TITLE:
Therapeutic Outcomes of HPV Positive and HPV Negative Oropharyngeal Squamous Cell Carcinomas
AUTHORS:
Aravindh Sivanandan Anand, Gopika Presenavarman, Salima Rema Windsor, Priya Venugopaladas Saraswathy
KEYWORDS:
Oropharyngeal Squamous Cell Carcinoma, HPV, Chemoradiation, Docetaxel, Cisplatin, 5-Fluorouracil, Treatment Response
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.11 No.9,
September
16,
2020
ABSTRACT: Background & Objectives: HPV associated (HPV+) oropharyngeal cancers,
compared with HPV non-associated ones (HPV?) have different characters and significantly better outcomes. HPV and
cancer characteristics differ among countries and few data is available in
Indian population regarding this issue. Thus, we attempted to determine the treatment response
and survival rates between HPV+ versus HPV negative oropharyngeal cancers in
Indian population. Methods: This prospective observational study was
conducted from
December 2016 - October 2018 in patients
with stage III/IV oropharyngeal squamous cell carcinomas (SCC) (n = 65). The patients received induction chemotherapy
with Docetaxel, Cisplatin, 5-Fluorouracil × 3 cycles, followed by concurrent chemoradiation 66 Gy as 33 fractions
along with cisplatin 40 mg/m2 weekly. The primary outcome was
treatment response rate, which was defined as per Response Evaluation Criteria
in Solid Tumours (RECIST) criteria. Secondary outcomes were
clinico-pathological differences between two groups, overall survival (OS),
progression free survival (PFS). Results: Of the 65 patients included in
the study, 17 were HPV positive and 48 patients were HPV negative. Median age
in HPV positive arm is 48 years and HPV negative arm is 59 years. HPV positive patients presented with
early T stage and advanced nodal (N) stage. Most common histopathology in both arms was
moderately differentiated squamous cell carcinomas followed by well
differentiated squamous cell carcinomas. HPV+ vs HPV? showed the following, treatment response 82.4% vs 52.1% (p-0.029). 1 year progression free
survival (PFS) of 76.5% vs 52.1% in HPV negative arm (p-0.08) & 1 year
overall survival was 82.4% vs 70.8% (p-0.353). Grade 3 or 4 toxicities did not differ
significantly between HPV positive and HPV negative arms. Conclusion: HPV
positive oropharyngeal SCC patients showed significantly better treatment
response than HPV negative ones. Progression free survival, overall survival
and toxicity profile did not differ significantly between the two groups.
Although due to small size, we did not compare data stratified by the cancer
characteristics, the data is worthy to further characterize this tumour
especially as HPV positive versus HPV negative.