Advertisement

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

  • Hisham Mehanna
  • Jennifer L. Bryant
  • Anthony H. Kong
Chapter

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.

Keywords

Human papillomavirus Chemotherapy Radiotherapy Toxicity De-escalate Head and neck cancer Oropharyngeal cancer Clinical trials 

References

  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 7.
    Mehanna H. Update on de-intensification and Intensification Studies in HPV. Recent Results Cancer Res. 2017;206:251–6.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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. 14.
    Haughey BH, Sinha P. Prognostic factors and survival unique to surgically treated p16+ oropharyngeal cancer. Laryngoscope. 2012;122(Suppl 2):S13–33.CrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 16.
    Shaw R, Mehanna H. Surgical trials in head & neck cancer - are you serious? Oral Oncol. 2013;49(9):843–4.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Hisham Mehanna
    • 1
  • Jennifer L. Bryant
    • 1
  • Anthony H. Kong
    • 1
  1. 1.Institute of Head and Neck Studies and Education (InHANSE), University of BirminghamBirminghamUK

Personalised recommendations