Head and neck cancer specialist Priyanka Bhateja, MD, Assistant Professor in the Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, was encouraged by the findings of the Quarterback trial. As she noted in her comments for The ASCO Post, human papillomavirus (HPV)-associated oropharyngeal cancer has been known for more than a decade to be linked to better oncologic outcomes than HPV-negative tumors, yet it has been challenging to show that de-intensified treatment regimens constitute adequate treatment.

“Several strategies, such as replacing cisplatin with cetuximab and, more recently, radiation deintensification to 60 Gy with cisplatin in NRG HN005 for low-risk HPV patients, have failed to meet prespecified noninferiority [thresholds] at interim analyses,” she noted. The Quarterback trial has now evaluated deintensification of radiation therapy (aimed at reducing radiation toxicity) in patients responding to induction with modified docetaxel, cisplatin, and fluorouracil (TPF), with deintensification of radiation therapy. The outcome seemed comparable to that in historical controls.

Priyanka Bhateja, MD

Dr. Bhateja highlighted several aspects of the study: “Posner et al should be commended for selecting high-risk HPV patients (extracapsular extension, T4 stage, bilateral lymph nodes, and high-risk genotype) for radiation de-escalation. The second key thing is the trial’s biological selection: Patients who responded to induction chemotherapy received reduced-dose radiation (56 Gy), whereas nonresponders received standard-dose chemo-radiation,” she noted. “With 45 patients, the 3-year locoregional control rate with de-intensification was 88%, compared with the historical control rate of 85%.”

“Given the phase II design and relatively small patient numbers, this trial currently does not directly change clinical practice. It does highlight the chemosensitivity of these patients and advantages of induction therapy. Future phase III clinical trials should include biological selection, perhaps with a combination of induction chemoimmunotherapy and biomarkers such as tumor tissue–modified HPV DNA, to tailor and de-intensify treatments and improve quality of life,” Dr. Bhateja suggested. 

DISCLOSURE: Dr. Bhateja reported no conflicts of interest.