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Weekly UpdatesThe largest and most definitive study to date has found that patients with stage III or IV oropharyngeal cancer (cancers of the upper throat) whose tumors contained the human papillomavirus (HPV) have better outcomes than patients with HPV-negative disease according to new research from the Radiation Therapy Oncology Group (RTOG). RTOG, an NCI-funded national clinical trials group, is a clinical research component of the American College of Radiology (ACR).
"Our findings showed that HPV status is as strong a predictor of outcome as cancer stage for patients with oropharyngeal cancers, even after considering other factors such as age and smoking history," said lead author Maura Gillison, M.D., Ph.D., professor of medicine, epidemiology, and otolaryngology at The Ohio State University. "We're still not entirely sure why this is, but these data provide further evidence that HPV-positive oropharyngeal cancer is a distinct disease entity."
Previous smaller studies have suggested that patients with HPV-positive oropharyngeal tumors fare better than their HPV-negative counterparts. But patients with HPV-positive oropharyngeal cancer also tend to be younger, have a smaller tumor at diagnosis, and are less likely to smoke than HPV-negative patients. This is the first study large enough to consider HPV together with these other factors in patients who received the same therapy in a large clinical trial.
In the RTOG phase III clinical trial, RTOG 0129, Dr. Gillison and her colleagues compared the time it took for cancer to progress or the patient to die (progression-free survival) and overall survival between 206 patients with oropharyngeal cancer containing HPV (mostly HPV subtype 16) and 117 patients with HPV-negative cancers; all patients received a combination of radiation therapy and chemotherapy.
At two years, 87.9 percent of HPV-positive patients were still alive, compared with 65.8 percent of HPV-negative patients. Two-year progression-free survival for the groups was 71.8 percent and 50.4 percent, respectively. The incidence of second primary cancers among HPV-positive patients was less than half that of HPV-negative patients at five years: 9.0 percent versus 18.5 percent.
Dr. Gillison noted that the association between HPV and head and neck cancers is already changing the way clinical trials are designed, with investigators stratifying patients by HPV status. Other studies are being designed to assess the efficacy of the HPV vaccine for the prevention of these cancers.
"When this study began accruing patients seven years ago we had no idea that HPV status would play a critical role in predicting outcome for head and neck cancer patients," said Walter J. Curran, Jr., M.D., the RTOG Group Chair, and the Lawrence W. Davis Professor and Chair of the Department of Radiation Oncology in the Emory School of Medicine and Chief Medical Officer of the Emory Winship Cancer Institute. "However, RTOG has made it a priority to prospectively collect material for future marker analyses and, after several small studies began to show a correlation between HPV status and outcome for head and neck cancer patients, Dr. Gillison and her team were able to quickly analyze the tumor specimens banked for this study and correlate them with outcomes data."
ASCO Abstract #6003, Survival outcomes by tumor human papillomavirus (HPV) status in stage III-IV oropharyngeal cancer (OPC) in RTOG 0129, is available at http://www.abstract.asco.org/AbstView_65_31969.html.
Information about RTOG is available at http://www.rtog.org.
In addition to Dr. Gillison, authors include: J. Harris, American College of Radiology, Philadelphia, PA; W. Westra, Johns Hopkins University, Baltimore, MD; C. Chung, Vanderbilt University, Nashville, TN; R. Jordan, University of California at San Francisco, San Francisco, CA; D. Rosenthal, University of Texas M. D. Anderson Cancer Center, Houston, TX; P. Nguyen-Tan, CHUM Hospital Notre Dame, Montreal, QC, Canada; W. J. Spanos, University of Louisville, Louisville, KY; K. P. Redmond, University of Cincinnati, Cincinnati, OH; K. Ang, University of Texas M. D. Anderson Cancer Center, Houston, TX. The research was funded by National Cancer Institute grants CA21661 and CA37422.
The Radiation Therapy Oncology Group (RTOG) is administered by the American College of Radiology (ACR), and located in the ACR Center for Clinical Research in Philadelphia, PA. RTOG is a multi-institutional international clinical cooperative group funded primarily by National Cancer Institute grants CA21661 and CA37422. RTOG has 40 years of experience in conducting clinical trials and is comprised of over 300 major research institutions in the United States, Canada, and internationally. The group currently is currently accruing to 40 studies that involve radiation therapy alone or in conjunction with surgery and/or chemotherapeutic drugs or which investigate quality of life issues and their effects on the cancer patient.
The American College of Radiology (ACR) is a national professional organization serving more than 32,000 radiologists, radiation oncologists, interventional radiologists and medical physicists with programs focusing on the practice of radiology and the delivery of comprehensive health care services.
For more information, call 703/648-8936 or visit http://www.acr.org.
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