Distinct Outcomes of Oropharyngeal Squamous Cell Carcinoma Patients after Distant Failure According to p16 Status: Implication in Therapeutic Options

Abstract

Introduction: Recent modifications in the epidemiology of oropharyngeal squamous cell carcinoma (OSCC) have led to the increase of Human papillomavirus (HPV) related metastatic head and neck cancer patients with high life expectancy even at advanced stage, low comorbidity and still restricted systemic therapy opportunities. In the recent era of ablative therapies’ development, oligometastatic HPV OSCC patients are indubitably good candidates for intensified treatment. However, data related to outcomes after optimised management of metastatic sites are dramatically missing. Materials and patients: In our cohort of 186 unselected consecutive OSCC patients treated with curative intent at our institution between 2009 and 2013, we analysed the incidence, treatment and outcomes of distant metastatic (DM) failure according to p16 status. Results: After a median follow-up of 4.2 years (95% CI: 3.8–4.4) from primary diagnosis of OSCC, 21/95 p16− patients (22.1%) vs. 8/91 (8.8%) p16+ patients presented DM failure with a median interval of 11 (range 0–46) and 28 months (range 0–71), respectively (p = 0.10). Overall survival (OS) after DM failure was significantly higher in p16+ patients with a two-year OS rate of 75% and 15% for p16+ and p16−, respectively (p = 0.002). In eight HPV-related metastatic patients, three underwent ablative lung metastasis treatment and are still complete responders four to five years later. Conclusion: This study highlights distinct outcomes of metastatic HPV-related OSCC patients emphasised by three long-term complete responders after lung ablative treatment. In patients with high life expectancy and limited tumour burden, the question of ablative treatment such as metastasectomy or stereotactic ablative radiotherapy (SBRT) should be addressed.

Exclusive Radio±chemoTherapy versus upfront Surgery in the treatment of HPV-related localized or locally ADvanced Oropharyngeal squamous cell Carcinoma (RT-SHADOC): a tricentric study of efficacy, tolerance and quality of life

“…Because patients with HPV-OPSCCs have better outcomes than those with non-HPV-related tumors (5,23), survival is longer, and treatment tolerance and QoL have become an increasing issue (24). Notably, all patients from our study received IMRT, as it was proven to reduce the incidence of xerostomia and improve saliva-related QoL compared to 3D RT (25,26).…”

Definitive radio(chemo)therapy versus upfront surgery in the treatment of HPV-related localized or locally advanced oropharyngeal squamous cell carcinoma

“…Because patients with HPV-OPSCCs have better outcomes compared to those with non-HPV-related tumors [ 5 , 23 ], the issue of treatment tolerance and QoL has become increasingly important [ 24 ]. Notably, all patients from our study received IMRT, as it has been demonstrated to reduce the incidence of xerostomia and improve saliva-related QoL compared to 3D RT [ 25 , 26 ].…”

Current Therapy for Metastatic Head and Neck Cancer: Evidence, Opportunities, and Challenges

“…27 Patients with HPV-related oropharynx oligometastatic HNSCC have better OS and disease-free survival than HPVÀ counterparts (2-year OS, 60% vs. 25%, p < .05). 28,29 Lee et al 30 showed that patients with metachronous oligometastatic HPV1 oropharynx carcinoma will benefit from initial definitive metastasis-directed therapy compared with upfront systemic therapy (median OS not reached vs. 40.7 months, p 5 .021). Similarly, patients with Epstein-Barr virus-associated oligometastatic nasopharyngeal carcinoma may benefit from long-term control by combining chemotherapy with local radiation therapy to the metastatic lesions.…”