Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_40_2542 - Impact of Chemotherapy Regimen on Treatment Outcomes in Patients with HPV-associated Oropharyngeal Squamous Cell Carcinoma with Clinical T4 Disease

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Impact of Chemotherapy Regimen on Treatment Outcomes in Patients with HPV-associated Oropharyngeal Squamous Cell Carcinoma with Clinical T4 Disease
O. Bhattasali1, L. D. Thompson2, and S. Iganej1; 1Southern California Permanente Medical Group, Los Angeles, CA, 2Southern California Permanente Medical Group, Woodland Hills, CA

Purpose/Objective(s): Patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) with clinical T4 disease are at higher likelihood of treatment failure compared to patients with less advanced T stages. The purpose of this study was to identify predictors of failure within this subgroup of p16-positive OPSCC.

Materials/Methods: A retrospective review was conducted of 93 consecutive patients who underwent definitive concurrent chemoradiation for locally advanced p16-positive OPSCC with clinical T4 disease from July 2006 to December 2015. Central pathology review was performed of all cases with standardized p16 reporting. Disease staging was updated to the AJCC 8th Edition Cancer Staging Manual. Concurrent agents employed included high-dose triweekly Cisplatin (100mg/m2) (n=46), triweekly Carboplatin (AUC=5) (n=37), Cetuximab (400mg/m2 loading dose followed by 250mg/m2 weekly) (n=7), weekly Cisplatin (40mg/m2) (n=2), and weekly Carboplatin (AUC=2) (n=1). Outcomes analyzed included locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS). Multivariate analysis was conducted analyzing patient characteristics, including age and smoking history (≥10 pack-years), disease characteristics, including N stage, the presence of overt radiographic extracapsular extension (ORECE), matted lymphadenopathy, low-neck (level IV and/or Vb) lymphadenopathy, and retropharyngeal lymphadenopathy, and chemotherapy regimen (high-dose Cisplatin vs. other).

Results: Median follow-up for surviving patients was 50 (range: 18-133) months. Median age was 61 (range: 36-86) years. For all-comers, 3-year LRR: 15%; 3-year DM: 19%; 3-year OS: 79%. On multivariate analysis, no factors demonstrated significant prognostic impact for LRR. Receipt of a concurrent agent other than high-dose Cisplatin was associated with higher rates of DM compared to high-dose Cisplatin, 28% vs. 10% (p=0.04), respectively. Receipt of a concurrent agent other than high-dose Cisplatin was also associated with inferior OS, 67% vs. 89% (p=0.04), respectively. The remaining factors evaluated did not demonstrate any prognostic significance for disease control or survival.

Conclusion: This analysis suggests that high-dose Cisplatin should remain the preferred concurrent regimen for patients with HPV-associated OPSCC with clinical T4 disease. Receipt of an alternative concurrent agent resulted in higher rates of distant failure which may have led to inferior survival outcomes.

Author Disclosure: O. Bhattasali: None. S. Iganej: None.

Onita Bhattasali, MD, MPH

Kaiser Permanente Los Angeles Medical Center

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