Difference between revisions of "Oropharyngeal cancer, HPV-positive"

From HemOnc.org - A Hematology Oncology Wiki
Jump to navigation Jump to search
m (Text replacement - "https://www.ncbi.nlm.nih.gov/pubmed/" to "https://pubmed.ncbi.nlm.nih.gov/")
 
(39 intermediate revisions by 3 users not shown)
Line 1: Line 1:
−
{| class="wikitable" style="text-align:center; width:50%;"
+
<span id="BackToTop"></span>
−
!colspan="2" align="center" style="color:white; font-size:125%; background-color:#08519c"|'''Section editor'''
+
<div class="noprint" style="background-color:LightGray; position:fixed; bottom:2%; right:0.25%; padding-left:5px; padding-right:5px; margin: 15px; opacity:0.8; border-style: solid; border-color:DarkGray; border-width: 1px">
−
|-
+
[[#top|Back to Top]]
−
|style="background-color:#F0F0F0"|[[File:Michaelgibson.jpg|frameless|upright=0.3|center]]
+
</div>
−
|<big>[[User:Michaelgibson|Michael Gibson, MD, PhD]]<br>Vanderbilt University<br>Nashville, TN</big><br>[[File:Social-twitter-icon.png|frameless|upright=0.1]][https://twitter.com/mgibson21212 mgibson21212]<br>[https://www.linkedin.com/in/michael-gibson-65137032/ LinkedIn]
+
{{#lst:Editorial board transclusions|hn}}
−
|-
+
'''Note: this page has regimens which are specific to oropharyngeal cancer that is human papilloma virus (HPV) positive. Please see the [[head and neck cancer]] page for other regimens.'''
−
|}
 
−
<big>'''Note: this page has regimens which are specific to oropharyngeal cancer that is human papilloma virus (HPV) positive. Please see the [[head and neck cancer]] page for other regimens.'''</big>
 
 
{| class="wikitable" style="float:right; margin-right: 5px;"
 
{| class="wikitable" style="float:right; margin-right: 5px;"
 
|-
 
|-
Line 13: Line 11:
 
|}
 
|}
 
{{TOC limit|limit=3}}
 
{{TOC limit|limit=3}}
−
=All lines of therapy=
+
=Guidelines=
 +
'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
 +
==ASCO==
 +
*'''2019:''' Adelstein et al. [https://doi.org/10.1200/jco.19.00441 Role of Treatment Deintensification in the Management of p16+ Oropharyngeal Cancer: ASCO Provisional Clinical Opinion] [https://pubmed.ncbi.nlm.nih.gov/31021656/ PubMed]
 +
 
 +
==EHNS/ESMO/ESTRO==
 +
*'''2020:''' Machiels et al. [https://doi.org/10.1016/j.annonc.2020.07.011 Squamous cell carcinoma of the oral cavity, larynx, '''oropharynx''' and hypopharynx: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up] [https://pubmed.ncbi.nlm.nih.gov/33239190 PubMed]
 +
 
 +
==NCCN==
 +
*''NCCN does not currently have guidelines at this granular level; please see [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437 NCCN Guidelines - Head and Neck Cancers].''
 +
 
 +
=Definitive therapy=
 
==Cisplatin & RT {{#subobject:c7061f|Regimen=1}}==
 
==Cisplatin & RT {{#subobject:c7061f|Regimen=1}}==
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
 
Cisplatin & RT: Cisplatin & '''<u>R</u>'''adiation '''<u>T</u>'''herapy
 
Cisplatin & RT: Cisplatin & '''<u>R</u>'''adiation '''<u>T</u>'''herapy
−
===Variant #1, 100 mg/m<sup>2</sup> q3wk x 2 {{#subobject:b44282|Variant=1}}===
+
<div class="toccolours" style="background-color:#eeeeee">
−
{| class="wikitable" style="width: 100%; text-align:center;"  
+
===Regimen variant #1, 100 mg/m<sup>2</sup> q3wk x 2 {{#subobject:b44282|Variant=1}}===
−
!style="width: 25%"|Study
+
{| class="wikitable sortable" style="width: 100%; text-align:center;"  
−
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
+
!style="width: 20%"|Study
−
!style="width: 25%"|Comparator
+
!style="width: 20%"|Dates of enrollment
−
!style="width: 25%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
+
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
!style="width: 20%"|Comparator
 +
!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
 
|-
 
|-
−
|[https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32779-X/fulltext Gillison et al. 2018 (RTOG 1016)]
+
|[https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6541928/ Gillison et al. 2018 (RTOG 1016)]
−
|style="background-color:#1a9851"|Phase III (C)
+
|2011-2014
−
|Cetuximab & RT
+
|style="background-color:#1a9851"|Phase 3 (C)
 +
|[[#Cetuximab_.26_RT_999|Cetuximab & RT]]
 
| style="background-color:#91cf60" |Seems to have superior OS
 
| style="background-color:#91cf60" |Seems to have superior OS
 
|-
 
|-
 
|}
 
|}
 +
<div class="toccolours" style="background-color:#b3e2cd">
 
====Chemotherapy====
 
====Chemotherapy====
−
*[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV once on day 1
+
*[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV once per day on days 1 & 22
−
'''21-day cycle for 2 cycles'''
 
