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Miyamoto S, Hirohashi Y, Morita R, Miyazaki A, Ogi K, Kanaseki T, Ide K, Shirakawa J, Tsukahara T, Murai A, Sasaya T, Koike K, Kina S, Kawano T, Goto T, Ntege EH, Shimizu Y, Torigoe T. Exploring olfactory receptor family 7 subfamily C member 1 as a novel oral cancer stem cell target for immunotherapy. Cancer Sci 2023; 114:3496-3508. [PMID: 37344992 PMCID: PMC10475777 DOI: 10.1111/cas.15873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 06/23/2023] Open
Abstract
The mortality rate of oral cancer has not improved over the past three decades despite remarkable advances in cancer therapies. Oral cancers contain a subpopulation of cancer stem cells (CSCs) that share characteristics associated with normal stem cells, including self-renewal and multi-differentiation potential. CSCs are tumorigenic, play a critical role in cancer infiltration, recurrence, and distant metastasis, and significantly contribute to drug resistance to current therapeutic strategies, including immunotherapy. Cytotoxic CD8+ T lymphocytes (CTLs) are key immune cells that effectively recognize peptide antigens presented by the major histocompatibility complex class I molecules. Increasing evidence suggests that cancer antigen-specific targeting by CTLs effectively regulates CSCs that drive cancer progression. In this study, we utilized data from public domains and performed various bioassays on human oral squamous cell carcinoma clinical samples and cell lines, including HSC-2 and HSC-3, to investigate the potential role of olfactory receptor family 7 subfamily C member 1 (OR7C1), a seven transmembrane G-protein-coupled olfactory receptor that is also expressed in nonolfactory tissues and was previously reported as a novel marker and target of colon cancer initiating cell-targeted immunotherapy, in CSC-targeted treatment against oral cancer. We found that the OR7C1 gene was expressed only in oral CSCs, and that CTLs reacted with human leukocyte antigen-A24-restricted OR7C1 oral CSC-specific peptides. Taken together, our findings suggest that OR7C1 represents a novel target for potent CSC-targeted immunotherapy in oral cancer.
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Affiliation(s)
- Sho Miyamoto
- Department of Oral SurgerySapporo Medical University School of MedicineSapporoJapan
| | - Yoshihiko Hirohashi
- Department of PathologySapporo Medical University School of MedicineSapporoJapan
| | - Rena Morita
- Division of Fundamental Health Sciences, School of Nursing and Social ServicesHealth Sciences University of HokkaidoTobetsu‐ChoJapan
| | - Akihiro Miyazaki
- Department of Oral SurgerySapporo Medical University School of MedicineSapporoJapan
| | - Kazuhiro Ogi
- Department of Oral SurgerySapporo Medical University School of MedicineSapporoJapan
| | - Takayuki Kanaseki
- Department of PathologySapporo Medical University School of MedicineSapporoJapan
| | - Kentaro Ide
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of MedicineUniversity of the RyukyusNishiharaJapan
| | - Jumpei Shirakawa
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of MedicineUniversity of the RyukyusNishiharaJapan
| | - Tomohide Tsukahara
- Department of PathologySapporo Medical University School of MedicineSapporoJapan
| | - Aiko Murai
- Department of PathologySapporo Medical University School of MedicineSapporoJapan
| | - Takashi Sasaya
- Department of Oral SurgerySapporo Medical University School of MedicineSapporoJapan
- Department of PathologySapporo Medical University School of MedicineSapporoJapan
| | - Kazushige Koike
- Department of Oral SurgerySapporo Medical University School of MedicineSapporoJapan
| | - Shinichiro Kina
- Center for Medical EducationGunma University Graduate School of MedicineMaebashiJapan
| | - Toshihiro Kawano
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of MedicineUniversity of the RyukyusNishiharaJapan
| | - Takahiro Goto
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of MedicineUniversity of the RyukyusNishiharaJapan
| | - Edward Hosea Ntege
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of MedicineUniversity of the RyukyusNishiharaJapan
- Department of Plastic and Reconstructive Surgery, Graduate School of MedicineUniversity of the RyukyusNishiharaJapan
| | - Yusuke Shimizu
- Department of Plastic and Reconstructive Surgery, Graduate School of MedicineUniversity of the RyukyusNishiharaJapan
| | - Toshihiko Torigoe
- Department of PathologySapporo Medical University School of MedicineSapporoJapan
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Sun L, Candelieri-Surette D, Anglin-Foote T, Lynch JA, Maxwell KN, D’Avella C, Singh A, Aakhus E, Cohen RB, Brody RM. Cetuximab-Based vs Carboplatin-Based Chemoradiotherapy for Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2022; 148:1022-1028. [PMID: 36136306 PMCID: PMC9501776 DOI: 10.1001/jamaoto.2022.2791] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/28/2022] [Indexed: 12/13/2022]
Abstract
Importance Cetuximab-based and carboplatin-based chemoradiotherapy (CRT) are often used for patients with locally advanced head and neck cancer who are ineligible for cisplatin. There are no prospective head-to-head data comparing cetuximab-based and carboplatin-based regimens for radiosensitization. Objective To compare survival with cetuximab-based and carboplatin-based CRT in locally advanced head and neck squamous cell carcinoma (HNSCC). Design, Setting, and Participants This cohort study included US veterans who received a diagnosis of HNSCC between January 2006 and December 2020 and were treated with systemic therapy and radiation. Data cutoff was March 1, 2022 and data analysis was conducted from April-May 2022. Exposures Cisplatin, cetuximab, or carboplatin-based systemic therapy as captured in VA medication data and cancer registry. Main Outcomes and Measures Overall survival by systemic therapy was estimated using Kaplan-Meier methods. We used propensity score and inverse probability weighting to achieve covariate balance between cetuximab-treated and carboplatin-treated patients and used Cox regression to estimate cause-specific hazard ratios of death associated with carboplatin vs cetuximab. We also performed subgroup analyses of patients with oropharynx vs nonoropharynx primary sites. Results A total of 8290 patients (median [IQR] age, 63 [58-68] years; 8201 men [98.9%]; 1225 [15.8%] Black or African American and 6424 [82.6%] White individuals) with nonmetastatic HNSCC were treated with CRT with cisplatin (5566 [67%]), carboplatin (1231 [15%]), or cetuximab (1493 [18%]). Compared with cisplatin-treated patients, patients treated with carboplatin and cetuximab were older with worse performance status scores and higher comorbidity burden. Median (IQR) overall survival was 74.4 (22.3-162.2) months in patients treated with cisplatin radiotherapy (RT), 43.4 (15.3-123.8) months in patients treated with carboplatin RT, and 31.1 (12.4-87.8) months in patients treated with cetuximab RT. After propensity score and inverse probability weighting, carboplatin was associated with improved overall survival compared with cetuximab (cause-specific hazard ratio, 0.85; 95% CI, 0.78-0.93; P = .001). This difference was prominent in the oropharynx subgroup. Conclusions and Relevance In this cohort study of a US veteran population with HNSCC undergoing treatment with CRT, almost a third of patients were ineligible to receive treatment with cisplatin and received cetuximab-based or carboplatin-based radiosensitization. After propensity score matching, carboplatin-based systemic therapy was associated with 15% improvement in overall survival compared with cetuximab, suggesting that carboplatin may be the preferred radiosensitizer, particularly in oropharynx cancers.
