1
|
Runge CL, Lyness J, Gillison M, Adelstein DJ, Harari PM, Ringash JG, Geiger JL, Krempl GA, Blakaj D, Bates J, Galloway TJ, Jones CU, Gensheimer M, Dunlap NE, Phan J, Caudell J, Pennington D, Torres-Saavedra P, Yom SS, Le QT, Movsas B. Hearing Outcomes in Cisplatin or Cetuximab Combined with Radiation for Patients with HPV-Associated Oropharyngeal Cancer in NRG/RTOG 1016. Int J Radiat Oncol Biol Phys 2023; 117:S122-S123. [PMID: 37784317 DOI: 10.1016/j.ijrobp.2023.06.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) NRG/RTOG 1016 was a noninferiority phase 3 trial comparing the efficacy of radiation with either cisplatin (RT+Cisp) or cetuximab (RT+Cetux) for patients with HPV+ oropharyngeal cancer (OPC). Perceived hearing handicap was included as a patient-reported outcome (PRO) secondary endpoint. The primary hypothesis was that perceived hearing handicap would be greater for patients receiving RT+Cisp compared to RT+Cetux. MATERIALS/METHODS Perceived hearing handicap was measured at baseline, end of treatment, 3, 6, and 12-months post-treatment using the Hearing Handicap Inventory for Adults Screening Version (HHIA-S), a 10-item self-assessment questionnaire designed to measure patients' reactions to their hearing loss. Total HHIA-S scores range from 0 to 40; higher total score indicates more severe perceived hearing handicap. Hearing handicap categories (none, mild/moderate, and severe) were also analyzed. Mixed ordinal logistic models were used to analyze the raw HHIA-S scores and handicap categories (2-sided alpha 0.05). RESULTS Participation in the PRO assessments was optional, with 368 patients participating in the hearing PRO. No significant differences in patient/tumor characteristics were found between PRO participants/non-participants. Pre-treatment (mean [SD]) HHIA-S scores were not different for RT+Cisp (3.23 [6.28]) and RT+Cetux (4.77 [8.14]) groups. Post-treatment HHIA-S scores increased for RT+Cisp, and remained stable at the later follow-up time points. RT+Cetux scores remained stable from baseline. Change score from pre- to post-treatment was higher for RT+Cisp (4.32, 95% CI = [2.57, 6.07]) than RT+Cetux (0.08, 95% CI = [-1.15, 1.31]; p < 0.001). For hearing handicap category, post-treatment RT+Cisp had a significantly higher percentage of mild/moderate and severe cases (32%) compared to RT+Cetux (20%). From pre- to post-treatment, worsening of hearing handicap category from normal to mild/moderate or severe was greater for RT+Cisp (24%) than for RT+Cetux (9%). The conditional odds of being in a higher self-perceived hearing handicap category in the RT+Cisp arm were 3.57 (95% CI [2.04, 6.25]) times that in the RT+Cetux arm. Averaging over patients, the marginal odds ratio was 2.46 (95% CI [1.65, 3.66]). CONCLUSION Patients receiving concurrent RT+Cisp for HPV-associated OPC have significantly higher odds of worsening self-perceived hearing handicap after treatment than with RT+Cetux. This was consistent across time through one-year post-treatment. These findings inform hearing-related outcomes for patients with HPV-associated OPC.
Collapse
Affiliation(s)
- C L Runge
- Medical College of Wisconsin, Milwaukee, WI
| | - J Lyness
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA; The American College of Radiology, Philadelphia, PA
| | | | | | - P M Harari
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - J G Ringash
- University Health Network- Princess Margaret Hospital, Toronto, ON, Canada
| | - J L Geiger
- Cleveland Clinic Foundation, Cleveland, OH
| | - G A Krempl
- University of Oklahoma Health Sciences Center, OKLAHOMA CITY, OK
| | - D Blakaj
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J Bates
- Emory University Hospital Midtown, Atlanta, GA
| | | | - C U Jones
- Sutter Medical Center Sacramento, Roseville, CA
| | - M Gensheimer
- Stanford Cancer Institute Palo Alto, Stanford, CA
| | - N E Dunlap
- The James Graham Brown Cancer Center at University of Louisville, Louisville, KY
| | - J Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - D Pennington
- University of Arizona Cancer Center-North Campus, Tucson, AZ
| | - P Torres-Saavedra
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA; The American College of Radiology, Philadelphia, PA
| | - S S Yom
- UCSF Medical Center-Mount Zion, San Francisco, CA
| | - Q T Le
- Stanford Cancer Institute Palo Alto, Stanford, CA
| | - B Movsas
- Henry Ford Hospital, Detroit, MI
| |
Collapse
|
2
|
Weidhaas JB, Harris J, Gillison M, Blakaj DM, Krempl GA, Higgins KA, Phan J, Dunlap NE, Mahmood S, Dorth JA, Caudell JJ, Desai AB, Galloway TJ, Pennington JDD, Zhou Z, Lathrop J, Torres-Saavedra P, Hayes DN, Yom SS, Le QT. The KRAS-Variant and Cetuximab in HPV-Positive Oropharyngeal Cancer in NRG/RTOG 1016. Int J Radiat Oncol Biol Phys 2023; 117:S151. [PMID: 37784383 DOI: 10.1016/j.ijrobp.2023.06.