Consensuses, controversies, and future directions in treatment deintensification for human papillomavirus-associated oropharyngeal cancer Review
| Authors: | Kang, J. J.; Yu, Y.; Chen, L.; Zakeri, K.; Gelblum, D. Y.; McBride, S. M.; Riaz, N.; Tsai, C. J.; Kriplani, A.; Hung, T. K. W.; Fetten, J. V.; Dunn, L. A.; Ho, A. L.; Boyle, J. O.; Ganly, I. S.; Singh, B.; Sherman, E. J.; Pfister, D. G.; Wong, R. J.; Lee, N. Y. |
| Review Title: | Consensuses, controversies, and future directions in treatment deintensification for human papillomavirus-associated oropharyngeal cancer |
| Abstract: | The most common cancer caused by human papillomavirus (HPV) infection in the United States is oropharyngeal cancer (OPC), and its incidence has been rising since the turn of the century. Because of substantial long-term morbidities with chemoradiation and the favorable prognosis of HPV-positive OPC, identifying the optimal deintensification strategy for this group has been a keystone of academic head-and-neck surgery, radiation oncology, and medical oncology for over the past decade. However, the first generation of randomized chemotherapy deintensification trials failed to change the standard of care, triggering concern over the feasibility of de-escalation. National database studies estimate that up to one third of patients receive nonstandard de-escalated treatments, which have subspecialty-specific nuances. A synthesis of the multidisciplinary deintensification data and current treatment standards is important for the oncology community to reinforce best practices and ensure optimal patient outcomes. In this review, the authors present a summary and comparison of prospective HPV-positive OPC de-escalation trials. Chemotherapy attenuation compromises outcomes without reducing toxicity. Limited data comparing transoral robotic surgery (TORS) with radiation raise concern over toxicity and outcomes with TORS. There are promising data to support de-escalating adjuvant therapy after TORS, but consensus on treatment indications is needed. Encouraging radiation deintensification strategies have been reported (upfront dose reduction and induction chemotherapy-based patient selection), but level I evidence is years away. Ultimately, stage and HPV status may be insufficient to guide de-escalation. The future of deintensification may lie in incorporating intratreatment response assessments to harness the powers of personalized medicine and integrate real-time surveillance. © 2022 The Authors. CA: A Cancer Journal for Clinicians published by Wiley Periodicals LLC on behalf of American Cancer Society. |
| Keywords: | cancer chemotherapy; treatment outcome; treatment response; review; cisplatin; fluorouracil; drug safety; patient selection; skin toxicity; paclitaxel; cancer radiotherapy; comparative study; chemotherapy; prospective study; prospective studies; treatment indication; disease association; carboplatin; ipilimumab; ticilimumab; consensus; nephrotoxicity; mucosa inflammation; neuropathy; evidence based practice; smoking; cetuximab; cancer therapy; docetaxel; dysphagia; gastrointestinal toxicity; patient care; radiation oncology; nausea and vomiting; oropharynx cancer; cancer epidemiology; everolimus; oropharyngeal neoplasms; oral mucositis; papillomavirus infections; personalized medicine; ototoxicity; human papillomavirus; oropharynx tumor; papillomavirus infection; transoral robotic surgery; nivolumab; radiation dose reduction; humans; human; circulating tumor dna; durvalumab; radiomics; deintensification; human papillomavirus viruses; oral and oropharyngeal neoplasms |
| Journal Title: | CA - A Cancer Journal for Clinicians |
| Volume: | 73 |
| Issue: | 2 |
| ISSN: | 0007-9235 |
| Publisher: | Wiley-Blackwell |
| Date Published: | 2023-03-01 |
| Start Page: | 164 |
| End Page: | 197 |
| Language: | English |
| DOI: | 10.3322/caac.21758 |
| PUBMED: | 36305841 |
| PROVIDER: | scopus |
| PMCID: | PMC9992119 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Source: Scopus |
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