Cooper Anna C, Fazer Casey A, Chintakuntlawar Ashish V, Fuentes Bayne Harry E, McGarrah Patrick W, Price Katharine A R
From Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
J Adv Pract Oncol. 2023 Nov;14(7):571-575. doi: 10.6004/jadpro.2023.14.7.2. Epub 2023 Nov 1.
Patients with metastatic human papillomavirus-associated oropharyngeal cancer (HPV-OPC) have a median overall survival exceeding 2 years and are often candidates for multiple lines of palliative therapy. With the approval of immunotherapy as first-line treatment, salvage therapeutic options are limited. We describe our experience using capecitabine as salvage therapy for patients with recurrent or metastatic (R/M) HPV-OPC.
We performed a retrospective study of patients with R/M HPV-OPC with distant metastatic disease. Eligible patients were identified from a medical oncology clinical database. Demographic and clinical data were abstracted from the medical record. Survival probabilities were estimated with the Kaplan-Meier method.
10 patients were identified. Sites of metastatic disease included lung, liver, mediastinal lymph nodes, bone, abdominal lymph nodes, and soft tissue. Most patients received capecitabine as fourth-line treatment. The median duration from start of capecitabine therapy until death was 10.5 months. Best treatment response was as follows: partial responses (PR) were seen in 4 of 10 (40%), stable disease (SD) in 3 of 10 (30%), and progressive disease (PD) in 2 of 10 (20%). The clinical benefit rate (CR + PR + SD) was 70%. Reasons for discontinuation included disease progression ( = 8) and side effects ( = 2). One patient notably had prolonged benefit from capecitabine and continued to be on treatment for 34 months total.
Capecitabine is a potential salvage treatment for heavily pretreated patients with R/M HPV-OPC, with some patients experiencing prolonged response. Clinical or molecular predictors of response would be helpful to identify patients likely to benefit; a larger prospective study would be useful to confirm efficacy in this patient population.
转移性人乳头瘤病毒相关口咽癌（HPV-OPC）患者的中位总生存期超过2年，通常适合接受多线姑息治疗。随着免疫疗法获批作为一线治疗，挽救性治疗选择有限。我们描述了使用卡培他滨作为复发性或转移性（R/M）HPV-OPC患者挽救性治疗的经验。
我们对患有远处转移性疾病的R/M HPV-OPC患者进行了一项回顾性研究。从肿瘤内科临床数据库中识别符合条件的患者。人口统计学和临床数据从病历中提取。生存概率采用Kaplan-Meier方法估计。
共识别出10例患者。转移部位包括肺、肝、纵隔淋巴结、骨、腹部淋巴结和软组织。大多数患者接受卡培他滨作为四线治疗。从开始卡培他滨治疗到死亡的中位持续时间为10.5个月。最佳治疗反应如下：10例中有4例（40%）出现部分缓解（PR），10例中有3例（30%）疾病稳定（SD），10例中有2例（20%）疾病进展（PD）。临床获益率（CR+PR+SD）为70%。停药原因包括疾病进展（=8）和副作用（=2）。1例患者从卡培他滨中显著获益，总共持续治疗了34个月。
卡培他滨是对经过大量预处理的R/M HPV-OPC患者的一种潜在挽救性治疗方法，一些患者有延长的反应。反应的临床或分子预测指标将有助于识别可能获益的患者；一项更大规模的前瞻性研究将有助于证实该患者群体中的疗效。