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Affiliation(s)
- Lova Sun
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | | | - Tori Anglin-Foote
- VA Salt Lake City Health Care System, University of Utah, Salt Lake City
| | - Julie A. Lynch
- VA Salt Lake City Health Care System, University of Utah, Salt Lake City
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City
| | - Kara N. Maxwell
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Christopher D’Avella
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Aditi Singh
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Erin Aakhus
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Roger B. Cohen
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert M. Brody
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Department of Otorhinolaryngology–Head & Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Bioradiotherapy with Cetuximab May Reduce the Risk of Neck Node Relapse in Locoregionally Advanced Laryngeal Glottic Carcinoma: May HER1-Profile Be Useful in the Bioselection of Patients? J Pers Med 2022; 12:jpm12091489. [PMID: 36143274 PMCID: PMC9504760 DOI: 10.3390/jpm12091489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022] Open
Abstract
The aim of the study was to evaluate survival in patients with advanced glottic laryngeal squamous cell carcinoma treated by bioradiotherapy (BioRT) with cetuximab and eventual salvage surgery (group A, n = 66) or upfront surgery (total laryngectomy or near-total laryngectomy) with or without postoperative radiotherapy (PORT) (group B, n = 66). The predictive role of HER1 expression in the bioselection of tumors was evaluated. Relapse-free (RFS), metastasis-free (MFS), overall (OS) survivals, salvageability, and rates of larynx preservation were analyzed. The two groups were balanced by propensity score method on their baseline characteristics. No significant differences in RFS and OS were found, while MFS results were significantly higher in group A (p = 0.04). Group A showed a 22% reduction in the probability of nodal metastasis (p = 0.0023), mostly in tumors with higher HER1 expression. The salvageability with TL at 3 years was 54% after prior BioRT and 18% after prior upfront NTL (p < 0.05). BioRT with cetuximab showed a reduction in the risk of lymph node relapse, particularly in the case of HER1 positive tumors, and it allowed to achieve a higher rate of functional larynx preservation and a higher salvageability compared with upfront surgery. HER1 analysis could be clinically useful in the bioselection of tumors that may benefit from BioRT with cetuximab, particularly in those with neck node metastatic propensity.
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Korpics MC, Turchan WT, Koshy M, Spiotto MT. Decreased overall survival in patients with locally advanced head and neck cancer receiving definitive radiotherapy and concurrent cetuximab: National Cancer Database analysis. Head Neck 2022; 44:1528-1544. [PMID: 35393753 DOI: 10.1002/hed.27050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/12/2022] [Accepted: 03/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Recently, randomized trials have questioned the efficacy of cetuximab-based bioradiotherapy compared to chemoradiation for patients with squamous cell carcinoma of the oropharynx, larynx, and hypopharynx (HNSCC). We compared the OS of patients treated with radiotherapy alone (RTonly), chemoradiotherapy (chemoRT), and bioradiotherapy (cetuxRT). METHODS Patients with stage III-IVB HNSCC treated with RTonly, chemoRT, or cetuxRT were identified in the National Cancer Database. OS was estimated using Cox proportional hazards. Analyses were conducted on the overall cohort and propensity matched cohorts. RESULTS 31 014 patients were treated with RTonly (22%), chemoRT (72%), or cetuxRT (6%) from 2013 to 2016. The 2-year OS was 69% for RTonly, 79% for chemoRT, and 66% for cetuxRT (p < 0.001). In the overall and propensity-matched cohorts, chemoRT and RTonly were associated with improved OS as compared to cetuxRT (p ≤ 0.001). CONCLUSION Compared to chemoRT or RTonly, cetuxRT is associated with decreased OS for patients with HNSCC, suggesting minimal benefit of bioradiotherapy in this population.
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Affiliation(s)
- Mark C Korpics
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - William Tyler Turchan
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Matthew Koshy
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Michael T Spiotto
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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5
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Postoperative chemoradiotherapy with cisplatin is superior to radioimmunotherapy with cetuximab and radiotherapy alone : Analysis of the Austrian head and neck cancer registry of the AGMT. Wien Klin Wochenschr 2021; 133:1131-1136. [PMID: 34528125 PMCID: PMC8599358 DOI: 10.1007/s00508-021-01939-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 08/11/2021] [Indexed: 12/15/2022]
Abstract
Background The addition of cisplatin or cetuximab to radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) has significantly improved the outcome. While the superiority of cisplatin over cetuximab in combination with radiotherapy has been shown in a definitive setting, we set out to compare postoperative chemoradiotherapy with cisplatin to radioimmunotherapy with cetuximab and radiotherapy alone within the Austrian head and neck cancer registry of the Working Group on Pharmaceutical Tumor Treatment (AGMT) study group. Material and methods In the AGMT head and neck cancer registry, data of 557 patients with SCCHN from five Austrian cancer centers were prospectively collected between 2012 and 2017. Of these patients 120 received postoperative chemoradiotherapy with cisplatin, 26 patients received postoperative radioimmunotherapy with cetuximab and 56 patients were treated with adjuvant radiotherapy only. Patient characteristics, stage of disease, details on treatment as well as survival were analyzed by a chart-based review. Results In patients treated with postoperative radiotherapy the addition of cisplatin significantly improved progression-free survival (PFS) and overall survival (OS) compared to cetuximab (PFS 84.2 months vs. 17.0 months, p = 0.04, OS not reached vs. 46.0 months, p = 0.02) and PFS compared to radiotherapy alone (PFS 84.2 months vs. 28.5 months, p < 0.01). Patients treated with cetuximab were significantly older and had a worse performance score than patients receiving cisplatin or radiotherapy alone. Conclusion This study confirmed the importance of multimodal treatment concepts in patients with locally advanced SCCHN. Postoperative cetuximab might be an option in patients not eligible for high-dose cisplatin but cisplatin should remain the standard of care.
