Rep Pract Oncol Radiother 23 (2018) 451-457.
Aim: To perform a comparison of Cisplatin vs. Cetuximab in p16-positive oropharyngealsquamous cell carcinoma (OPSCC) in the context of the revised HPV-based staging.
Background: Previous reports comparing these agents in head and neck cancer haveincluded heterogenous disease and p16-status.
Materials and methods: A retrospective review was conducted from 2006 to 2016 ofpatients with p16-positive OPSCC who underwent definitive radiotherapy concurrent witheither triweekly Cisplatin (n = 251) or Cetuximab (n = 40). AJCC 8th Edition staging wasadapted.
Results: Median follow-up for surviving patients was 40 months. On multivariate analysisfor all-comers, comparing Cisplatin and Cetuximab, 3-year locoregional recurrence (LRR):6% vs. 16% (p = 0.07), 3-year distant metastasis (DM): 8% vs. 21% (p = 0.04), 3-year overallrecurrence rate (ORR): 11% vs. 29% (p = 0.01), and 3-year cause-specific survival (CSS): 94%vs. 79% (p = 0.06), respectively. On stage-based subgroup analysis, for stage I II disease, 3-year LRR: 5% vs. 10% (p = 0.51), 3-year DM: 7% vs. 16% (p = 0.32), 3-year ORR: 10% vs. 23%(p = 0.15), and 3-year CSS: 95% vs. 82% (p = 0.38). For stage III disease, 3-year LRR: 10% vs. 40%(p = 0.07), 3-year DM: 9% vs. 43% (p = 0.07), 3-year ORR: 15% vs. 55% (p = 0.04), and 3-year CSS:94% vs. 57% (p = 0.048).
Conclusions: When given concurrently with radiotherapy, Cetuximab and triweekly Cisplatin demonstrated comparable efficacy for AJCC 8th Edition stage I–II p16-positive OPSCC. However, Cetuximab appeared to be associated with higher rates of treatment failure and cancer-related deaths in stage III disease. Upon availability of the RTOG 1016 trial results, analysis based on the revised HPV-based staging should be performed to confirm these
findings.
findings.
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