 
====Radiotherapy====
 
====Radiotherapy====
−
*Concurrent [[External_beam_radiotherapy|radiation therapy]] 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 6 times per week
+
*Concurrent [[External_beam_radiotherapy|radiation therapy]] 200 cGy fractions x 35 fractions (total dose: 7000 cGy), given 6 times per week
 
'''6-week course'''
 
'''6-week course'''
−
 
+
</div></div><br>
−
===Variant #2, 100 mg/m<sup>2</sup> q3wk x 3 {{#subobject:aca3c0|Variant=1}}===
+
<div class="toccolours" style="background-color:#eeeeee">
−
{| class="wikitable" style="width: 100%; text-align:center;"  
+
===Regimen variant #2, 100 mg/m<sup>2</sup> q3wk x 3 {{#subobject:aca3c0|Variant=1}}===
−
!style="width: 25%"|Study
+
{| class="wikitable sortable" style="width: 100%; text-align:center;"  
−
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
+
!style="width: 20%"|Study
−
!style="width: 25%"|Comparator
+
!style="width: 20%"|Dates of enrollment
−
!style="width: 25%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
+
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
!style="width: 20%"|Comparator
 +
!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
 
|-
 
|-
−
|[https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32752-1/fulltext Mehanna et al. 2018 (De-ESCALaTE HPV)]
+
|[https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6319250/ Mehanna et al. 2018 (De-ESCALaTE HPV)]
−
|style="background-color:#1a9851"|Phase III (C)
+
|2012-2016
−
|Cetuximab & RT
+
|style="background-color:#1a9851"|Phase 3 (C)
 +
|[[#Cetuximab_.26_RT_999|Cetuximab & RT]]
 
| style="background-color:#1a9850" |Superior OS
 
| style="background-color:#1a9850" |Superior OS
 
|-
 
|-
 
|}
 
|}
 +
<div class="toccolours" style="background-color:#b3e2cd">
 
====Chemotherapy====
 
====Chemotherapy====
−
*[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV once on day 1
+
*[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV once per day on days 1, 22, 43
−
'''21-day cycle for 3 cycles'''
 
 
====Radiotherapy====
 
====Radiotherapy====
−
*Concurrent [[External_beam_radiotherapy|radiation therapy]] 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 6 times per week  
+
*Concurrent [[External_beam_radiotherapy|radiation therapy]] 200 cGy fractions x 35 fractions (total dose: 7000 cGy), given 6 times per week  
−
'''6-week course'''
+
'''9-week course'''
−
 
+
</div></div>
 
===References===
 
===References===
−
# '''RTOG 1016:''' Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, Sturgis EM, Burtness B, Ridge JA, Ringash J, Galvin J, Yao M, Koyfman SA, Blakaj DM, Razaq MA, Colevas AD, Beitler JJ, Jones CU, Dunlap NE, Seaward SA, Spencer S, Galloway TJ, Phan J, Dignam JJ, Le QT. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet. 2018 Nov 15. [Epub ahead of print] [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32779-X/fulltext link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/30449625 PubMed]
+
# '''RTOG 1016:''' Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, Sturgis EM, Burtness B, Ridge JA, Ringash J, Galvin J, Yao M, Koyfman SA, Blakaj DM, Razaq MA, Colevas AD, Beitler JJ, Jones CU, Dunlap NE, Seaward SA, Spencer S, Galloway TJ, Phan J, Dignam JJ, Le QT. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet. 2019 Jan 5;393(10166):40-50. Epub 2018 Nov 15. Erratum in: Lancet. 2020 Mar 7;395(10226):784. [https://doi.org/10.1016/S0140-6736(18)32779-X link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6541928/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/30449625/ PubMed] [https://clinicaltrials.gov/study/NCT01302834 NCT01302834]
−
# '''De-ESCALaTE HPV:''' Mehanna H, Robinson M, Hartley A, Kong A, Foran B, Fulton-Lieuw T, Dalby M, Mistry P, Sen M, O'Toole L, Al Booz H, Dyker K, Moleron R, Whitaker S, Brennan S, Cook A, Griffin M, Aynsley E, Rolles M, De Winton E, Chan A, Srinivasan D, Nixon I, Grumett J, Leemans CR, Buter J, Henderson J, Harrington K, McConkey C, Gray A, Dunn J; De-ESCALaTE HPV Trial Group. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet. 2018 Nov 15. [Epub ahead of print] [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32752-1/fulltext link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/30449623 PubMed]
+
# '''De-ESCALaTE HPV:''' Mehanna H, Robinson M, Hartley A, Kong A, Foran B, Fulton-Lieuw T, Dalby M, Mistry P, Sen M, O'Toole L, Al Booz H, Dyker K, Moleron R, Whitaker S, Brennan S, Cook A, Griffin M, Aynsley E, Rolles M, De Winton E, Chan A, Srinivasan D, Nixon I, Grumett J, Leemans CR, Buter J, Henderson J, Harrington K, McConkey C, Gray A, Dunn J; De-ESCALaTE HPV Trial Group. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet. 2019 Jan 5;393(10166):51-60. Epub 2018 Nov 15. [https://doi.org/10.1016/S0140-6736(18)32752-1 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6319250/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/30449623/ PubMed] ISRCTN33522080
−
 