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Larizadeh MH, Mohammadi F, Shabani M, Damghani MA. Induction Chemotherapy Followed by either Chemoradiotherapy or Bioradiotherapy in Laryngeal Cancer. Asian Pac J Cancer Prev 2021; 22:1633-1637. [PMID: 34048195 PMCID: PMC8408382 DOI: 10.31557/apjcp.2021.22.5.1633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: In loco regionally advanced head and neck cancer, the superiority of concomitant cetuximab with radiation over radiation alone has been proven previously. But comparison between chemo radiation and bioradiation has not been well studied. Methods: Between October 2013 and August 2017, 38 patients with locoregionally advanced laryngeal cancer and more than 50% response to 3 cycles of induction chemotherapy (docetaxel and cisplatin: both with a dose of 75 mg/m2 on the first day and 5-flurouracil: 750 mg/m2 during days 1to 3; repeated every 21 days) were selected to receive either carboplatin (18 patients, AUC 1.5 , weekly) or cetuximab (20 patients, with loading dose of 400 mg/m2 and weekly dose of 250 mg/m2) with radiation. A Kaplan–Meier analysis was used to calculate progression free survival and overall survival rates. The log–rank test was used to compare overall survival between treatment groups. Results: The median follow up time was 36 months. The 2-year organ preservation rate of 78.9% was achieved. The 3- year progression-free survival rates of 65.2%, 72.7% and 58.2% were observed for all patients, carboplatin group and cetuximab group, respectively (p=0.4). The 3-year estimates of overall survival were 67.8%, 69.2 %, and 66.3 % for all patients, carboplatin group and cetuximab group, respectively (p=0.47). Concomitant carboplatin was discontinued in 3 patients due to toxicity Conclusion: Concomitant cetuximab is a reasonable alternative to concomitant chemotherapy. But the difference in treatment outcome between bioradiation and chemoradiation remains to be defined.
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Affiliation(s)
- Mohammad Hasan Larizadeh
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Mohammadi
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Shabani
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Ali Damghani
- Department of Ear, Nose and Throat, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Mei M, Chen YH, Meng T, Qu LH, Zhang ZY, Zhang X. Comparative efficacy and safety of radiotherapy/cetuximab versus radiotherapy/chemotherapy for locally advanced head and neck squamous cell carcinoma patients: a systematic review of published, primarily non-randomized, data. Ther Adv Med Oncol 2020; 12:1758835920975355. [PMID: 33343720 PMCID: PMC7727048 DOI: 10.1177/1758835920975355] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/28/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Cetuximab (CTX) has been approved to be administered concurrently with radiotherapy (RT) to treat locally advanced head and neck squamous cell carcinoma (HNSCC). The aim of this study was to assess the efficacy and safety of concurrent CTX with RT (ExRT). Method: The PubMed, Cochrane Library, EMBASE databases were systematically searched to find relevant articles. The combined hazard ratio (HR), risk ratio (RR) and 95% confidence interval were calculated to assess the efficacy and safety of ExRT in contrast to concurrent platinum-based chemotherapy with RT (ChRT). Results: In total, 32 articles with 4556 patients were included. The pooled HRs indicated that ExRT achieved an unfavorable overall survival (HR: 1.86, p < 0.0001), disease-specific survival (HR: 2.58, p = 0.002), locoregional control (HR: 1.94, p < 0.00001), and progression-free survival (HR: 2.04, p = 0.003) compared with ChRT for locally advanced HNSCC patients. In human papillomavirus-positive patient subgroups, ExRT showed inferior disease-specific survival (HR: 2.55, p = 0.009) and locoregional control (HR: 2.27, p < 0.0001) in contrast to ChRT. Additionally, ExRT increased the occurrence of mucositis (RR: 1.17, p < 0.005), skin toxicity (RR: 6.26, p < 0.00001), and infection (RR: 2.27, p = 0.04) compared with non-CTX groups (ChRT and RT), and was associated with lower incidence of anemia (RR: 0.35, p = 0.009), leukocytopenia (RR: 0.17, p < 0.0001), neutropenia (RR: 0.06, p < 0.0001), nausea/vomiting (RR: 0.23, p < 0.0001), and renal toxicity (RR: 0.14, p = 0.007). Conclusion: ChRT should remain the standard treatment for locally advanced HNSCC patients. ExRT was recognized as an effective alternative treatment for locally advanced HNSCC patients who experienced unbearable toxicities caused by non-CTX treatments.
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Affiliation(s)
- Mei Mei
- First Clinical Division, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yu-Huan Chen
- First Clinical Division, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Tian Meng
- First Clinical Division, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ling-Han Qu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Zhi-Yong Zhang
- First Clinical Division, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, No. 37A Xishiku Road, Xichen District, Beijing, 100034, China
| | - Xiao Zhang
- First Clinical Division, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, No. 37A Xishiku Road, Xichen District, Beijing, 100034, China
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Gebre-Medhin M, Brun E, Engström P, Haugen Cange H, Hammarstedt-Nordenvall L, Reizenstein J, Nyman J, Abel E, Friesland S, Sjödin H, Carlsson H, Söderkvist K, Thomasson M, Zackrisson B, Nilsson P. ARTSCAN III: A Randomized Phase III Study Comparing Chemoradiotherapy With Cisplatin Versus Cetuximab in Patients With Locoregionally Advanced Head and Neck Squamous Cell Cancer. J Clin Oncol 2020; 39:38-47. [PMID: 33052757 PMCID: PMC7771720 DOI: 10.1200/jco.20.02072] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We performed an open-label randomized controlled phase III study comparing treatment outcome and toxicity between radiotherapy (RT) with concomitant cisplatin versus concomitant cetuximab in patients with locoregionally advanced head and neck squamous cell carcinoma (HNSCC; stage III-IV according to the Union for International Cancer Control TNM classification, 7th edition).
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Affiliation(s)
- Maria Gebre-Medhin
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Eva Brun
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per Engström
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Hedda Haugen Cange
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lalle Hammarstedt-Nordenvall
- Division of Ear, Nose, and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Jan Nyman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Edvard Abel
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Signe Friesland
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Helena Sjödin
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Carlsson
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Karin Söderkvist
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Marcus Thomasson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Björn Zackrisson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Per Nilsson
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
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Tang WH, Sun W, Long GX. Concurrent cisplatin or cetuximab with radiotherapy in patients with locally advanced head and neck squamous cell carcinoma: A meta-analysis. Medicine (Baltimore) 2020; 99:e21785. [PMID: 32899005 PMCID: PMC7478598 DOI: 10.1097/md.0000000000021785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Concurrent cisplatin with radiotherapy (CRT) or concurrent cetuximab with radiotherapy (BRT) improves outcomes in locally advanced head and neck squamous cell carcinoma (HNSCC) compared with radiotherapy alone. Nevertheless, a detailed comparison between CRT and BRT in locally advanced HNSCC is required due to inconclusive results. METHODS A comprehensive literature search was conducted on PubMed, Web of Science, Cochrane databases, and EMBASE. Studies that evaluated CRT vs BRT in locally advanced HNSCC were included. The primary outcome that was overall survival (OS), whereas the secondary outcomes were progression-free survival (PFS), locoregional control (LRC), and distant metastasis-free survival (DMFS). Pooled hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were used to evaluate prognosis. All the analyses were performed using Stata Statistical Software 12.0. RESULTS Twenty-three studies, with a total of 8701 patients, were considered eligible and included in this meta-analysis. Our results revealed that patients treated with CRT had longer OS (HR = 0.51, 95%CI, 0.41-0.64, P < .001), PFS (HR = 0.37, 95%CI, 0.23-0.60, P < .001), LRC (HR = 0.46, 95%CI, 0.37-0.57, P < .001), and DMFS (HR = 0.56, 95%CI, 0.40-0.77, P < .001) than those treated with BRT. Furthermore, the results of the subgroup analyses were consistent with the primary analysis. CONCLUSIONS CRT has a better OS, PFS, LRC, and DMFS than BRT in locally advanced HNSCC, and should be the preferred treatment for patients with the disease.
