NECTORS for Advanced HPV-Related Head and Neck Cancer?

TOPLINE:

Compared with standard concurrent chemoradiation, neoadjuvant chemotherapy followed by transoral robotic surgery (NECTORS) and neck dissection led to superior distant metastasis-free and overall survival outcomes in patients with advanced human papillomavirus–related oropharyngeal squamous cell carcinoma (HPV-OPSCC).

METHODOLOGY:

• Distant metastasis is a leading cause of death in patients with HPV-OPSCC, and standard of care concurrent chemoradiation carries significant long-term toxicities and may not address occult micrometastasis. De-escalation strategies such as NECTORS offer a potential alternative by addressing micrometastasis while sparing patients from radiation-related side effects.
• To assess the potential survival benefits of NECTORS, researchers compared outcomes in patients with stage III and IVa HPV-OPSCC who received NECTORS to patients from a historical cohort who had received concurrent chemoradiation therapy.
• The study included 342 patients who had received concurrent chemoradiation with 70 Gy intensity-modulated radiotherapy plus cisplatin (n = 232) or NECTORS with cisplatin and docetaxel (n = 110) every 3 weeks for three cycles, followed by transoral robotic surgery and neck dissection.
• The median follow-up duration was 5.8 years for the concurrent chemoradiation group and 5.1 years for the NECTORS group.

TAKEAWAY:

• After matching patients for tumor and nodal staging, 14.3% (15 of 105) patients in the standard care group developed distant metastasis following locoregional recurrence, 12.4% of which was distant-only metastasis, whereas only 1% (1 of 104) of patients in the NECTORS group developed distant metastasis and none developed distant-only metastasis.
• The one patient with distant metastasis in the NECTORS group initially had regional recurrence, salvaged with surgery and radiotherapy, and then developed distant metastasis. The patient is still alive at 6 years posttreatment.
• Patients receiving concurrent chemoradiation had a higher risk for distant metastasis (hazard ratio [HR], 9.98) and for relapse anywhere (HR, 3.21) than those receiving NECTORS.
• At 5 years, 20% of patients in the concurrent chemoradiation group had died compared with none in the NECTORS group. The higher mortality rate in the concurrent chemoradiation cohort could be attributed to increased distant metastasis and reduced efficacy of salvage surgery for locoregional recurrence.

IN PRACTICE:

The current findings indicate a reduced rate of distant-only metastasis and improved overall survival in patients receiving NECTORS compared with those receiving concurrent chemoradiation, the authors concluded. “However, due to the study’s retrospective nature and the low numbers of events, these findings must be validated in prospective randomized clinical trials,” the researchers added.

SOURCE:

The study, led by Nader Sadeghi, MD, McGill University Health Centre, Montreal, Canada, published online in JAMA Otolaryngology-Head & Neck Surgery.

LIMITATIONS:

Patients considered unfavorable for transoral robotic surgery may have been overrepresented in the concurrent chemoradiation therapy group. The shorter median follow-up period in the NECTORS group than in the concurrent chemoradiation therapy group may not account for all recurrences, particularly since most recurrences in the concurrent chemoradiation therapy group occurred after 36 months.

DISCLOSURES:

This study was supported by the Simon and Morris Fast Award for Oncology of the Research Institute of McGill University Health Centre. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.