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Contact: Michelle Kirkwood
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American Society for Radiation Oncology
HPV-positive OPSCC patients nearly twice as likely to survive as HPV-negative patients

Scottsdale, Ariz., February 20, 2014�A retrospective analysis of oropharyngeal patients with recurrence of disease after primary therapy in the Radiation Therapy Oncology Group (RTOG) studies 0129 or 0522 found that HPV-positive patients had a higher overall survival (OS) rate than HPV-negative patients (at two years post-treatment, 54.6 percent vs. 27.6 percent, respectively), according to research presented today at the 2014 Multidisciplinary Head and Neck Cancer Symposium.

The analysis 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 after 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 determined by a surrogate, p16 immunohistochemistry.

Median time to progression was virtually the same for HPV-positive and HPV-negative patients (8.2 months vs. 7.3 months, respectively). Increased risk of death in univariate analysis was associated with high tumor stage at diagnosis (T4 vs. T2-T3), fewer on-protocol cisplatin cycles (&#8804;1 vs. 2-3) and distant vs. local/regional recurrent (for all, hazard ratios (HRs) >2.0 and p<0.05). Risk of death after disease progression increased by 1 percent per cigarette pack-year at diagnosis. Rates were estimated by Kaplan-Meier method and compared by log-rank. HRs were estimated by Cox proportional hazards models and stratified by treatment protocol.

In addition, HPV-positive and HPV-negative patients who underwent surgery after cancer recurrence also experienced improved OS compared to those who did not undergo surgery. (The effect may have been more pronounced 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," said lead author Carole Fakhry, MD, MPH, assistant professor in the Department of Otolaryngology Head and Neck Surgery at Johns Hopkins Medicine in Baltimore. "These findings provide us with valuable knowledge to better counsel and treat patients."

http://www.eurekalert.org/pub_releases/2014-02/asfr-hop021914.php

This research is just a continuation of data we already are aware of that was published several years ago, that there is a distinct survival advantage in HPV+ patients. This paper just extends the length of the survival time since the original paper was published. You can always pass these things by the OCF office first, and certainly look for them in the OCF OC RSS news feed, which is FREE and you should subscribe to since it puts up, as they become available, the most current stories from hard science to human interest as it relates to OC. It is good to care that others are informed, just please check the news feed first to see if it is already there in the history or current articles.

Here is a link to get to the OCF News Feed...

OCF News Feed

Uh... What the hell? Really? I must be interpret this incorrectly. It can't be saying that at two years post, HPV+ survivors still standing is 54.7%.

My understanding is HPV+ survivability was more like 90% at FIVE years.

I sure hope I am not reading this statistic correctly.

Don

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

This group all had recurrences and some even distant tumors. So that is a subset of people. Remember that most do not have recurrences, so they are not in this group of statistics in this paper. This is looking at people that did the dance twice.

Whew thanks for the clarification Brian

I picked up on that too Don, and read a few other reports from the symposium. As Brian mentioned, that's after a recurrence or failure as often say. I read, and Brian knows better, that there were around 181 head and neck cancer abstracts at this symposium, which probably made for an interesting weekend, and reading since, and shed new light on this disease.

I previously understand that HPV postitive recurrences are about 15%, much less compared to HPV negative, but it is still high, to me, if you're in that subgroup like myself.

Another take from this analysis, John Hopkins, states that salvage surgery significantly reduced the risk of death in both groups, but even more so for HPV positive related, so this may change the course of treatment, decisions in the future, when it was previously thought any recurrence was dismal.

http://www.medscape.com/viewarticle/821045 (may have to register)

http://www.newswise.com/articles/re...-deadly-when-caused-by-virus-study-shows

Oropharyngeal SCC Survival at 2 years:

HPV-Positive after salvage surgery 72%, without Salvage Surgery 47%

HPV-Negative after salvage Surgery 45%, without Salvage Surgery 20.9%

Guys, this really didn't advance our knowledge much. People with recurrences do more poorly than those that don't, we already knew that. Since the bulk of people who go through treatment have had radiation, that tool is most of the time out of the question, we already knew that. This is comparing people that had a recurrence and essentially did nothing� or perhaps went on chemo for palliative care, and people who aggressively were willing to salvage the situation through what many times was extensive surgical intervention ( something that many patients particularly of an older age often decline because of the qol afterwards). So it is no surprise that those that did nothing and let the cancer progress did more poorly. I don't see how this moved the ball down the field very much from where our knowledge already was. What Carole's presentation did point out was that in the past doctors were reluctant to be treatment aggressive in their recommendations to patients in recurrence. This should give them some pause for thought about that. If the doctor and a patient are willing to take the leap, there are better outcomes and longer life spans�. in HPV patients in particular.