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Affiliation(s)
- Wen-Hua Tang
- Department of Oncology, Chengdu Seventh People's Hospital, Chengdu, Sichuan, China
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Sun
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guo-Xian Long
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Beckham TH, Barney C, Healy E, Wolfe AR, Branstetter A, Yaney A, Riaz N, McBride SM, Tsai CJ, Kang J, Yu Y, Chen L, Sherman E, Dunn L, Pfister DG, Tan J, Rupert R, Bonomi M, Zhang Z, Lobaugh SM, Grecula JC, Mitchell DL, Wobb JL, Miller ED, Blakaj DM, Diavolitsis VM, Lee N, Bhatt AD. Platinum-based regimens versus cetuximab in definitive chemoradiation for human papillomavirus-unrelated head and neck cancer. Int J Cancer 2019; 147:107-115. [PMID: 31609479 DOI: 10.1002/ijc.32736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/27/2019] [Accepted: 08/30/2019] [Indexed: 11/08/2022]
Abstract
For patients ineligible for cisplatin with definitive radiotherapy (CP-CRT) for locally advanced head and neck squamous cell carcinoma (LA-HNSCC), concurrent cetuximab (C225-RT) is a popular substitute. Carboplatin-based chemoradiation (CB-CRT) is another option; however, relative efficacies of CP-CRT, CB-CRT and C225-RT are unclear, particularly in the human papillomavirus (HPV)-unrelated population. We identified 316 patients with stage III-IVB cancers of the oropharynx (24.7%), larynx (58.2%) and hypopharynx (17.1%) undergoing definitive C225-RT (N = 61), CB-CRT (N = 74) or CP-CRT (N = 181). Kaplan-Meier and cumulative incidence functions were generated to estimate overall survival (OS), locoregional failure (LRF) and distant metastasis (DM). Cox proportional hazards were used to determine the association of survival endpoints with clinical characteristics. Respectively, 3-year cumulative incidences for CP-CRT, CB-CRT and C225-RT were: LRF (0.19, 0.18 and 0.48, p ≤ 0.001), DM (0.17, 0.12 and 0.25, p = 0.32). Kaplan-Meier estimates for 3 year OS were: CP-CRT: 71%; CB-CRT: 59% and C225-RT: 54%; p = 0.0094. CP-CRT (hazard ratio [HR] 0.336; 95% confidence interval [CI] 0.203-0.557, p < 0.01) and CB-CRT (HR 0.279; 95% CI 0.141-0.551, p < 0.01) were associated with reduced hazard for LRF on multivariable analysis. CP-CRT (HR 0.548; 95% CI 0.355-0.845, p < 0.01) and CB-CRT (HR 0.549; 95% CI 0.334-0.904, p = 0.02) were associated with a reduced hazard for death on multivariable analysis. Propensity matching confirmed reduced hazards with a combined CP/CB-CRT group compared to C225-RT for LRF: HR 0.384 (p = 0.018) and OS: HR 0.557 (p = 0.045) and CB-CRT group compared to C225-RT for LRF: HR 0.427 (p = 0.023). In conclusion, CB-CRT is an effective alternative to CP-CRT in HPV-unrelated LA-HNSCC with superior locoregional control and OS compared to C225-RT.
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Affiliation(s)
- Thomas H Beckham
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christian Barney
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH.,Methodist Health System, Omaha, NE
| | - Erin Healy
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Adam R Wolfe
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Andrew Branstetter
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alexander Yaney
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Julie Kang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Linda Chen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Sherman
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lara Dunn
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David G Pfister
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeremy Tan
- Department of Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Robert Rupert
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Marcelo Bonomi
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, Omaha, NE
| | - Stephanie M Lobaugh
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, Omaha, NE
| | - John C Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Darrion L Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jessica L Wobb
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH.,Fort Hamilton Hospital, Kettering Medical Center, Hamilton, OH
| | - Eric D Miller
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Virginia M Diavolitsis
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH.,Riverside Radiation Oncology, OhioHealth, Columbus, OH
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aashish D Bhatt
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH.,UH Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
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Cisplatin-based chemoradiotherapy vs. cetuximab-based bioradiotherapy for p16-positive oropharyngeal cancer: an updated meta-analysis including trials RTOG 1016 and De-ESCALaTE. Eur Arch Otorhinolaryngol 2019; 276:1275-1281. [DOI: 10.1007/s00405-019-05387-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/12/2019] [Indexed: 12/22/2022]
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12
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Amini A, Eguchi M, Jones BL, Stokes WA, Gupta A, McDermott JD, Massarelli E, Bradley CJ, Karam SD. Comparing outcomes of concurrent chemotherapy regimens in patients 65 years old or older with locally advanced oropharyngeal carcinoma. Cancer 2018; 124:4322-4331. [PMID: 30291789 PMCID: PMC6892396 DOI: 10.1002/cncr.31740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The comparative efficacy of cisplatin (CDDP), carboplatin, and cetuximab (CTX) delivered concurrently with radiation for locally advanced oropharyngeal squamous cell carcinoma continues to be evaluated. METHODS The linked Surveillance, Epidemiology, and End Results-Medicare database was used to identify and compare patient and disease profiles, mortality, toxicity, and overall cost for patients with oropharynx cancer undergoing definitive concurrent chemoradiation with CDDP, carboplatin, or CTX between 2006 and 2011. The human papillomavirus status was unknown. The primary outcome was 2-year overall survival (OS). RESULTS Four hundred nine patients receiving concurrent CDDP (n = 167), carboplatin (n = 69), or CTX (n = 173) were included. Those who were older, those who were nonwhite, and those with a Charlson Comorbidity Index ≥ 2 were less likely to receive CDDP. Two-year OS was inferior with CTX (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.08-2.60; P = .020) and no different with carboplatin (HR, 1.31; 95% CI, 0.73-2.35; P = .362) in a Cox proportional hazards model (reference CDDP). There was no statistically significant difference between carboplatin and CTX (HR, 1.28; 95% CI, 0.77-2.14; P = .891). Rates of antiemetic use and hospital visits for nausea/emesis/diarrhea or dehydration were statistically higher with CDDP. Pneumonia rates were higher with carboplatin. In the multivariate model, the corrected mean per-patient spending was significantly higher for CTX and carboplatin than CDDP ($61,133 and $65,721 vs $48,709). CONCLUSIONS Patients who received CDDP had improved OS. CDDP was also associated with slightly lower overall costs and higher antiemetic usage and hospital visit rates, although a strong selection bias was observed because those receiving CTX and carboplatin were older and had higher comorbidity scores.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