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) NRG/RTOG 1016 was a non-inferiority phase III trial comparing radiation with cisplatin versus cetuximab monotherapy for patients with HPV-positive oropharyngeal squamous cell carcinoma (SCC). The trial did not meet the non-inferiority criteria for overall survival (OS) and had significantly worse progression-free survival (PFS) and locoregional failure (LRF) in patients treated with cetuximab. Based on prior evidence that HNSCC patients with a germ-line mutation in KRAS (the KRAS-variant) had a positive response to radiation with cisplatin plus cetuximab without increased toxicity, samples from RTOG 1016 were used to test the protocol-specified hypothesis that KRAS-variant patients will have better outcomes when receiving IMRT + cetuximab monotherapy compared to IMRT + cisplatin. MATERIALS/METHODS The KRAS-variant was tested in 562 samples at MiraDx, a CLIA-certified laboratory. OS, PFS, LRF, and distant metastases (DM) were as defined per the RTOG 1016 protocol, and hazard ratios (HRs) were estimated by (cause-specific) Cox models. Negative binomial regression was used to model the number of treatment-related acute and late (≤ and > 180 days from end of treatment, respectively) grade 3-5 adverse events. To assess the predictive role of the KRAS-variant, all models included KRAS, assigned treatment, and their interaction, with the interaction tested at two-sided 0.05. HRs and toxicity ratios are expressed as IMRT + cetuximab / IMRT + cisplatin. RESULTS The prevalence of the KRAS-variant was 16% with similar patient and tumor characteristics and well-balanced treatment arms for variant and non-variant patients. Median follow-up was 8.6 years. There was no significant interaction between KRAS and treatment for OS (p = 0.99), PFS (p = 0.56), LRF (p = 0.09), or DM (p = 0.19) (Table 1). In KRAS-variant patients the mean acute and late toxicity ratios were 0.53 (95% CI 0.36, 0.80) and 1.62 (95% CI 0.57, 4.62). In non-variant patients, the mean acute and late toxicity ratios were 0.80 (95% CI 0.67, 0.95) and 0.55 (95% CI 0.35, 0.87), respectively. The interaction of KRAS and treatment was not significant for acute (p = 0.07) or late toxicity (p = 0.07). CONCLUSION While this study does not directly refute prior evidence that KRAS-variant patients benefit from radiation + cisplatin and cetuximab, this study does not support the hypothesis that the KRAS-variant is a predictive biomarker of improved outcome in HPV+ oropharyngeal SCC patients treated with IMRT + cetuximab alone, and suggests that for KRAS-variant patients, potential benefits in LRF and acute toxicity with cetuximab may be offset by worse DM and worse late toxicity.
Collapse
Affiliation(s)
- J B Weidhaas
- Department of Radiation Oncology, UCLA, Los Angeles, CA
| | - J Harris
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | - D M Blakaj
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - G A Krempl
- University of Oklahoma Health Sciences Center, OKLAHOMA CITY, OK
| | - K A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - J Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - N E Dunlap
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - S Mahmood
- Allan Blair Cancer Centre, Saskatchewan, SK, Canada
| | - J A Dorth
- Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, OH
| | | | | | - T J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | | | | | - P Torres-Saavedra
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | - S S Yom
- University of California, San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - Q T Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
3
|
Mell L, Torres-Saavedra P, Wong S, Chang S, Kish J, Minn A, Jordan R, Liu T, Truong M, Winquist E, Wise-Draper T, Rodriguez C, Musaddiq A, Beadle B, Henson C, Narayan S, Spencer S, Harris J, Yom S. Radiotherapy with Durvalumab vs. Cetuximab in Patients with Locoregionally Advanced Head and Neck Cancer and a Contraindication to Cisplatin: Phase II Results of NRG-HN004. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
4
|
Garden A, Harris J, Eisbruch A, Chao K, Morrison W, Harari P, Swanson T, Jones C, Yom S, Spencer S, Scrimger R, Shenouda G, Shukla M, Lau H, Mierzwa M, Torres-Saavedra P, Le Q. Final Report of NRG Oncology RTOG 0022: A Phase I/II Study of Conformal and Intensity Modulated Radiation for Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
5
|
Sherman E, Harris J, Bible K, Xia P, Ghossein R, Chung C, Riaz N, Gunn B, Foote R, Yom S, Wong S, Koyfman S, Dzeda M, Clump D, Khan S, Chakravarti A, Redmond K, Torres-Saavedra P, Le QT, Lee N. 1914MO Randomized phase II study of radiation therapy and paclitaxel with pazopanib or placebo: NRG-RTOG 0912. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
6
|
Caudell J, Torres-Saavedra P, Rosenthal D, Axelrod R, Nguyen-Tan P, Sherman E, Weber R, Galvin J, El-Naggar A, Konski A, Trotti A, Dunlap N, Shenouda G, Singh A, Beitler J, Garsa A, Birrer M, Garden A, Herman T, Le Q. Long-Term Update of NRG Oncology RTOG 0522: A Randomized Phase III Trial of Concurrent Radiation and Cisplatin with or without Cetuximab in Locoregionally Advanced Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Yom S, Torres-Saavedra P, Caudell J, Waldron J, Gillison M, Truong M, Jordan R, Subramaniam R, Yao M, Chung C, Geiger J, Chan J, O'Sullivan B, Blakaj D, Mell L, Thorstad W, Jones C, Banerjee R, Lominska C, Le Q. NRG-HN002: A Randomized Phase II Trial for Patients With p16-Positive, Non-Smoking-Associated, Locoregionally Advanced Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.08.038] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|