HPV+ - Oropharynx-Tumoren:Deescalation
Allgemeines
HPV-positive Tumoren haben eine bessere Prognose. Daher sollte auch mit geringerer Therapieintensität ein akzeptables Ergebnis erzielbar sein.
HPV
Studien
| Trial | Design | N | Eligibility | Primary endpoint | Treatment |
| ECOG 1308 | Phase 2 | 90 | Stage III-IV resectable | 2-y progression-free survival | Induction with 3 cycles of paclitaxel/cisplatinum/ cetuximab followed by IMRT þ cetuximab, either 54 Gy for complete responders (27 fractions, 5 wk) or 69.3 Gy for partial responders (33 fractions, 6 wk) |
| ECOG 3311 | Randomized phase 2 | 377 | Stage III-IV resectable | 2-y progression-free survival | Transoral surgery followed by risk-based adjuvant treatment: (1) low pathologic risk are observed; (2) intermediate pathologic risk are randomized to 50 Gy alone vs 60 Gy alone; and (3) high pathologic risk receive 66 Gy with concurrent weekly cisplatinum (40 mg/m 2 ) |
| RTOG 1016 | Phase 3 | 706 | T1-2, N2a-N3 T3-4, any N | 4-year overall survival | ARM 1: IMRT 70 Gy, 6 wk þ cisplatinum ARM 2: IMRT 70 Gy, 6 wk þ cetuximab |
| TROG 12.01 | Phase 3 | 200 | T3 N0, T1-T3 N2a-c | Symptom severity | ARM 1: IMRT 70 Gy, 7 wk þ cisplatinum ARM 2: IMRT 70 Gy, 7 wk þ cetuximab |
| NRG-HN002 | Randomized phase 2 | 296 | T1-T2, N1-N2b or T3 N0-N2b Minimal smoking history | 2-year progression-free survival | Arm 1: IMRT 60 Gy, 6 wk þ weekly cisplatinum Arm 2: 60 Gy, 5 wk |
| LCCC 1120(2) | Phase 2 | 45 | T0-3, N0-N2c Minimal smoking history | Complete pathologic response | IMRT 60 Gy þ weekly cisplatinum followed by biopsy of primary site and limited neck dissection |
| LCCC 1413(2) | Phase 2 | 60 | T0-3, N0-N2c Minimal to moderate smoking history | 2-year progression-free survival | IMRT 60 Gy þ weekly cisplatinum |
Quelle
Human papillomavirus and survival of patients with oropharyngeal cancer.
N Engl J Med 363(2010):24-35
2.) Chera BS, et al.:
Phase 2 Trial of De-intensified Chemoradiation Therapy for Favorable-Risk Human Papillomavirus - Associated Oropharyngeal Squamous Cell Carcinoma.
Int J Radiation Oncol Biol Phys 2015;93:976-985
Lineberg Comprehensive Cancer Center, NC USA
