Human papillomavirus in head and neck cancer in India: Current status and consensus recommendations

Murthy, Vedang; Calcuttawala, Adnan; Chadha, Kirti; D’Cruz, Anil; Mallick, Indranil; Nair, Sudhir; Teni, Tanuja; Pawar, Sagar; Talapatra, Kaustav; Patil, Asawari; Bhatt, Amit; Chatterjee, Sanjoy; Swain, Monali; Parameswaran, Narayanan; Ghadyalpatil, N.; Singhal, Manish; Kuriakose, Moni Abraham; Prabhash, Kumar; Agarwal, Jitendra; Parikh, Purvish

doi:10.4103/sajc.sajc_96_17

Cited by 38 publications

(32 citation statements)

References 65 publications

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“…The incidence is low in the Indian population (range, Cancer September 15, 2019 15.0%-22.8%). 48 However, HPV status was similar between both the arms, which ensured the statistical integrity of the analysis. There were disproportionately higher numbers of hypopharyngeal cancers (which carry a poor prognosis) in the NCRT arm, but this does not affect the study conclusions.…”

Section: Discussionmentioning

confidence: 97%

A randomized phase 3 trial comparing nimotuzumab plus cisplatin chemoradiotherapy versus cisplatin chemoradiotherapy alone in locally advanced head and neck cancer

Patil

Noronha

Joshi

et al. 2019

Cancer

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BACKGROUND:Because the addition of nimotuzumab to chemoradiation in patients with locally advanced head and neck cancer improved outcomes in a phase 2 study, the authors conducted a phase 3 study to confirm these findings. METHODS: This openlabel, investigator-initiated, phase 3, randomized trial was conducted from 2012 to 2018. Adult patients with locally advanced head and neck cancer who were fit for radical chemoradiation were randomized 1:1 to receive either radical radiotherapy (66-70 grays) with concurrent weekly cisplatin (30 mg/m 2 ) (CRT) or the same schedule of CRT with weekly nimotuzumab (200 mg) (NCRT). The primary endpoint was progression-free survival (PFS); key secondary endpoints were disease-free survival (DFS), duration of locoregional control (LRC), and overall survival (OS). An intent-to-treat analysis also was performed. RESULTS: In total, 536 patients were allocated equally to both treatment arms. The median follow-up was 39.13 months. The addition of nimotuzumab improved PFS (hazard ratio [HR], 0.69; 95% CI, 0.53-0.89; P = .004), LRC (HR, 0.67; 95% CI, 0.50-0.89; P = .006), and DFS (HR, 0.71; 95% CI, 0.55-0.92; P = .008) and had a trend toward improved OS (HR, 0.84; 95% CI, 0.65-1.08; P = .163). Grade 3 through 5 adverse events were similar between the 2 arms, except for a higher incidence of mucositis in the NCRT arm (66.7% vs 55.8%; P = .01). CONCLUSIONS: The addition of nimotuzumab to concurrent weekly CRT improves PFS, LRC, and DFS. This combination provides a novel alternative therapeutic option to a 3-weekly schedule of 100 mg/m 2 cisplatin in patients with locally advanced head and neck cancer who are treated with radical-intent CRT. Cancer 2019;125:3184-3197.

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Section: Discussionmentioning

confidence: 97%

A randomized phase 3 trial comparing nimotuzumab plus cisplatin chemoradiotherapy versus cisplatin chemoradiotherapy alone in locally advanced head and neck cancer

Patil

Noronha

Joshi

et al. 2019

Cancer

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“…[59] Tobacco-related HPV-positive cancers might be a different entity altogether as reported by their atypical behavior in many Indian studies. [62] A systematic review suggests a significantly increased risk of developing oral and oropharyngeal cancers proportional to the number of lifetime sexual partners and practice of oral sex and homosexual relations. The other parameters, though inconsistent, included younger age at first engagement, lifetime oral and oral-anal sex partners, and ever performing anal sex.…”

