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Survival Rate Higher for HPV-positive OPSCC patients compared to HPV-negative patients

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Based on research presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, a retrospective analysis of oropharyngeal patients with recurrence of disease following primary therapy in the Radiation Therapy Oncology Group (RTOG) studies 0129 or 0522 discovered that HPV-positive patients had a higher overall survival (OS) rate when compared to HPV-negative patients (at two years post-treatment, 54.6 percent vs. 27.6 percent, respectively).

The investigation included 181 patients with stage III-IV oropharyngeal squamous cell carcinoma (OPSCC) with known HPV status (HPV-positive = 105; HPV-negative = 76), and cancer progression that was local, regional and/or distant following completion of primary cisplatin-based chemotherapy and radiation therapy (standard vs. accelerated fractionation (AFX)) in RTOG 0129 or cisplatin-AFX with or without cetuximab in RTOG 0522. Tumor status was measured by a substitute, p16 immunohistochemistry.

Average time to progression was alomst the same for HPV-positive and HPV-negative patients (8.2 months vs. 7.3 months, respectively). Higher risk of death in univariate analysis was linked to 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 (HRs) >2.0 and p<0.05). Risk of death following disease progression rose by 1 percent per cigarette pack-year at diagnosis. Rates were determined by Kaplan-Meier method and compared by log-rank. HRs were determined by Cox proportional hazards models and categorized by treatment protocol.hpv

Furthermore, HPV-positive and HPV-negative patients who received surgery following cancer recurrence also experienced improved OS as opposed to those who did not receive surgery; the effect may have been more apparent among HPV-positive than HPV-negative patients. Recurrence is most commonly in the lungs for both groups of patients.

"Our findings demonstrate that HPV-positive OPSCC 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. These findings provide us with valuable knowledge to better counsel and treat patients," said lead author and assistant professor in the Department of Otolaryngology Head and Neck Surgery at Johns Hopkins Medicine in Baltimore, Carole Fakhry, MD, MPH.


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