2007;8(7):613–24.

    Article  Google Scholar 

  6. Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363(1):24–35.

    Article  CAS  Google Scholar 

  7. Mehanna H. Update on de-intensification and Intensification Studies in HPV. Recent Results Cancer Res. 2017;206:251–6.

    Article  Google Scholar 

  8. Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006;354(6):567–78.

    Article  CAS  Google Scholar 

  9. Mirghani H, Amen F, Moreau F, Guigay J, Hartl DM, Lacau S, Guily J. Oropharyngeal cancers: Relationship between epidermal growth factor receptor alterations and human papillomavirus status. Eur J Cancer. 2014;50(6):1100–11.

    Article  CAS  Google Scholar 

  10. Eisbruch A, Schwartz M, Rasch C, Vineberg K, Damen E, Van As CJ, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys. 2004;60(5):1425–39.

    Article  Google Scholar 

  11. Feng FY, Kim HM, Lyden TH, Haxer MJ, Feng M, Worden FP, et al. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2007;68(5):1289–98.

    Article  Google Scholar 

  12. Cmelak A, Li S, Marur S, Zhao W, Westra WH, Chung CH, et al. E1308: Reduced-dose IMRT in human papilloma virus (HPV)-associated resectable oropharyngeal squamous carcinomas (OPSCC) after clinical complete response (cCR) to induction chemotherapy (IC). J Clin Oncol. 2014;32(15_suppl):LBA6006-LBA.

    Article  Google Scholar 

  13. Seiwert T, Melotek JM, Foster CC, Blair EA, Karrison TG, Agrawal N, et al. OPTIMA—a phase II trial of induction chemotherapy response-stratified RT dose and volume de-escalation for HPV+ oropharynx cancer: efficacy, toxicity, and HPV subtype analysis (abstract 5). 2018. Available from https://www.astro.org/uploadedFiles/_MAIN_SITE/News_and_Publications/News_and_Media_Center/Press_Kits/2018/Head_and_Neck/HNCS%202018%20-%20Abstract%205%20(Seiwert).pdf.

  14. Haughey BH, Sinha P. Prognostic factors and survival unique to surgically treated p16+ oropharyngeal cancer. Laryngoscope. 2012;122(Suppl 2):S13–33.

    Article  Google Scholar 

  15. Sinha P, Lewis JS, Piccirillo JF, Kallogjeri D, Haughey BH. Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer. 2012;118(14):3519–30.

    Article  CAS  Google Scholar 

  16. Shaw R, Mehanna H. Surgical trials in head & neck cancer - are you serious? Oral Oncol. 2013;49(9):843–4.

    Article  Google Scholar 

  17. Mellin H, Dahlgren L, Munck-Wikland E, Lindholm J, Rabbani H, Kalantari M, et al. Human papillomavirus type 16 is episomal and a high viral load may be correlated to better prognosis in tonsillar cancer. Int J Cancer. 2002;102(2):152–8.

    Article  CAS  Google Scholar 

  18. O’Sullivan B, Huang SH, Siu LL, Waldron J, Zhao H, Perez-Ordonez B, et al. Deintensification candidate subgroups in human papillomavirus-related oropharyngeal cancer according to minimal risk of distant metastasis. J Clin Oncol. 2013;31(5):543–50.

    Article  Google Scholar 

  19. O’Sullivan B, Huang SH, Perez-Ordonez B, Massey C, Siu LL, Weinreb I, et al. Outcomes of HPV-related oropharyngeal cancer patients treated by radiotherapy alone using altered fractionation. Radiother Oncol. 2012;103(1):49–56.

    Article  Google Scholar 

  20. Brotherston DC, Poon I, Le T, Leung M, Kiss A, Ringash J, et al. Patient preferences for oropharyngeal cancer treatment de-escalation. Head Neck. 2013;35(2):151–9.

    Article  Google Scholar 

  21. Mehanna HM, Sen M, Chester JD, Sanghera P, Paleri V, Gaunt P, et al. Phase III randomised controlled trial (RCT) comparing alternative regimens for escalating treatment of intermediate and high-risk oropharyngeal cancer (CompARE). J Clin Oncol. 2017;35(15_suppl):TPS6091-TPS.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK

    Hisham Mehanna, Jennifer L. Bryant & Anthony H. Kong

Authors
  1. Hisham Mehanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer L. Bryant
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony H. Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium

    Jan B. Vermorken

  2. Department of Radiation Oncology, Charité University Medicine, Berlin, Germany

    Volker Budach

  3. Department of Otolaryngology , VU University Medical Center, Amsterdam, The Netherlands

    C. René Leemans

  4. Institut Roi Albert II, Université Catholique de Louvain , Louvain-la-Neuve, Belgium

    Jean-Pascal Machiels

  5. Department of Otorhinolarynology, University of Brescia, Brescia, Italy

    Piero Nicolai

  6. Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    Brian O'Sullivan

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mehanna, H., Bryant, J.L., Kong, A.H. (2018). Should We De-escalate Treatment for HPV Positive Oropharyngeal Head and Neck Cancer?. In: Vermorken, J., Budach, V., Leemans, C., Machiels, JP., Nicolai, P., O'Sullivan, B. (eds) Critical Issues in Head and Neck Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-98854-2_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98854-2_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98853-5

  • Online ISBN: 978-3-319-98854-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation