HPV-Positive Oropharyngeal Cancer Associated With Higher Overall Survival Rate After Progression Than HPV-Negative Disease


Key Points

  • Patients with HPV-positive oropharyngeal squamous cell carcinoma and disease progression had a significantly improved 2-year overall survival compared to HPV-negative patients  (54.6% vs 27.6%).
  • Factors associated with increased risk of death included high tumor stage at diagnosis, fewer on-protocol cisplatin cycles, and distant vs local/regional recurrent recurrence.
  • Salvage surgery was found to improve overall survival among both HPV-positive and HPV-negative patients.

A retrospective analysis of patients with oropharyngeal cancer with recurrence of disease after primary therapy in the Radiation Therapy Oncology Group (RTOG) studies 0129 and 0522 found that human papillomavirus (HPV)-positive patients had a higher overall survival rate than HPV-negative patients, according to research presented today at the 2014 Multidisciplinary Head and Neck Cancer Symposium. At 2 years post-treatment, overall survival was 54.6% for HPV-positive patients vs 27.6% for HPV-negative patients.

Study Details

The analysis included 181 patients with stage III to IV oropharyngeal squamous cell carcinoma with known HPV status (HPV-positive = 105, HPV-negative = 76), and cancer progression that was local, regional, and/or distant after completion of primary cisplatin-based chemotherapy and radiation therapy (standard vs accelerated fractionation in RTOG 0129 or cisplatin–accelerated fractionation with or without cetuximab [Erbitux] in RTOG 0522). Tumor status was determined by a surrogate, p16 immunohistochemistry.

Median time to progression was similar for HPV-positive and HPV-negative patients (8.2 vs 7.3 months, respectively). Increased risk of death in univariate analysis was associated with high tumor stage at diagnosis (T4 vs T2-T3), fewer on-protocol cisplatin cycles (1 vs 2–3), and distant vs local/regional recurrent (for all, hazard ratios [HR] > 2.0 and P < .05). Risk of death after disease progression increased by 1% per cigarette pack-year at diagnosis.

Rates were estimated by Kaplan-Meier method and compared by log-rank. Hazard ratios were estimated by Cox proportional hazards models and stratified by treatment protocol.

Salvage Surgery Improves Survival

HPV-positive and HPV-negative patients who underwent surgery after cancer recurrence also experienced improved overall survival compared to those who did not undergo surgery, with the effect appearing to be more pronounced among HPV-positive than HPV-negative patients. Recurrence occurs most commonly in the lungs for both groups of patients.

“Our findings demonstrate that HPV-positive oropharyngeal squamous cell carcinoma patients have significantly improved survival after progression of disease when compared with HPV-negative patients. Median survival after disease progression was strikingly longer for HPV-positive than HPV-negative patients,” said lead author Carole Fakhry, MD, MPH, Assistant Professor in the Department of Otolaryngology Head and Neck Surgery at Johns Hopkins Medicine in Baltimore. “These findings provide us with valuable knowledge to better counsel and treat patients.”

This study was supported by National Cancer Institute and Bristol-Meyers Squibb. Study author Maura L. Gillison, MD, PhD, is a consultant for Bristol-Myers Squibb and GlaxoSmithKline.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.