 
 
[[Category:Head and neck cancer regimens]]
 
[[Category:Head and neck cancer regimens]]
 
[[Category:Biomarker-specific pages]]
 
[[Category:Biomarker-specific pages]]
 
[[Category:Head and neck cancers]]
 
[[Category:Head and neck cancers]]

Latest revision as of 12:00, 6 July 2024

Back to Top

Section editor Page editor
Choe.jpeg
 Jennifer H. Choe, MD, PhD
Vanderbilt University
Nashville, TN, USA
LinkedIn
Beau.jpeg
 C. Beau Hilton, MD
Vanderbilt University
Nashville, TN, USA
LinkedIn

Note: this page has regimens which are specific to oropharyngeal cancer that is human papilloma virus (HPV) positive. Please see the head and neck cancer page for other regimens.

1 regimens on this page
2 variants on this page


Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

ASCO

EHNS/ESMO/ESTRO

NCCN

Definitive therapy

Cisplatin & RT

Cisplatin & RT: Cisplatin & Radiation Therapy

Regimen variant #1, 100 mg/m2 q3wk x 2

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Gillison et al. 2018 (RTOG 1016) 2011-2014 Phase 3 (C) Cetuximab & RT Seems to have superior OS

Chemotherapy

Radiotherapy

  • Concurrent radiation therapy 200 cGy fractions x 35 fractions (total dose: 7000 cGy), given 6 times per week

6-week course


Regimen variant #2, 100 mg/m2 q3wk x 3

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Mehanna et al. 2018 (De-ESCALaTE HPV) 2012-2016 Phase 3 (C) Cetuximab & RT Superior OS

Chemotherapy

Radiotherapy

  • Concurrent radiation therapy 200 cGy fractions x 35 fractions (total dose: 7000 cGy), given 6 times per week

9-week course

References

  1. RTOG 1016: Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, Sturgis EM, Burtness B, Ridge JA, Ringash J, Galvin J, Yao M, Koyfman SA, Blakaj DM, Razaq MA, Colevas AD, Beitler JJ, Jones CU, Dunlap NE, Seaward SA, Spencer S, Galloway TJ, Phan J, Dignam JJ, Le QT. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet. 2019 Jan 5;393(10166):40-50. Epub 2018 Nov 15. Erratum in: Lancet. 2020 Mar 7;395(10226):784. link to original article contains dosing details in abstract link to PMC article PubMed NCT01302834
  2. De-ESCALaTE HPV: Mehanna H, Robinson M, Hartley A, Kong A, Foran B, Fulton-Lieuw T, Dalby M, Mistry P, Sen M, O'Toole L, Al Booz H, Dyker K, Moleron R, Whitaker S, Brennan S, Cook A, Griffin M, Aynsley E, Rolles M, De Winton E, Chan A, Srinivasan D, Nixon I, Grumett J, Leemans CR, Buter J, Henderson J, Harrington K, McConkey C, Gray A, Dunn J; De-ESCALaTE HPV Trial Group. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet. 2019 Jan 5;393(10166):51-60. Epub 2018 Nov 15. link to original article contains dosing details in abstract link to PMC article PubMed ISRCTN33522080
Retrieved from "https://hemonc.org/w/index.php?title=Oropharyngeal_cancer,_HPV-positive&oldid=88811"