- Department of Radiation Oncology, City of Hope Cancer Center, Duarte, California
| | - Megan Eguchi
- Department of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L. Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - William A. Stokes
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Abhinav Gupta
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica D. McDermott
- Department of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Erminia Massarelli
- Department of Radiation Oncology, City of Hope Cancer Center, Duarte, California
| | - Cathy J. Bradley
- Department of Health Systems Management and Policy, Colorado Comprehensive Cancer Center, University of Colorado, Aurora, Colorado
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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13
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Xiang M, Holsinger FC, Colevas AD, Chen MM, Le QT, Beadle BM. Survival of patients with head and neck cancer treated with definitive radiotherapy and concurrent cisplatin or concurrent cetuximab: A Surveillance, Epidemiology, and End Results-Medicare analysis. Cancer 2018; 124:4486-4494. [PMID: 30332498 DOI: 10.1002/cncr.31708] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cisplatin and cetuximab are both systemic therapies commonly used in combination with radiation (RT) for the definitive treatment of head and neck cancers, but their comparative efficacy is unclear. METHODS Patients with locoregionally advanced (American Joint Committee on Cancer stage III-IVB) squamous cell carcinomas of the oropharynx, larynx, or hypopharynx were identified in the Surveillance, Epidemiology, and End Results-Medicare database. Patients received either cisplatin or cetuximab concurrent with RT, as determined by Medicare claims. The primary study outcome was head and neck cancer-specific mortality (CSM) analyzed with competing risks. Filtering, propensity score matching, and multivariable Fine-Gray regression were used to adjust for differences between the cisplatin and cetuximab cohorts, including age, comorbidity, and cycles of systemic therapy received. RESULTS The total cohort consisted of 1395 patients, of whom 786 (56%) received cisplatin and 609 (44%) received cetuximab; the median follow-up was 3.5 years in the patients who remained alive. In the cetuximab cohort, CSM was significantly higher than in the cisplatin cohort (39% vs 25% at 3 years; P < .0001). In the matched cohorts (n = 414), the adjusted hazard ratio of CSM for cetuximab was 1.65 (95% confidence interval, 1.30-2.09; P < .0001) relative to cisplatin, corresponding to an absolute difference of approximately 10% in both CSM and overall survival at 3 years. Cetuximab was associated with less dysphagia, more dermatitis, and a similar incidence of mucositis. CONCLUSIONS In this sizeable, national patient population, treatment with cetuximab was associated with significantly higher CSM than cisplatin. These results suggest that cisplatin may be the preferred chemotherapeutic agent in this setting.
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Affiliation(s)
- Michael Xiang
- Department of Radiation Oncology, Stanford University, Stanford, California, United States
| | - F Christopher Holsinger
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University, Stanford, California, United States
| | - A Dimitrios Colevas
- Department of Medicine, Division of Oncology, Stanford University, Stanford, California, United States
| | - Michelle M Chen
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University, Stanford, California, United States
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California, United States
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California, United States
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14
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Onita B, Lester D R T, Iman A A, Jergin C, Shawn I. Comparison of high-dose Cisplatin-based chemoradiotherapy and Cetuximab-based bioradiotherapy for p16-positive oropharyngeal squamous cell carcinoma in the context of revised HPV-based staging. Rep Pract Oncol Radiother 2018; 23:451-457. [PMID: 30210266 DOI: 10.1016/j.rpor.2018.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/16/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022] Open
Abstract
AIM To perform a comparison of Cisplatin vs. Cetuximab in p16-positive oropharyngeal squamous cell carcinoma (OPSCC) in the context of the revised HPV-based staging. BACKGROUND Previous reports comparing these agents in head and neck cancer have included heterogenous disease and p16-status. MATERIALS AND METHODS A retrospective review was conducted from 2006 to 2016 of patients with p16-positive OPSCC who underwent definitive radiotherapy concurrent with either triweekly Cisplatin (n = 251) or Cetuximab (n = 40). AJCC 8th Edition staging was adapted. RESULTS Median follow-up for surviving patients was 40 months. On multivariate analysis for all-comers, comparing Cisplatin and Cetuximab, 3-year locoregional recurrence (LRR): 6% vs. 16% (p = 0.07), 3-year distant metastasis (DM): 8% vs. 21% (p = 0.04), 3-year overall recurrence rate (ORR): 11% vs. 29% (p = 0.01), and 3-year cause-specific survival (CSS): 94% vs. 79% (p = 0.06), respectively. On stage-based subgroup analysis, for stage I-II disease, 3-year LRR: 5% vs. 10% (p = 0.51), 3-year DM: 7% vs. 16% (p = 0.32), 3-year ORR: 10% vs. 23% (p = 0.15), and 3-year CSS: 95% vs. 82% (p = 0.38). For stage III disease, 3-year LRR: 10% vs. 40% (p = 0.07), 3-year DM: 9% vs. 43% (p = 0.07), 3-year ORR: 15% vs. 55% (p = 0.04), and 3-year CSS: 94% vs. 57% (p = 0.048). CONCLUSIONS When given concurrently with radiotherapy, Cetuximab and triweekly Cisplatin demonstrated comparable efficacy for AJCC 8th Edition stage I-II p16-positive OPSCC. However, Cetuximab appeared to be associated with higher rates of treatment failure and cancer-related deaths in stage III disease. Upon availability of the RTOG 1016 trial results, analysis based on the revised HPV-based staging should be performed to confirm these findings.
