TY - JOUR
T1 - Comparative effectiveness of induction chemotherapy for oropharyngeal squamous cell carcinoma
T2 - A population-based analysis
AU - Sher, David J.
AU - Schwartz, David L.
AU - Nedzi, Lucien
AU - Khan, Saad
AU - Hughes, Randall
AU - Fidler, Mary Jo
AU - Koshy, Matthew
N1 - Publisher Copyright:
© 2016 Elsevier Ltd. All rights reserved.
PY - 2016/3
Y1 - 2016/3
N2 - Objectives Despite several randomized trials, the optimal chemotherapy paradigm for locally advanced oropharyngeal carcinoma (OPSCC) is controversial. This population-based analysis assessed the overall survival (OS) benefit of induction chemotherapy (IC) for patients with stage III-IVB OPSCC. Materials and Methods Patients in the National Cancer Database with stage III-IVA-B OPSCC treated with curative-dose radiotherapy and IC or concurrent chemotherapy (CRT) between 2003 and 2011 were eligible. The primary outcome was OS, and secondary endpoints included OS for high-risk (T4 and/or N3 disease) and human papillomavirus (HPV) subsets. Results Of the 14,856 analyzed patients, 78% and 22% received CRT and IC, respectively. With a median follow-up for surviving patients of 44 months, the 5-year OS probability for the entire cohort was 66% (66% CRT vs. 64% IC, p = 0.022). Multivariable survival analysis showed no significant difference between CRT and IC (hazard ratio, HR, 0.95 for IC, p = 0.255), and sensitivity analyses to adjust for immortal time bias brought the HR to 1.0 (p = 0.859). There was also no OS difference for high-risk patients. There was a trend in favor of CRT for HPV-positive OPSCC (HR 1.63 with IC, p = 0.064), with a significant OS benefit for HPV-negative, high-risk OPSCC (HR 0.63, p = 0.048). Conclusion For the vast majority of patients, including HPV-positive individuals, there was no difference in OS with IC, arguing for CRT to remain as the standard therapy. Subset analysis revealed a small cohort of aggressive cancer (T4/N3 HPV-negative) which may benefit from from IC, although selection bias could not be ruled out.
AB - Objectives Despite several randomized trials, the optimal chemotherapy paradigm for locally advanced oropharyngeal carcinoma (OPSCC) is controversial. This population-based analysis assessed the overall survival (OS) benefit of induction chemotherapy (IC) for patients with stage III-IVB OPSCC. Materials and Methods Patients in the National Cancer Database with stage III-IVA-B OPSCC treated with curative-dose radiotherapy and IC or concurrent chemotherapy (CRT) between 2003 and 2011 were eligible. The primary outcome was OS, and secondary endpoints included OS for high-risk (T4 and/or N3 disease) and human papillomavirus (HPV) subsets. Results Of the 14,856 analyzed patients, 78% and 22% received CRT and IC, respectively. With a median follow-up for surviving patients of 44 months, the 5-year OS probability for the entire cohort was 66% (66% CRT vs. 64% IC, p = 0.022). Multivariable survival analysis showed no significant difference between CRT and IC (hazard ratio, HR, 0.95 for IC, p = 0.255), and sensitivity analyses to adjust for immortal time bias brought the HR to 1.0 (p = 0.859). There was also no OS difference for high-risk patients. There was a trend in favor of CRT for HPV-positive OPSCC (HR 1.63 with IC, p = 0.064), with a significant OS benefit for HPV-negative, high-risk OPSCC (HR 0.63, p = 0.048). Conclusion For the vast majority of patients, including HPV-positive individuals, there was no difference in OS with IC, arguing for CRT to remain as the standard therapy. Subset analysis revealed a small cohort of aggressive cancer (T4/N3 HPV-negative) which may benefit from from IC, although selection bias could not be ruled out.
KW - Chemoradiotherapy
KW - Combined modality therapy
KW - Head and neck cancer
KW - Human papillomavirus
KW - Induction chemotherapy
KW - Oropharyngeal cancer
KW - Outcomes research
UR - http://www.scopus.com/inward/record.url?scp=84960473390&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84960473390&partnerID=8YFLogxK
U2 - 10.1016/j.oraloncology.2015.12.008
DO - 10.1016/j.oraloncology.2015.12.008
M3 - Article
C2 - 26794877
AN - SCOPUS:84960473390
SN - 1368-8375
VL - 54
SP - 58
EP - 67
JO - Oral Oncology
JF - Oral Oncology
ER -