HPV-Positive Disease Predicts Longer Overall Survival After Progression of Oropharyngeal Squamous Cell Carcinoma
Patients with human papillomavirus (HPV)-positive oropharyngeal cancer have reduced risk of progression compared with those with HPV-negative disease, but the effect of HPV status on overall survival after progression has not been clear. In a study reported in the Journal of Clinical Oncology, Fakhry et al found that p16-positive disease was associated with improved overall survival vs p16-negative disease after progression of stage III or IV oropharyngeal squamous cell carcinoma.
Study Details
The retrospective study included 181 p16-positive (n = 105) or p16-negative (n = 76) patients from Radiation Therapy Oncology Group trials 0129 (July 2002 to June 2005) and 0522 (November 2005 to March 2009) with local, regional, and/or distant progression after platinum-based chemoradiotherapy.
Patients with p16-positive disease were significantly (all P < .05) more likely to be younger (median, 53 vs 58 years), of white race (93% vs 77%), report less cumulative cigarette exposure (median, 16.5 vs 38.5 pack-years), and present with tonsilar fossa or tonsil as primary site (37% vs 25%) and lower T stage (T2 in 41% vs 25%); p16-positive patients also received a nonsignificantly greater number of cisplatin cycles during primary therapy. Patterns of failure and median time to progression (8.2 vs 7.3 months, P = .67) were similar in the two groups. The majority of p16-positive and p16-negative patients had disease progression within the first year after primary therapy (65% vs 63%).
Independent Predictor of Overall Survival
After median follow-up of 4.0 years after disease progression, 2-year overall survival was 54.6% vs 27.6% and median overall survival was 2.6 vs 0.8 years in the p16-positive vs p16-negative groups. On multivariate analysis (adjusting for age, sex, race, Zubrod performance status, anemia, pack-years, T stage, N stage, protocol therapy, salvage surgery, and site of progression), the hazard ratio (HR) for overall survival was 0.48 (P < .001). Receipt of salvage surgery was also an independent predictor of overall survival (HR = 0.48, P = .01), as were T stage at enrolment (HR = 1.61, P = .03, for T4 vs T2-T3), distant vs locoregional progression (HR = 1.99, P = .002), and > 20 vs ≤ 20 pack-years (HR = 1.57, P = .04).
The investigators concluded, “Tumor HPV status is a strong and independent predictor of overall survival after disease progression and should be a stratification factor for clinical trials for patients with recurrent or metastatic [oropharyngeal cancer]…. Importantly, surgical salvage significantly improved overall survival for both patient groups.”
Carole Fakhry, MD, MPH, of Johns Hopkins Medical Institutions, is the corresponding author for the Journal of Clinical Oncology article.
The study was support by National Cancer Institute grants and Bristol-Myers Squibb. Study author Maura Gillison, MD, PhD, reported a consultant or advisory role with GlaxoSmithKline and Bristol-Myers Squibb and honoraria and other remuneration from Merck Serono.
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®.