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Affiliation(s)
- Bhattasali Onita
- Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles Medical Center, 4950 Sunset Boulevard, Los Angeles, CA, USA
| | - Thompson Lester D R
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Ave, Woodland Hills, CA, USA
| | - Abdalla Iman A
- Department of Hematology/Oncology, Southern California Permanente Medical Group, Los Angeles Medical Center, 1515 North Vermont Avenue, Los Angeles, CA, USA
| | - Chen Jergin
- Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles Medical Center, 4950 Sunset Boulevard, Los Angeles, CA, USA
| | - Iganej Shawn
- Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles Medical Center, 4950 Sunset Boulevard, Los Angeles, CA, USA
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15
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Bhatia S, Sharma J, Bukkapatnam S, Oweida A, Lennon S, Phan A, Milner D, Uyanga N, Jimeno A, Raben D, Somerset H, Heasley L, Karam SD. Inhibition of EphB4-Ephrin-B2 Signaling Enhances Response to Cetuximab-Radiation Therapy in Head and Neck Cancers. Clin Cancer Res 2018; 24:4539-4550. [PMID: 29848571 DOI: 10.1158/1078-0432.ccr-18-0327] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/23/2018] [Accepted: 05/25/2018] [Indexed: 01/30/2023]
Abstract
Purpose: The clinical success of targeted therapies such as cetuximab and radiotherapy (RT) is hampered by the low response rates and development of therapeutic resistance. In the current study, we investigated the involvement of EphB4-ephrin-B2 protumorigenic signaling in mediating resistance to EGFR inhibition and RT in head and neck cancers.Experimental Design: We used patient-derived xenograft (PDX) models of head and neck squamous cell carcinoma (HNSCC) and HNSCC cell lines to test our hypothesis. Tumor tissues were subjected to PhosphoRTK array, and Western blotting to detect changes in EphB4-ephrin-B2 targets. mRNA sequencing and microarray data analysis were performed on PDX tumors and HNSCC cell lines, respectively, to determine differences in gene expression of molecules involved in tumor cell growth, proliferation, and survival pathways. Effects on cell growth were determined by MTT assay on HNSCC cells downregulated for EphB4/ephrin-B2 expression, with and without EGFR inhibitor and radiation.Results: Our data from locally advanced HNSCC patients treated with standard-of-care definitive chemo-RT show elevated EphB4 and ephrin-B2 levels after failure of treatment. We observed significant response toward cetuximab and RT following EphB4-ephrin-B2 inhibition, resulting in improved survival in tumor-bearing mice. Tumor growth inhibition was accompanied by a decrease in the levels of proliferation and prosurvival molecules and increased apoptosis.Conclusions: Our findings underscore the importance of adopting rational drug combinations to enhance therapeutic effect. Our study documenting enhanced response of HNSCC to cetuximab-RT with EphB4-ephrin-B2 blockade has the potential to translate into the clinic to benefit this patient population. Clin Cancer Res; 24(18); 4539-50. ©2018 AACR.
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Affiliation(s)
- Shilpa Bhatia
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Jaspreet Sharma
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Sanjana Bukkapatnam
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Ayman Oweida
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Shelby Lennon
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Andy Phan
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Dallin Milner
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Nomin Uyanga
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Antonio Jimeno
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Hilary Somerset
- Department of Pathology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Lynn Heasley
- Department of Craniofacial Biology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
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Carlsson L, Bratman SV, Siu LL, Spreafico A. The Cisplatin Total Dose and Concomitant Radiation in Locoregionally Advanced Head and Neck Cancer: Any Recent Evidence for Dose Efficacy? Curr Treat Options Oncol 2018; 18:39. [PMID: 28555374 DOI: 10.1007/s11864-017-0482-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OPINION STATEMENT Concurrent chemoradiotherapy (CRT) with high-dose (100 mg/m2), single-agent cisplatin is considered the standard of care for locoregionally advanced head and neck cancer (LAHNC). Poor compliance often due to significant treatment-related toxicities observed during CRT regimen has stimulated research efforts to examine for evidence of the optimal cumulative cisplatin dose and schedule. The findings from this systematic literature review demonstrate that there are insufficient prospective, randomized controlled data to determine the optimal total dose (and schedule) of cisplatin to administer concomitantly with radiotherapy in the treatment of LAHNC. Given the clinical challenges associated with administering concurrent CRT with single-agent high-dose cisplatin, as well as the long-term toxicities accompanying this treatment, an examination of the available literature for evidence of dose efficacy is of continued clinical interest. Moving forward, it is critical that researchers include complete descriptions of key disease and treatment variables (i.e. treatment compliance and HPV status) to inform and strengthen clinical decisions. The substantial heterogeneity of LAHNC has led to the focus of recent research efforts to risk-stratify using a combination of clinical and molecular markers (e.g. HPV status). Thus, the optimal total dose (and schedule) of cisplatin may need to be modified to reflect the specific characteristics of the individual patient subpopulations being treated. At present, CRT remains the standard of care for LAHNC, but this field is rapidly evolving. National and international clinical trials are ongoing to evaluate treatment de-intensification in favourable risk patient subsets and treatment intensification in poor-risk patient subsets, these will provide evidence-based guidance to individualize therapy with the ultimate goal of improving patient outcomes.
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Affiliation(s)
- Lindsay Carlsson
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 700 University Avenue, Toronto, ON, CA M5G 1Z5, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 700 University Avenue, Toronto, ON, CA M5G 1Z5, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 700 University Avenue, Toronto, ON, CA M5G 1Z5, Canada.
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Bonomo P, Loi M, Desideri I, Olmetto E, Delli Paoli C, Terziani F, Greto D, Mangoni M, Scoccianti S, Simontacchi G, Francolini G, Meattini I, Caini S, Livi L. Incidence of skin toxicity in squamous cell carcinoma of the head and neck treated with radiotherapy and cetuximab: A systematic review. Crit Rev Oncol Hematol 2017; 120:98-110. [DOI: 10.1016/j.critrevonc.2017.10.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 09/28/2017] [Accepted: 10/29/2017] [Indexed: 12/27/2022] Open
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18
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Cetuximab for Squamous Cell Carcinoma of the Head and Neck. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.10502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mehta V, Moore-Medlin T, Flores JM, Ma X, Ekshyyan O, Nathan CAO. Survival outcomes based on systemic agent used concurrently with radiation in human-papillomavirus associated oropharyngeal cancer. Oncotarget 2017; 8:70907-70915. [PMID: 29050332 PMCID: PMC5642607 DOI: 10.18632/oncotarget.20197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/17/2017] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate survival outcomes of patients treated with concurrent cetuximab and radiotherapy for primary management of both HPV positive and negative OPSCC, and compare the results to traditional platinum-based therapy. We hypothesize that the use of cetuximab in the HPV positive OPSCC patients will result in inferior survival based on tumor biological differences. STUDY DESIGN A single institution retrospective analysis of 304 patients. The primary outcomes of interest were 1) overall survival and 2) relapse free survival. Pearson Chi-square tests were used to compare proportions between subgroups. One-way analysis of variance was used to compare the continuous variable age between subgroups. Kaplan-Meier method was used to produce survival curves, and comparisons between survival curves were made using the log-rank test. The survival functions comparing subgroups of chemotherapy were analyzed using semi-parametric (i.e. Cox proportional hazards models) and fully parametric regression with Weibull distributions. Multivariable models were adjusted for age at diagnosis, gender, race, chemotherapy, radiotherapy, and cancer stage. RESULTS In the multivariable analysis, the hazard ratio for cetuximab compared to cisplatin or carboplatin/paclitaxel was HR=0.77[95% CI = 0.67, 0.90] in the HPV - group, suggesting more favorable outcomes for the patients on cetuximab in this group. However, in the HPV + cohort, the hazard ratio was 1.88 [95% CI = 1.42, 2.50] for those patients treated with cetuximab vs platinum-based therapy. CONCLUSIONS Our data suggest that cetuximab may have inferior outcomes in HPV-associated OPSCC compared to traditional platinum-based therapy.
