Long-term survival of adjuvant high-dose (HDC) vs weekly cisplatin (WC) for human papilloma-virus (HPV) and non-HPV head and neck squamous cell carcinoma (HNSCC).

person Katharine Andress Rowe Price Mayo Clinic, Rochester, MN info_outline Katharine Andress Rowe Price, Ashish V. Chintakuntlawar, Robert Leonard Foote, Yolanda I. Garces, Daniel Ma, Michelle A. Neben-Wittich, Eric J. Moore, Jan C. Kasperbauer, Daniel L. Price, Jeffrey R. Janus, Kathryn M. Van Abel, Jessica Lyn Geiger

Authors person Katharine Andress Rowe Price Mayo Clinic, Rochester, MN info_outline Katharine Andress Rowe Price, Ashish V. Chintakuntlawar, Robert Leonard Foote, Yolanda I. Garces, Daniel Ma, Michelle A. Neben-Wittich, Eric J. Moore, Jan C. Kasperbauer, Daniel L. Price, Jeffrey R. Janus, Kathryn M. Van Abel, Jessica Lyn Geiger Organizations Mayo Clinic, Rochester, MN, Department of Radiation Oncology, Mayo Clinic, Rochester, MN, Cleveland Clinic, Cleveland, OH Abstract Disclosures Research Funding Other Background: Phase III data suggests a benefit of HDC in the adjuvant setting, but the effect of HDC and WC on long term survival and for HPV+ HNSCC is unknown. Methods: Data from a published retrospective study (Geiger Oral Onc 2013) of HDC vs WC in resected HNSCC was updated. Overall survival (OS) and recurrence-free survival (RFS) was assessed by Kaplan-Meier method for all pts and by HPV status. Multivariate analyses were performed to assess impact of HPV status, smoking, age, HDC vs WC, and cumulative cisplatin dose ( < 200mg/m 2 vs ≥200 mg/m 2 ). Results: 51 patients (pts) received HDC and 53 WC. Median follow-up was 8.7 yrs (0.8-13.7). For the whole cohort, HDC had significantly improved OS over WC (p = 0.0095; 5- and 10-yr OS 84% and 80% vs 72% and 60%). No OS benefit for HDC was seen in pts with HPV+HNSCC (5- and 10-yr OS 90% and 87% for HDC and 81% and 81% for WC; p = 0.51). For HPV-negative HNSCC, OS had borderline significance with HDC vs WC (5- and 10-yr OS 73% and 68% vs 65% and 44%; p = 0.06). For the whole cohort, there was no difference in 5- and 10-yr RFS (78% and 74% for HDC vs 72% and 62% for WC; p = 0.32). When analyzed by HPV status, there was no difference in RFS with HDC or WC for either HPV+ (p = 0.43) or HPV-negative HNSCC (p = 0.97). On multivariate analyses of OS for all pts, only HPV status was significant (p = 0.0011; HR 0.27, CI 0.12-0.62). For HPV+ HNSCC, there was no significant predictor of OS. For non-HPV HNSCC, the benefit of HDC approached significance with a decreased risk of death (HR 0.38; p = 0.07). For all pts, those who received ≥200mg/m 2 had significantly improved OS (5-yr 90% vs 72% and 10-yr 86% vs 61%; p = 0.004). By HPV status, cumulative dose had no significant effect on OS. Conclusions: OS is better with HDC and with cumulative dose > 200 mg/m 2 in unselected patients. The benefit of cisplatin is likely higher for non-HPV HNSCC. A difference in OS with no difference in RFS suggests non cancer-related causes of death in the WC cohort. Ability to receive HDC could be a surrogate marker of comorbidity. Original study cohort characteristics. HDC WC p-value Median age 53 61 < 0.01 Male 90% 83% 0.28 Pack-yr smoking 6 15 0.04 HPV+ 63% 42% 0.03 T, N-stage, primary site NS