RTP On Demand — Head & Neck/Thyroid | Research To PracticeRole of cetuximab in combination with radiation therapy in head and neck cancer
2:50 minutes.
TRANSCRIPTION:
DR LOVE: What do we know in terms of efficacy or response to cetuximab and radiation compared to chemoradiation? DR COHEN: That’s an unanswered question. And a very controversial one. We have retrospective data, some of which suggest that they’re equivalent. Some of it suggests that especially platinum/radiation is more effective than cetuximab/radiation. But we have really very few prospective studies. We have 1 study that looked at a population who were candidates for laryngectomy. This is the so-called “TROMPLON” study performed in France that took patients who were candidates for laryngectomy, gave them induction chemotherapy with the triplet regimen of docetaxel/platinum/5-FU. And then for responders, randomized to either cisplatin/radiation or cetuximab/radiation. And in that specific population, responders, there didn’t seem to be a difference in efficacy between the 2 arms, but that was a randomized Phase II relatively small trial. There is a large study by the RTOG that just completed, almost 1,000-patient trial, in HPV-positive oropharynx cancer, that randomized patients to either cisplatin/radiation versus cetuximab/radiation. That’ll take probably a couple of years still to mature. We will have prospective data, but we don’t right now. DR LOVE: If those are equivalent, what would you do? And what would you do about HPV-negative? DR COHEN: Right. So I think if the RTOG study — so that RTOG 1016 — turns out to be — and it was basically an inferiority design, so they’re looking for the arms not to be different. If that turns out to be equivalent, then I think cetuximab/radiation will likely be the treatment of choice for HPV-positive disease, because it’s better tolerated than cisplatin/radiation. DR LOVE: Why is it not considered for HPV-negative disease? DR COHEN: And then for HPV-negative disease, it certainly is considered and there’s every reason to believe that cetuximab/radiation works in HPV-negative. And, in fact, we now have data to support that. We had a presentation of the HPV analysis from the cetuximab/radiation trial. And what that showed was that there was no difference. If a patient was HPV-positive or HPV-negative, they had the same likelihood to benefit. HPV-positive patients did better as a whole, but that’s because of the prognostic value of HPV. But in terms of a predictor, both groups appeared to benefit equally. So there’s every reason to believe that cetuximab/radiation works in HPV-negative. The trial, though, the RTOG study, was performed in an HPV-positive population. |