Standard chemotherapy treatment for HPV-positive throat cancer remains the most effective, study finds

November 15, 2018, University of Birmingham

A new study funded by Cancer Research UK and led by the University of Birmingham has found that the standard chemotherapy used to treat a specific type of throat cancer remains the most effective.

The findings of the trial, which aimed to compare for the first time the outcomes of using two different kinds of for patients with Human papillomavirus (HPV)-positive , are published today (November 15th) in The Lancet.

Throat cancer is one of the fastest rising cancers in Western countries. In the UK, incidence was unchanged between 1970 and 1995, then doubled between 1996 and 2006, and doubled again between 2006 and 2010. The rise has been attributed to HPV, which is often a sexually transmitted infection. Most throat cancers were previously caused by smoking and alcohol and affected 65 to 70 year old working class men. Today, HPV is the main cause of throat cancer and patients are middle class, working, have young children and are aged around 55.

HPV-positive throat cancer responds well to a combination of cisplatin chemotherapy and radiotherapy, and patients can survive for 30 to 40 years, but the treatment causes lifelong side effects including dry mouth, difficulty swallowing, and loss of taste.

The De-ESCALaTE HPV study, which was sponsored by the University of Warwick, compared the side effects and survival of 164 patients who were treated with radiotherapy and cisplatin, and 162 who were given radiotherapy and . The patients were enrolled between 2012 and 2016 at 32 centres in the UK, Ireland, and the Netherlands. Patients were randomly allocated to be treated with radiotherapy and either cisplatin or cetuximab. Eight in ten patients were male and the average age was 57 years.

Importantly, the results found that there was very little difference between the two drugs in terms of toxicity in patients and side effects such as dry mouth, however, there was a significant difference in the survival rates and recurrences of cancer in patients taking part in the trial.

They found that the patients who received the current standard chemotherapy cisplatin had a significantly higher two-year overall survival rate (97.5%) than those on cetuximab (89.4%). During the six-year study, there were 29 recurrences and 20 deaths with cetuximab, compared to 10 recurrences of cancer and six deaths in patients who were treated with the current standard chemotherapy cisplatin.

And cancer was three times more likely to recur in two years following treatment with cetuximab compared to cisplatin, with recurrence rates of 16.1 per cent versus six per cent, respectively.

Study lead Professor Hisham Mehanna, Director of the University of Birmingham's Institute of Head and Neck Studies and Education, said: "Many patients have been receiving cetuximab with radiotherapy on the assumption that it was as effective as cisplatin chemotherapy with radiotherapy and caused fewer side effects but there has been no head-to-head comparison of the two treatments.

"Cetuximab did not cause less toxicity and resulted in worse overall survival and more cancer recurrence than cisplatin.

"This was a surprise—we thought it would lead to the same survival rates but better toxicity. Patients with throat cancer who are HPV positive should be given , and not cetuximab, where possible."

Dr. Emma King, Cancer Research UK Associate Professor in head and neck surgery at the University of Southampton, said: "Studies like this are essential for us to optimise treatments for patients. We now know that for HPV-positive throat cancer, the standard chemotherapy treatment remains the most effective option.

"However, we must keep testing new alternatives to ensure patients always have access to cutting-edge and kinder treatments. Chemotherapy and radiotherapy can leave head and neck patients with long term pain and difficulties swallowing, so we should always strive to minimise side effects."

Professor Janet Dunn from the University of Warwick, whose team ran the De-ESCALaTE HPV trial, said: "In the current trend for de-escalation of treatment, the results of the De-ESCALaTE HPV trial are very important as they were not as we expected. They do highlight the need for academic clinical and are an acknowledgement of the key role played by Warwick Clinical Trials Unit at the University of Warwick as the co-ordination and analysis centre for this important international trial."

The on the De-ESCALaTE trial Steering Committee endorsed the importance of research findings.

Malcom Babb, who is also President of the National Association of Laryngectomee Clubs, said: "From a patient perspective, De-ESCALaTE has been a success by providing definitive information about the comparative effectiveness of treatment choices."

Explore further: Patients with HPV-positive oropharynx cancer should receive chemoradiation

More information: Mehanna et al (2018). 'Radiation with cisplatin or cetuximab in Human papillomavirus-related low risk oropharyngeal cancer - the De-ESCALaTE HPV trial'. The Lancet. DOI: 10.1016/ S0140-6736(18)32752-1

Related Stories

Patients with HPV-positive oropharynx cancer should receive chemoradiation

October 22, 2018
Patients with human papilloma virus (HPV)-positive throat cancer should receive chemoradiotherapy rather than cetuximab with radiotherapy, according to late-breaking research reported at the ESMO 2018 Congress in Munich.

Cetuximab+RT found to be inferior to standard treatment in HPV+ oropharyngeal cancer

August 14, 2018
An interim analysis of data from a randomized clinical trial of patients with human papillomavirus (HPV)-positive oropharyngeal cancer found that treatment with radiation therapy and cetuximab is associated with worse overall ...

Radiation/cisplatin combination established as standard of care for HPV+ oral cancer

October 22, 2018
Combinations of radiation and chemotherapy drugs have been shown to cure HPV-related head and neck cancer with a high success rate. A new phase III trial has now determined that cisplatin chemotherapy, combined with radiation ...

Experimental drug trial seeks to improve treatment for head and neck cancer

November 24, 2017
A trial to test an experimental drug in patients with head and neck cancer launches in the UK today (Friday), through the Combinations Alliance – a joint initiative between Cancer Research UK and the Experimental Cancer ...

Immunotherapy improves survival in metastatic or recurrent head and neck cancer

October 22, 2018
Immunotherapy with pembrolizumab improves survival in patients with head and neck cancer that has recurred or metastasised, according to late-breaking results from the KEYNOTE-048 study reported at the ESMO 2018 Congress ...

New treatment approach for advanced anal cancer

October 22, 2018
A new approach to treating advanced anal cancer is safer and more effective than the most widely used current treatment, according to the first ever randomised clinical trial in this group of patients.

Recommended for you

Potential seen for tailoring treatment for acute myeloid leukemia

December 8, 2018
Advances in rapid screening of leukemia cells for drug susceptibility and resistance are bringing scientists closer to patient-tailored treatment for acute myeloid leukemia (AML).

Study may offer doctors a more effective way to treat neuroblastoma

December 7, 2018
A very large team of researchers, mostly from multiple institutions across Germany, has found what might be a better way to treat patients with neuroblastoma, a type of cancer. In their paper published in the journal Science, ...

Major breakthrough in quest for cancer vaccine

December 6, 2018
The idea of a cancer vaccine is something researchers have been working on for over 50 years, but until recently they were never able to prove exactly how such a vaccine would work.

'Chemo brain' caused by malfunction in three types of brain cells, study finds

December 6, 2018
More than half of cancer survivors suffer from cognitive impairment from chemotherapy that lingers for months or years after the cancer is gone. In a new study explaining the cellular mechanisms behind this condition, scientists ...

Scientists develop new technology for profiling unique genetic makeup of myeloma tumor cells

December 6, 2018
Cancer arises when cells lose control. Deciphering the "blueprint" of cancer cells—outlining how cancer cells hijack specific pathways for uncontrolled proliferation—will lead to more efficient ways to fight it. Joint ...

Putting the brakes on tumor stealth

December 6, 2018
New research undertaken at Monash University has shed new light on how some cancers are able to escape our immune system.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.