In p16+ Oropharyngeal Squamous Cell Carcinoma (OPSCC) – Does any Efficacy Endpoint Favor Cetuximab-RT over Cisplatin-RT?

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • In p16+ OPSCC, does any efficacy endpoint favor cetuximab-RT over cisplatin-RT?
    • Best answer: 
      • No
    • Why: 
      • Neither OS, PFS, nor LRC improved with cetuximab:
    • When to deviate: 
      • Only with absolute cisplatin ineligibility PMC:
        • Discuss RT + cetuximab (Bonner) or altered-fractionation RT
    • Pitfalls: 
      • Extrapolating the Bonner 2006 RT + cetuximab vs RT-alone result:
        • To cisplatin-eligible patients is incorrect New England Journal of Medicine
        • Bonner:
          • 5-yr OS 45.6% with RT + cetuximab vs 36.4% RT alone:
            • Not a comparison to cisplatin
      • Under-discussing ototoxicity / renal toxicity risks with cisplatin:
        • Document shared decision-making when deviating
    • Numbers: 

      • RTOG – 1016 (NI trial, Lancet 2019):

        • 5-yr OS:  84.6% cisplatin vs 77.9% cetuximab (non-inferiority failed; cetuximab inferior) 

        • PFS and LRC: both significantly worse with cetuximab (PFS HR ≈ 1.72; LRF HR ≈2.05) Oral Cancer Foundation+1

          •  

      • De-ESCALaTE HPV (Lancet 2019):

        • ~ 2-yr OS:  97.5% cisplatin vs 89.4% cetuximab (HR ~ 5.0)

        • Recurrence: higher with cetuximab (HR ~ 3.4)

        • Severe toxicity rates overall similar — no compensatory safety win. 

Rodrigo Arrangoiz, MD (Oncology Surgeon)
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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