Effect of P16 status on the quality of life experience during chemoradiation for locally advanced oropharyngeal cancer: A sub-study of randomized trial TROG 02.02 (HeadSTART)

Publication date: Available online 23 March 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Jolie Ringash, Richard Fisher, Lester Peters, Andy Trotti, Brian O'Sullivan, June Corry, Lizbeth Kenny, Walter Van Den Bogaert, Chris Wratten, Danny Rischin
PurposeHuman papillomavirus-associated OPC has a favorable prognosis. Current research de-escalates treatment, aiming to improve QOL. Understanding the QOL experience with current standard treatment (chemoradiotherapy) provides context for emerging data. We report the impact of p16 status on QOL for patients with stage III or IV OPC undergoing chemoradiotherapy in an international phase III trial (xx).Methods and MaterialsA subgroup analysis by p16 status was conducted in patients with OPC treated on a phase III randomized trial. The study sub-set with OPC and known p16 status was mainly from Australasia, western Europe, and North America. Of 861 participants, 200 had OPC, known p16 status, and baseline QOL; 82 were p16-, 118 p16+. Radiotherapy (70 Gy/7 weeks) was given concurrently with 3 cycles of either cisplatin (100mg/m2) or cisplatin (75 mg/m2) plus tirapazamine. QOL was measured with the FACT-H&N at baseline, 2,6,12, 23 and 38 months. As no significant difference in QOL score was observed between arms, results by p16 status are reported with arms combined.ResultsP16+ patients were younger, had better ECOG PS, and were less often current smokers. Our primary hypothesis that the change in FACT-H&N score from baseline to 6 months would be more favorable in the p16+ cohort was not met (p16+ -6.3, p16-, -1.8; p=0.14). Baseline mean FACT-H&N score was statistically and clinically significantly better in p16+ patients (111 vs. 102, p<0.001); at 2 months, scores declined in both groups, but more dramatically for p16+ patients. By 12 months, p16+ patients again had superior scores. Higher baseline FACT-H&N score and p16+ status were independent predictors of overall survival.ConclusionsPatients with p16+ OPC exhibited better baseline QOL, but a more dramatic QOL drop with concurrent chemoradiation. Given the favorable prognosis of p16+ OPC, efforts to reduce the QOL burden of treatment are warranted.

Teaser

Among 861 overall participants in a negative phase III randomized trial of concurrent chemoradiotherapy +/- the hypoxic cell cytotoxic agent tirapazamine, a subset of 200 had oropharyngeal cancer (OPC), known p16 status, and quality of life (QOL) data. A comparison of QOL by p16 status showed that patients with p16+ OPC exhibited better baseline QOL, but a more dramatic QOL drop with aggressive concurrent chemoradiation.


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