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Deintensifiying Treatment of HPV-Positive Oropharyngeal Cancer Could Reduce
Toxicity While Maintaining Function and Survival
By Charlotte Bath
April 25, 2017
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“The status quo for HPV [human papillomavirus]-associated oropharyngeal
squamous cell carcinoma is not sufficient.… Our treatment is effective,
but the toxicity associated with it is not tolerable.” And HPV-associated
oropharyngeal cancer “is a cancer of relatively younger patients,” said
Nishant Agrawal, MD, Professor and Director of Head and Neck Surgical
Oncology, University of Chicago, at the 2016 Multidisciplinary Head & Neck
Symposium sponsored by the Robert H. Lurie Comprehensive Cancer Center of
Northwestern University, Chicago.1
Our patients are asking us to do better and reduce toxicity.
— Nishant Agrawal, MD
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We have seen a significant increase in the incidence of HPV-associated
oropharyngeal cancer in relatively younger patients, with the median age of
diagnosis in the 50s, even patients in their 30s,” Dr. Agrawal said. “
These patients have a long life expectancy—you can expect them to live 30
to 50 years or even longer as life expectancy continues to increase—vs
head and neck cancer patients with disease related to smoking, who are
diagnosed in their 60s and have maybe another 10 to 20 years to live
because of other smoking-related cancers and medical comorbidities.”
The long life expectancy and the possibility of quality of life being
compromised by chronic adverse events of current head and neck cancer
treatments are reasons for considering deintensification. “Acute toxicity
is significant with our current treatments,” Dr. Agrawal said. An
estimated 80% of patients will have grade 3 toxicity with current
treatments, and up to 25% to 60% will “continue to suffer from grade 3
toxicity.” Adverse events include dermatitis, mucositis, xerostomia, and
dysphagia and can be “life-altering” for patients.
According to Sandeep Samant, MD, Chief of Head and Neck Surgery at
Northwestern Medicine and symposium Chair, “The goal of deintensification
is to reduce late toxicity, while maintaining high survival and normal
functioning related to swallowing, saliva, and taste.”2 Dr. Samant served
as moderator and was one of the speakers at the keynote session on de-
escalating therapy in HPV-positive oropharyngeal cancer.
Two Different Diseases
“Most people involved in treating HPV-positive and HPV-negative
oropharyngeal cancers recognize that they are two different diseases,” Dr.
Samant stated. That statement was supported by responses to an audience
poll that showed 70% answered no to the question, “Do you think HPV and
non-HPV cancer should be treated similarly?” and 96% said no to the follow
-up question, “Do you think in 5 years’ time, they will be treated the
same way?”
The goal of deintensification is to reduce late toxicity, while maintaining
high survival and normal functioning related to swallowing, saliva, and
taste.
— Sandeep Samant, MD
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“There is probably a reason to believe that patients with HPV are
currently being overtreated. There is just no clarity on how that treatment