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Affiliation(s)
- Vikas Mehta
- Departments of Otolaryngology-Head and Neck Surgery, Louisiana State University Health and Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Tara Moore-Medlin
- Departments of Otolaryngology-Head and Neck Surgery, Louisiana State University Health and Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Jose M Flores
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaohui Ma
- Departments of Otolaryngology-Head and Neck Surgery, Louisiana State University Health and Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Oleksandr Ekshyyan
- Departments of Otolaryngology-Head and Neck Surgery, Louisiana State University Health and Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Cherie-Ann O Nathan
- Departments of Otolaryngology-Head and Neck Surgery, Louisiana State University Health and Feist-Weiller Cancer Center, Shreveport, LA, USA
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20
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A comparison of concurrent cisplatin versus cetuximab with radiotherapy in locally-advanced head and neck cancer: A bi-institutional analysis. Rep Pract Oncol Radiother 2017; 22:389-395. [PMID: 28808428 DOI: 10.1016/j.rpor.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/06/2017] [Accepted: 07/11/2017] [Indexed: 12/30/2022] Open
Abstract
AIM To present our experience comparing cisplatin- and cetuximab-based radiotherapy for locally-advanced head and neck squamous cell carcinoma. BACKGROUND The comparative effectiveness of cisplatin-based chemoradiotherapy (CRT) versus cetuximab-based bioradiotherapy (BRT) for locally-advanced head and neck squamous cell carcinoma (LAHNSCC) continues to be explored. MATERIALS AND METHODS Outcomes of LAHNSCC patients treated with CRT (125) or BRT (34) at two institutions were compared retrospectively, with attention to overall survival (OS), cancer-specific survival (CSS), locoregional control (LRC), and distant control (DC). Univariate analysis (UVA) using Cox regression was performed to explore the association of intervention with survival and disease control, and multivariate (MVA) Cox regression was then performed to assess the association of intervention with survival. RESULTS There were significant baseline differences between the CRT and BRT groups with respect to age, race, performance status, N-classification, tobacco history, and human papillomavirus status. UVA demonstrated inferiority of BRT versus CRT with respect to both OS (hazard ratio [HR] 2.19, 95% confidence interval [95%CI] 1.03-4.63, p = 0.04) and CSS (HR 3.33, 95%CI 1.42-7.78, p < 0.01), but non-significantly different outcomes in LRC (HR 0.99, 95%CI 0.37-2.61, p = 0.98) and DC (HR 2.01, 95%CI 0.78-5.37, p = 0.14). On MVA, there was no significant OS difference between interventions (HR 1.19, 95%CI 0.42-3.35, p = 0.74); there were too few events for the other outcomes to draw meaningful conclusions with MVA. CONCLUSIONS In our retrospective analysis, patients undergoing CRT experienced improved OS and CSS over those receiving BRT; however, disease control did not significantly differ. These findings may inform management of LAHNSCC patients.
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Weller MA, Ward MC, Berriochoa C, Reddy CA, Trosman S, Greskovich JF, Nwizu TI, Burkey BB, Adelstein DJ, Koyfman SA. Predictors of distant metastasis in human papillomavirus-associated oropharyngeal cancer. Head Neck 2017; 39:940-946. [PMID: 28188964 DOI: 10.1002/hed.24711] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 11/23/2016] [Accepted: 12/12/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-positive oropharyngeal cancer is associated with favorable outcomes, prompting investigations into treatment deintensification. The purpose of this study was for us to present the predictors of distant metastases in patients with HPV-positive oropharyngeal cancer treated with cisplatin-based chemoradiotherapy (CRT) or cetuximab-based bioradiotherapy (bio-RT). METHODS In patients with stage III to IVb HPV-positive oropharyngeal cancer, the Kaplan-Meier analysis was used to calculate distant metastases rates. Univariate analysis (UVA) and multivariate analysis (MVA) were used to identify factors associated with distant metastases. RESULTS Increased distant metastases rates were noted in active smokers versus never/former smokers (22% vs 5%), T4 vs T1 to T3 (15% vs 6%), and cetuximab-based bio-RT versus CRT (23% vs 5%). All remained significant on MVA. CONCLUSION T4 tumors and active smokers have substantial rates of distant metastases, and trials investigating intensified systemic therapies may be considered. Higher rates of distant metastases observed with concurrent cetuximab are hypothesis generating, but further data are needed. © 2017 Wiley Periodicals, Inc. Head Neck 39: 940-946, 2017.
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Affiliation(s)
- Michael A Weller
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Matthew C Ward
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | | | - Chandana A Reddy
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Samuel Trosman
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Brian B Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
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Vesci L, Milazzo FM, Anastasi AM, Petronzelli F, Chiapparino C, Carollo V, Roscilli G, Marra E, Luberto L, Aurisicchio L, Pacello ML, Spagnoli LG, De Santis R. Intra-tumor AvidinOX allows efficacy of low dose systemic biotinylated Cetuximab in a model of head and neck cancer. Oncotarget 2016; 7:914-28. [PMID: 26575422 PMCID: PMC4808042 DOI: 10.18632/oncotarget.6089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/26/2015] [Indexed: 12/15/2022] Open
Abstract
For locally advanced and metastatic head and neck squamous cell carcinoma (HNSCC), the current clinical use of Cetuximab in chemo/radiotherapy protocols is often associated to severe systemic toxicity. Here we report in vitro data in human FaDu pharynx SCC cells, showing that inactive concentrations of biotinylated Cetuximab (bCet) become active upon anchorage to AvidinOX on the surface of tumor cells. AvidinOX-anchored bCet induces apoptosis and DNA damage as well as specific inhibition of signaling, degradation and abrogation of nuclear translocation of EGFR. In the mouse model of FaDu cancer, we show that intra-tumor injection of AvidinOX allows anti-tumor activity of an otherwise inactive, intraperitoneally delivered, low dose bCet. Consistently with in vitro data, in vivo tumor inhibition is associated to induction of apoptosis, DNA damage and reduced angiogenesis. AvidinOX is under clinical investigation for delivering radioactive biotin to inoperable tumors (ClinicalTrials.gov NCT02053324) and present data support its use for the local treatment of HNSCC in combination with systemic administration of low dose bCet.
