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Introduction. Concurrent chemoradiotherapy (CRT) with cisplatin radiosensitization currently represents the gold standard for the treatment of locally advanced oropharyngeal cancer. More than 80 % of patients present with a substantial tumor burden at initial diagnosis, underscoring the critical need for induction chemotherapy (ICT) as the first treatment step. However, a major limitation of ICT is the high toxicity of the only approved TPF regimen. Here, we present the results of a prospective, non-randomized, multicenter study evaluating the efficacy of a de-escalated ICT regimen (docetaxel + cisplatin) in HPV-associated squamous cell carcinoma of the oropharynx.
Aim. To evaluate three-year oncologic outcomes of a de-escalated ICT regimen (TP) compared with the standard TPF regimen in the treatment of locally advanced HPV-positive squamous cell carcinoma of the oropharynx.
Materials and Methods. Since 2021, 68 patients with locally advanced HPV-positive squamous cell carcinoma of the oropharynx (T3–4N0–1 or T1–4N2–3) have been enrolled in the study. Patients were divided into two equal groups: the study group received three cycles of ICT according to the de-escalated TP regimen, and the control group received three cycles of the standard TPF regimen. At the second stage of combined treatment, patients in both groups received standard-volume CRT to a total dose of 70 Gy with carboplatin radiosensitization.
Results. Immediate response rates were comparable between the groups: TP — 73.5 %; TPF — 82.4 % (p = 0.213). A statistically significant reduction in the incidence of mucositis was observed with the two-drug ICT regimen (p = 0.025). Three-year oncologic outcomes also showed no statistically significant differences. Three-year progression-free survival (PFS) was 79.4 % in the TP group versus 67.6 % in the control group (p = 0.809). Three-year overall survival (OS) reached 85.3 % in the study group and 76.5 % in the control group (p = 0.442).
Conclusion. The investigational two-drug ICT regimen demonstrated high objective response rates and three-year OS and PFS outcomes comparable to those of the standard TPF regimen, with numerical superiority in some measures. Notably, the study regimen was associated with better tolerability. These findings support further investigation of the two-drug ICT regimen as a potential alternative to the approved regimen in the treatment of patients with locally advanced HPV-positive squamous cell carcinoma of the oropharynx.
References
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