Current Evidence of a Deintensification Strategy for Patients with HPV-Related Oropharyngeal Cancer
Human papillomavirus (HPV)-related oropharyngeal cancer differs from HPV-negative oropharyngeal cancer in terms of etiology, epidemiology, and prognosis. Younger and lower comorbidity patient demographics and favorable prognosis allow HPV-related oropharyngeal cancer patients to anticipate longer li...
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MDPI AG
2022-08-01
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| Online Access: | https://www.mdpi.com/2072-6694/14/16/3969 |
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| author | Soo-Yoon Sung Yeon-Sil Kim Sung Hwan Kim Seung Jae Lee Sea-Won Lee Yoo-Kang Kwak |
| author_facet | Soo-Yoon Sung Yeon-Sil Kim Sung Hwan Kim Seung Jae Lee Sea-Won Lee Yoo-Kang Kwak |
| author_sort | Soo-Yoon Sung |
| collection | DOAJ |
| description | Human papillomavirus (HPV)-related oropharyngeal cancer differs from HPV-negative oropharyngeal cancer in terms of etiology, epidemiology, and prognosis. Younger and lower comorbidity patient demographics and favorable prognosis allow HPV-related oropharyngeal cancer patients to anticipate longer life expectancy. Reducing long-term toxicities has become an increasingly important issue. Treatment deintensification to reduce toxicities has been investigated in terms of many aspects, and the reduction of radiotherapy (RT) dose in definitive treatment, replacement of platinum-based chemotherapy with cetuximab, response-tailored dose prescription after induction chemotherapy, and reduction of adjuvant RT dose after transoral surgery have been evaluated. We performed a literature review of prospective trials of deintensification for HPV-related oropharyngeal cancer. In phase II trials, reduction of RT dose in definitive treatment showed comparable survival outcomes to historical results. Two phase III randomized trials reported inferior survival outcomes for cetuximab-based chemoradiation compared with cisplatin-based chemoradiation. In a randomized phase III trial investigating adjuvant RT, deintensified RT showed noninferior survival outcomes in patients without extranodal extension but worse survival in patients with extranodal extension. Optimal RT dosage and patient selection require confirmation in future studies. Although many phase II trials have reported promising outcomes, the results of phase III trials are needed to change the standard treatment. Since high-level evidence has not been established, current deintensification should only be performed as part of a clinical study with caution. Implementation in clinical practice should not be undertaken until evidence from phase III randomized trials is available. |
| first_indexed | 2024-03-09T13:42:31Z |
| format | Article |
| id | doaj.art-a52554d38dc5456aba72e8544a9039eb |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T13:42:31Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-a52554d38dc5456aba72e8544a9039eb2023-11-30T21:04:30ZengMDPI AGCancers2072-66942022-08-011416396910.3390/cancers14163969Current Evidence of a Deintensification Strategy for Patients with HPV-Related Oropharyngeal CancerSoo-Yoon Sung0Yeon-Sil Kim1Sung Hwan Kim2Seung Jae Lee3Sea-Won Lee4Yoo-Kang Kwak5Department of Radiation Oncology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, KoreaDepartment of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, KoreaDepartment of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, KoreaMedical Library, The Catholic University of Korea, Seoul 06591, KoreaDepartment of Radiation Oncology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, KoreaDepartment of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, KoreaHuman papillomavirus (HPV)-related oropharyngeal cancer differs from HPV-negative oropharyngeal cancer in terms of etiology, epidemiology, and prognosis. Younger and lower comorbidity patient demographics and favorable prognosis allow HPV-related oropharyngeal cancer patients to anticipate longer life expectancy. Reducing long-term toxicities has become an increasingly important issue. Treatment deintensification to reduce toxicities has been investigated in terms of many aspects, and the reduction of radiotherapy (RT) dose in definitive treatment, replacement of platinum-based chemotherapy with cetuximab, response-tailored dose prescription after induction chemotherapy, and reduction of adjuvant RT dose after transoral surgery have been evaluated. We performed a literature review of prospective trials of deintensification for HPV-related oropharyngeal cancer. In phase II trials, reduction of RT dose in definitive treatment showed comparable survival outcomes to historical results. Two phase III randomized trials reported inferior survival outcomes for cetuximab-based chemoradiation compared with cisplatin-based chemoradiation. In a randomized phase III trial investigating adjuvant RT, deintensified RT showed noninferior survival outcomes in patients without extranodal extension but worse survival in patients with extranodal extension. Optimal RT dosage and patient selection require confirmation in future studies. Although many phase II trials have reported promising outcomes, the results of phase III trials are needed to change the standard treatment. Since high-level evidence has not been established, current deintensification should only be performed as part of a clinical study with caution. Implementation in clinical practice should not be undertaken until evidence from phase III randomized trials is available.https://www.mdpi.com/2072-6694/14/16/3969oropharyngeal cancerhuman papillomavirusp16radiotherapychemotherapytransoral surgery |
| spellingShingle | Soo-Yoon Sung Yeon-Sil Kim Sung Hwan Kim Seung Jae Lee Sea-Won Lee Yoo-Kang Kwak Current Evidence of a Deintensification Strategy for Patients with HPV-Related Oropharyngeal Cancer Cancers oropharyngeal cancer human papillomavirus p16 radiotherapy chemotherapy transoral surgery |
| title | Current Evidence of a Deintensification Strategy for Patients with HPV-Related Oropharyngeal Cancer |
| title_full | Current Evidence of a Deintensification Strategy for Patients with HPV-Related Oropharyngeal Cancer |
| title_fullStr | Current Evidence of a Deintensification Strategy for Patients with HPV-Related Oropharyngeal Cancer |
| title_full_unstemmed | Current Evidence of a Deintensification Strategy for Patients with HPV-Related Oropharyngeal Cancer |
| title_short | Current Evidence of a Deintensification Strategy for Patients with HPV-Related Oropharyngeal Cancer |
| title_sort | current evidence of a deintensification strategy for patients with hpv related oropharyngeal cancer |
| topic | oropharyngeal cancer human papillomavirus p16 radiotherapy chemotherapy transoral surgery |
| url | https://www.mdpi.com/2072-6694/14/16/3969 |
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