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Affiliation(s)
- Loredana Vesci
- Biotechnology, Research & Development, Sigma-Tau SpA, 00071 Pomezia, Rome, Italy
| | | | - Anna Maria Anastasi
- Biotechnology, Research & Development, Sigma-Tau SpA, 00071 Pomezia, Rome, Italy
| | - Fiorella Petronzelli
- Biotechnology, Research & Development, Sigma-Tau SpA, 00071 Pomezia, Rome, Italy
| | - Caterina Chiapparino
- Biotechnology, Research & Development, Sigma-Tau SpA, 00071 Pomezia, Rome, Italy
| | - Valeria Carollo
- Tissue Macro Array Lab, University of Tor Vergata, via della Ricerca Scientifica, 00133, Rome, Italy
| | | | | | | | | | | | - Luigi Giusto Spagnoli
- Tissue Macro Array Lab, University of Tor Vergata, via della Ricerca Scientifica, 00133, Rome, Italy
| | - Rita De Santis
- Biotechnology, Research & Development, Sigma-Tau SpA, 00071 Pomezia, Rome, Italy
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Anti EGFR therapy in the treatment of non-metastatic head and neck squamous cell carcinoma: The current evidence. J Egypt Natl Canc Inst 2016; 28:141-8. [DOI: 10.1016/j.jnci.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022] Open
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24
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Huang J, Zhang J, Shi C, Liu L, Wei Y. Survival, recurrence and toxicity of HNSCC in comparison of a radiotherapy combination with cisplatin versus cetuximab: a meta-analysis. BMC Cancer 2016; 16:689. [PMID: 27565887 PMCID: PMC5002133 DOI: 10.1186/s12885-016-2706-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 08/10/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cisplatin-based treatment has been considered the standard treatment regimen of HNSCC. Cetuximab is an emerging target therapy that has potential therapeutic benefits over cisplatin. Nevertheless, curative effects of cisplatin-based chemoradiotherapy (CRT) versus cetuximab-based bioradiotherapy (BRT) are still controversial. METHODS Potentially eligible studies were retrieved using PubMed, Embase and Medline. Basic characteristics of patients and statistical data were collected. A meta-analysis model was established to compare CRT and BRT. RESULTS Thirty-one eligible studies and 4212 patients were found. The pooled HRs with 95 % confidence intervals (CIs) for OS and PFS were 0.32 [0.09, 0.55] and 0.51 [0.22, 0.80], respectively, and both were in favor of cisplatin. However, 3-year survival and recurrence analysis of the subgroups showed no differences between the two groups (p > 0.05). In subgroup analysis, oropharyngeal primary tumors exhibited improved results by cetuximab with a pooled HR of 1.56 [1.14, 2.13] for PFS. Additionally, the HPV+ status was a significant factor in positive outcomes with cetuximab with a pooled HR of 1.12 [0.46, 2.17] for OS. CONCLUSION Long-term use of BRT showed no significant difference compared with CRT, and both arms showed different aspects of toxicity. In subgroup analysis, taking the effects of treatment and adverse events into consideration, cetuximab plus radiation may show superior responses regarding OS and PFS in patients who have HPV+ or primary oropharyngeal HNSCC, respectively, but physicians should administer them with caution.
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Affiliation(s)
- Jingwen Huang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zhang
- West China Medical School, West China Hospital, Sichuan University, Chengdu, China
| | - Changle Shi
- West China Medical School, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School Sichuan University, Chengdu, China.
| | - Yuquan Wei
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School Sichuan University, Chengdu, China
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25
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Ou D, Levy A, Blanchard P, Nguyen F, Garberis I, Casiraghi O, Scoazec JY, Janot F, Temam S, Deutsch E, Tao Y. Concurrent chemoradiotherapy with cisplatin or cetuximab for locally advanced head and neck squamous cell carcinomas: Does human papilloma virus play a role? Oral Oncol 2016; 59:50-57. [DOI: 10.1016/j.oraloncology.2016.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 12/25/2022]
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26
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Bonner JA, Giralt J, Harari PM, Baselga J, Spencer S, Bell D, Raben D, Liu J, Schulten J, Ang KK, Rosenthal DI. Association of human papillomavirus and p16 status with mucositis and dysphagia for head and neck cancer patients treated with radiotherapy with or without cetuximab: Assessment from a phase 3 registration trial. Eur J Cancer 2016; 64:1-11. [PMID: 27323346 PMCID: PMC5027878 DOI: 10.1016/j.ejca.2016.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/28/2016] [Accepted: 05/06/2016] [Indexed: 11/19/2022]
Abstract
Background Mucositis and dysphagia are common adverse effects of radiotherapy (RT) treatment of locally advanced squamous cell cancer of the head and neck (LA-SCCHN). Chemotherapy added to RT increases survival rates but causes worse mucositis and dysphagia. The aim of this analysis was to assess the impact of p16 status on mucositis, dysphagia, and feeding tube use in LA-SCCHN among patients treated with RT ± cetuximab in the phase 3 IMCL-9815 trial. Methods Patients received RT plus weekly cetuximab or RT alone. Subgroup analyses were conducted on patients with p16-positive (n = 75) or p16-negative (n = 106) oropharyngeal cancer (OPC), as determined by immunohistochemical analysis. The onset and duration of mucositis and dysphagia by treatment arm and p16 status were displayed using Kaplan–Meier curves and the log-rank test. P values for the incidence of mucositis and dysphagia were calculated using the Fisher exact test. Feeding tube use was assessed as the percent of patients reporting use. Results The baseline characteristics of patients treated with RT ± cetuximab were similar in both the p16-positive and p16-negative OPC subgroups. Patients within the p16-positive OPC subgroup had higher Karnofsky scores and were more likely to have stage T1–T3 cancer and be from the United States. Regardless of p16 status, there was no difference in the onset or duration of grade 3/4 mucositis or dysphagia in patient receiving RT plus cetuximab compared with those receiving RT alone. In the overall population, and the p16-positive and p16-negative OPC subpopulations, feeding tube use was not different for patients receiving RT plus cetuximab compared with RT alone. Conclusion Regardless of p16 status, the addition of cetuximab to RT did not alter the incidence, time to onset, severity, or duration of mucositis and dysphagia and did not impact the frequency of feeding tube use.
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Affiliation(s)
- James A Bonner
- University of Alabama at Birmingham Comprehensive Cancer Center, Department of Radiation Oncology, 619 19th Street South, Birmingham, AL 35233, USA.
| | - Jordi Giralt
- Servei d'Oncologia Radioteràpica, Hospital Universitari Valld'Hebron, 08035 Barcelona, Spain
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue K4/336, Madison, WI 53792, USA
| | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sharon Spencer
- University of Alabama, Hazelrig-Salter Radiation Oncology Center, 1700 6th Avenue South, Birmingham, AL 35233, USA
| | - Diana Bell
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - David Raben
- Department of Radiation Oncology at the Anschutz Medical Campus, 1665 Aurora Court, Suite 1032, Aurora, CO 80045, USA
| | | | - Jeltje Schulten
- Merck KGaA, Frankfurter Str 250, 135/001, 64293 Darmstadt, Germany
| | - Kian K Ang
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - David I Rosenthal
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Tjioe KC, Tostes Oliveira D, Gavard J. Luteolin Impacts on the DNA Damage Pathway in Oral Squamous Cell Carcinoma. Nutr Cancer 2016; 68:838-47. [DOI: 10.1080/01635581.2016.1180411] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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