New Study Shows Variable Risk in HPV-Positive Oropharyngeal Cancer
by Kate Johnson for Medscape Deintensification of chemotherapy might not be the best option for all patients with oropharyngeal cancer whose disease is associated with human papillomavirus (HPV). However, such an approach might be reasonable for patients with a low risk for distant recurrence; namely, those with less advanced disease and limited exposure to smoking, according to a large retrospective institutional study conducted by Brian O'Sullivan, MD, from the Princess Margaret Hospital in Toronto, Ontario, Canada, and colleagues. The study was published in the February 10 issue of the Journal of Clinical Oncology. The findings "provocatively suggest there is a limit to the favorable biology of HPV-associated OPSCC [oropharyngeal squamous cell carcinoma]," write Harry Quon, MD, and Arlene Forastiere, MD, from the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, Maryland, in an accompanying editorial. "It could be that today's treatment paradigms result in the over treatment of many patients (and the consequent late effects on swallowing function) and under treatment of a smaller subset," they add. There is growing concern among OPSCC experts about patients' risks for radiation-related morbidity, particularly severe late swallowing complications, Dr. Forastiere told Medscape Medical News. "The potential for this damage is increased when chemotherapy is added to the radiation," she explained. "One simple strategy is to drop the chemotherapy from the treatment of those with a low risk for recurrence of tumor in the oropharynx or the regional lymph nodes in the neck." However, she pointed out that Dr. O'Sullivan and colleagues "have refined this 'risk definition' [...]