Section: Marijuanamentioning

confidence: 99%

Addictions Causing Head-and-Neck Cancers

Singh

Sharin

Singhavi

et al. 2020

Indian Journal of Medical and Paediatric Oncology

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Background: Head-and-neck cancers pose a serious economic burden, with most countries investing significant resources to reduce the incidence, primarily focusing on understanding addictive etiologies. The traditional literature focused on tobacco and alcohol use, with few studies on contemporary factors such as e-cigarette, waterpipe smoking, and human papillomavirus. This article attempts to collate and present an update on the globally identified etiologic factors. Aims: The aim of this study was to identify and review the addictive etiologic factors causing head-and-neck cancers. Methods: An electronic search was performed on Medline, Embase, and Google Scholar to identify the etiologies causing head-and-neck cancers and narrowed down on those driven by addiction. Further, we identified their constituents, mechanism of action, and the risks attributable to various forms of products. Results: Substances identified included smoked and chewed tobacco, alcohol, mate, marijuana, areca nut and betel quid, and viruses. An alarming majority of youth are now utilizing these substances. Furthermore, migrant movements have led to the spread of traditional practices across the regions, especially from the Asian subcontinent. Conclusion: Ironically, despite modern advances and technology, we still see that a large proportion of population succumb to these cancers, emphasizing the need for more effective and targeted policies to combat this menace at the grassroots level.

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“…Patients with HPV positive disease have a favorable prognosis as opposed to HPV negative disease [2]. The incidence of HPV positive disease is variable across the globe with the incidence in North America in the range of 48-81.4% [3], and 15-22.8% in the Indian subcontinent [4].…”

Section: Introductionmentioning

confidence: 99%

Nimotuzumab-cisplatin-radiation versus cisplatin-radiation in HPV negative oropharyngeal cancer

et al. 2020

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Background: Addition of nimotuzumab to weekly cisplatin and radiation improves outcomes in head and neck cancer. HPV negative oropharyngeal cancer has unsatisfactory treatment outcomes and is a candidate for escalation of treatment. We wanted to determine whether the addition of nimotuzumab to cisplatin-radiation could improve outcomes in these poor-risk tumors. Methods: This was a subgroup analysis of a phase 3 randomized study. In this study, locally advanced head and neck cancer patients undergoing definitive chemoradiation were randomly allocated to weekly cisplatin (30 mg/m2 IV)-radiation (66-70 Gy) {CRT arm} or nimotuzumab (200 mg weekly)-weekly cisplatin (30 mg/m2)-radiation (66-70 Gy) {NCRT arm}. The data of HPV negative oropharyngeal cancer was extracted from the database of this study for the analysis. HPV testing was done with p16 immunohistochemistry (IHC) staining and reported according to the CAP criteria. The outcomes assessed were progression-free survival (PFS), disease-free survival (DFS), locoregional control, and overall survival (OS). Interaction test was performed between the study arms and HPV status prior to doing any HPV specific analysis for each of the studied outcomes. Kaplan Meier estimates for 2 year OS with 95%CI was calculated. The hazard ratio was obtained using COX regression analysis. Results: We had 187 HPV negative oropharyngeal cancers, 91 in the CRT arm and 96 in NCRT arm. The interaction test was significant for PFS (p = 0.000), locoregional control (p = 0.007) and overall survival (p = 0.002) but not for DFS (p = 0.072). The 2-year PFS was 31.5% (95%CI 21.5-42) in CRT arm versus 57.2% (95%CI 45.8-67.1) in NCRT arm (HR-0.54; 95%CI 0.36-0.79, p = 0.002). The 2-year LRC was 41.4% (95%CI 29.8-52.6) in the CRT arm versus in 60.4% (95%CI 48.7-70.2) in the NCRT arm (HR-0.61; 95%CI 0.4-0.94, p = 0.024). The addition of nimotuzumab also lead to an improvement in 2-year OS from 39.0% (95%CI 28.4-49.6) to 57.6% (95%CI 46.3-67.4) (HR-0.63, 95%CI 0.43-0.92, p = 0.018). Conclusions: The addition of nimotuzumab to weekly cisplatin-radiation improves outcomes inclusive of OS in HPV negative oropharyngeal cancers.

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Human papillomavirus in head and neck cancer in India: Current status and consensus recommendations

Cited by 38 publications

References 65 publications

A randomized phase 3 trial comparing nimotuzumab plus cisplatin chemoradiotherapy versus cisplatin chemoradiotherapy alone in locally advanced head and neck cancer

A randomized phase 3 trial comparing nimotuzumab plus cisplatin chemoradiotherapy versus cisplatin chemoradiotherapy alone in locally advanced head and neck cancer

Addictions Causing Head-and-Neck Cancers

Nimotuzumab-cisplatin-radiation versus cisplatin-radiation in HPV negative oropharyngeal cancer

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