Onita Bhattasali, Lester D R Thompson, Iman A Abdalla, Jergin Chen, Shawn Iganej
Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles Medical Center, 4950 Sunset Boulevard, Los Angeles, CA, USA.
Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Ave, Woodland Hills, CA, USA.
Rep Pract Oncol Radiother. 2018 Sep-Oct;23(5):451-457. doi: 10.1016/j.rpor.2018.08.007. Epub 2018 Sep 7.
To perform a comparison of Cisplatin vs. Cetuximab in p16-positive oropharyngeal squamous cell carcinoma (OPSCC) in the context of the revised HPV-based staging.
Previous reports comparing these agents in head and neck cancer have included heterogenous disease and p16-status.
A retrospective review was conducted from 2006 to 2016 of patients with p16-positive OPSCC who underwent definitive radiotherapy concurrent with either triweekly Cisplatin ( = 251) or Cetuximab ( = 40). AJCC 8th Edition staging was adapted.
Median follow-up for surviving patients was 40 months. On multivariate analysis for all-comers, comparing Cisplatin and Cetuximab, 3-year locoregional recurrence (LRR): 6% vs. 16% ( = 0.07), 3-year distant metastasis (DM): 8% vs. 21% ( = 0.04), 3-year overall recurrence rate (ORR): 11% vs. 29% ( = 0.01), and 3-year cause-specific survival (CSS): 94% vs. 79% ( = 0.06), respectively. On stage-based subgroup analysis, for stage I-II disease, 3-year LRR: 5% vs. 10% ( = 0.51), 3-year DM: 7% vs. 16% ( = 0.32), 3-year ORR: 10% vs. 23% ( = 0.15), and 3-year CSS: 95% vs. 82% ( = 0.38). For stage III disease, 3-year LRR: 10% vs. 40% ( = 0.07), 3-year DM: 9% vs. 43% ( = 0.07), 3-year ORR: 15% vs. 55% ( = 0.04), and 3-year CSS: 94% vs. 57% ( = 0.048).
When given concurrently with radiotherapy, Cetuximab and triweekly Cisplatin demonstrated comparable efficacy for AJCC 8th Edition stage I-II p16-positive OPSCC. However, Cetuximab appeared to be associated with higher rates of treatment failure and cancer-related deaths in stage III disease. Upon availability of the RTOG 1016 trial results, analysis based on the revised HPV-based staging should be performed to confirm these findings.
在基于人乳头瘤病毒（HPV）的修订分期背景下，比较顺铂与西妥昔单抗治疗p16阳性口咽鳞状细胞癌（OPSCC）的疗效。
既往关于头颈部癌中比较这些药物的报告纳入了异质性疾病和p16状态。
对2006年至2016年接受根治性放疗并同时每三周接受一次顺铂治疗（n = 251）或西妥昔单抗治疗（n = 40）的p16阳性OPSCC患者进行回顾性分析。采用美国癌症联合委员会（AJCC）第8版分期。
存活患者的中位随访时间为40个月。在对所有患者进行的多因素分析中，比较顺铂和西妥昔单抗，3年局部区域复发（LRR）率分别为6%和16%（P = 0.07），3年远处转移（DM）率分别为8%和21%（P = 0.04），3年总复发率（ORR）分别为11%和29%（P = 0.01），3年病因特异性生存率（CSS）分别为94%和79%（P = 0.06）。在基于分期的亚组分析中，对于I-II期疾病，3年LRR率分别为5%和10%（P = 0.51），3年DM率分别为7%和16%（P = 0.32），3年ORR率分别为10%和23%（P = 0.15），3年CSS率分别为95%和82%（P = 0.38）。对于III期疾病，3年LRR率分别为10%和40%（P = 0.07），3年DM率分别为9%和43%（P = 0.07），3年ORR率分别为15%和55%（P = 0.04），3年CSS率分别为94%和57%（P = 0.048）。
与放疗同时使用时，西妥昔单抗和每三周一次的顺铂在AJCC第8版I-II期p16阳性OPSCC中显示出相当的疗效。然而，在III期疾病中，西妥昔单抗似乎与更高的治疗失败率和癌症相关死亡率相关。在获得放射肿瘤学组（RTOG）1016试验结果后，应基于修订后的基于HPV的分期进行分析以证实这些发现。