Correct, much of this info I read, knew before, and have first hand knowledge after 5 neck dissections, 8 recurrences, but finding some reports again, stats, was another story for me after I lost them, and was good to reread, and see in print, but many are on the news page. I guess I meant more to say it shed more light on this disease from the other readings too, from this one symposium, as far as HPV survivorship, distant mets, Sinus Humidifier, targeted therapy failure of one drug, Math biomarker, voice qualit loss, salivary gland sparing during radiation in oropharynx, etc. I haven't seen anything on the peg tube per say, except the sinus humidifier reducing hospitalization during treatment, and fewer needing the peg tube or requring for lesser tme. I guess it was a presentation of some selection of the hundreds, if not more, articles in print, as you say, but thanks for attending, and having the inside track.

The MATH score piece was interesting. I have seen all sorts of studies attempting to shake prognostic markers out of the data, and wonder if we're not looking at the same thing in different ways. The presentation PowerPoint didn't, for example, show any other tumor characteristics - size, in particular.

The humidifier presentation, on the other hand, made me very pleased that I found OCF when I did, and knew to purchase a humidifier when my husband was undergoing therapy. Not as good as the fancy machine in the article, but very much better than nothing.
Maria

So Paul, since you mentioned the PEG� here we go, PEG WAR TIME!!!!

The latest data shows that some individuals definitely have to have a PEG tube, they just can't get through things without it. That's just a FACT. New data - patients that get them ahead of time, or patients that wait till their doctors decide that they have just lost too much body weight to go without it any longer, (usually about the end of week three of treatment) have the same outcomes as it related to survival, though obviously one group had greater weight loss during treatment. Apparently in the long view that weight loss did not impact ultimate outcome. Now the really new stuff, PEG users had slightly higher rates of dysphasia than no PEG users. Yup, I actually said it.

There are some caveats to that. The first is that IF the PEG user did swallowing exercises / physical throat therapy during PEG time, they had the same rate of dysphasia as non PEG users. Validating the "if you don't use it you can lose it" school of thought. So if you are going to have to PEG because of weight loss, then you better keep up with swallowing exercises, even though they are a pain in the rear (throat). My personal belief is that like me some people HAVE TO GO THE PEG ROUTE, but I am totally convinced they can offset any swallowing issues if they will just do the swallowing exercise protocol. Data now supports that. I personally think there is a big issue here, and that is patient compliance. I didn't want to do so many things during the worst parts of my treatment and this is one more MUST DO thing on the list. Staying after oral hygiene, hydration, swallowing exercises, taking meds on time, record keeping, and the list goes on� no just sleeping the days away during treatment if you want to avoid some QOL issues when it is all said and done.

It was well established that IMRT has the potential (in another study that was discussed in private conversations but not presented here) to reduce radiation to the nerves that control the swallowing reflex, reducing the post treatment dysphagia issues. Radiated nerves = swallowing issues regardless of PEG or no PEG. So tumor location and how the treatment radiation is mapped can cause dysphagia regardless of PEG or not.

I am curious if vomiting exercises the swallow muscles. I know it's not the same from the perspective of pharyngeal parastolsis but it would make sense the process keeps some of the muscles working. And yes, I ask with a straight face. :|

Thanks for the info Brian, and Peg Wars lol. I can relate to the Must Do list, which I sometimes translate into Don't Do, and probably one of the worst patients as far as compliance goes, even if I know better, but for doing so, I pay for it. I still have my 2nd peg, for a number of reasons, more for a back-up as opposed to really needing it now, but did use it during recent surgery, treatment for additional nutrients, hydration. I'm still down about 70lbs from my pre-cancer weight, not going back either, but did gain back 45lbs at my current weight from my lowest, actually was more, but lost 25lbs since the summer unintentionally.

My goodness Brian. The one I would least expect to light a match around the open gas can. :-)

Maybe it's been a long day, so I got no energy to join the scuffle. What about some sources to read on a rainy day?
Also, is loss of speech the dysphasia you mention?

Many folks have swallow issues and do dilation and have various issues with food sticking and aspiration sort of stuff. It is pretty hard to recollect many posts describing loss of voice unless it is related to trach kinds of things.

If we are talking about loss of voice, personally, based on anecdotal reference, it is not much of a argument to add to the PEG discussion, in that the occurrence is so rare. Now, if the data shows that swallow issues are related to PEG, then let's hit the octagon!!!!!!!!!!

Don, this is in the OCF News Feed from the symposium regarding effects of Chemoradiation and speech with oropharyngeal patients:

http://oralcancernews.org/wp/effect...nd-speech-quality-of-hn-cancer-patients/

Uptown, I don't think that counts. Muscle memory which accounts for things like great aerobatic pilots or even riding a bicycle is different than an involuntary muscle reflex. The brain is part of it, both conscious and unconscious. The nerves and muscles get accused to a repeated movement and that allows you to do with subconsciously exactly the same way each time.