Princess Margaret Cancer Centre, Toronto, ON, Canada
Anna Spreafico , Shao Hui Huang , Wei Xu , Roberta Granata , Chen-Shin Liu , John N. Waldron , Eric Chen , Jolie Ringash , Andrew Bayley , Kelvin K. Chan , Andrew J. Hope , Albiruni R. A. Razak , Bayardo Perez-Ordonez , Ilan Weinreb , Paolo Bossi , Ester Orlandi , Lisa F. Licitra , Brian O'Sullivan , Lillian L. Siu , Joon-Hyung J. Kim
Background: Definitive radiotherapy with concurrent cisplatin (CDDP) is a standard treatment for patients (pts) with LAHNSCC. We evaluated the impact of CDDP dose intensity (mg/m2) on overall survival (OS) of HPV+ and HPV- LAHNSCC pts. Methods: Princess Margaret Cancer Centre (PM) and Istituto Nazionale dei Tumori (INT) LAHNSCC cohorts treated from 2000 to 2012 were reviewed. Kaplan-Meier method was used to estimate the 5-year (yr) OS in HPV+ vs HPV− pts. HPV status was determined by p16 staining or in situhybridization HPV DNA for all oropharyngeal (OPC), unknown primary (UNK), and ≤ 10 pack-year (PY) smoking laryngo-hypopharyngeal cancer (LHC). Untested p16, >10 PY LHC pts were assumed HPV−. Multivariable analysis (MVA) with Cox regression identified OS predictors for HPV+ and HPV− pts. Results: A total of 659 pts (584 PM; 75 INT) were evaluated. Pts characteristics included: median age 58 (range: 27-81); primary site: OPC 73%, LHC 24%, UNK 3%; non-smokers 27%; stage: T4 25%, N2c-N3 60%; HPV+ 404 (61%), HPV− 255 (39%) pts. Median CDDP dose was 200 mg/m2 for both HPV+ and HPV− cohorts. Median follow-up was 4.3 yrs. Five year OS was inferior for HPV− CDDP ≤ 200 vs > 200 mg/m2 (44 vs 62%, p < 0.01), while no difference was detected in HPV+ CDDP ≤ 200 vs > 200 mg/m2 (83 vs 87%, p = 0.30), confirmed by MVA (Table). In N3 or T4 HPV+ pts, a trend on OS in CDDP >200 mg/m2(HR = 0.62, 95% CI: 0.30-1.31) was observed. Conclusions: In this large multicenter cohort study, CDDP dose intensity ≤ 200 mg/m2had a detrimental impact on OS in HPV− LAHNSCC pts. The impact of CDDP dose intensity on HPV+ pts was not significant. These results warrant prospective validation.
HR (95% CI) & p value | ||||||
---|---|---|---|---|---|---|
CDDP (mg/m2) > 200 vs ≤ 200 | Age 1 yr increment | Smoking 10 PY increment | T HPV+: T4 vs T0-3 HPV–: T3-4 vs T1-2 | N HPV+: N2c-3 vs N0-2b HPV–: N2b-3 vs N0-2a | Disease Site Non-OPC vs OPC | |
HPV+ | 0.8 (0.4-1.4) p = 0.46 | 0.98 (0.95-1.01) p = 0.25 | 1.2 (1.02-1.3) p = 0.03 | 2.5 (1.3-4.5) p < 0.01 | 2.4 (1.3-4.4) p < 0.01 | NA |
HPV– | 0.5 (0.3-0.8) p < 0.01 | 1.00 (0.98-1.02) p = 0.93 | 1.1 (0.98-1.2) p = 0.12 | 1.4 (0.9-2.1) p = 0.13 | 2.4 (1.5-3.9) p < 0.01 | 1.2 (0.8-1.8) p = 0.38 |
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2023 ASCO Annual Meeting
First Author: Robert L. Ferris
2023 ASCO Annual Meeting
First Author: Bailey Fabiny Garb
2023 ASCO Annual Meeting
First Author: Ari Rosenberg
2024 ASCO Gastrointestinal Cancers Symposium
First Author: Timothy J. Brown