6th ICHNO Abstract Book

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6th ICHNO page 17
6th ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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Institute of Oncology, Department of Pathology, Gliwice,
Poland
Purpose or Objective
Circulating free HPV DNA (cfHPV DNA) could be found in
patients with HPV-related HNSCC. Amount of cfHPV DNA
may be related to treatment respond. If the response to
treatment is reflected in cfHPV DNA detection, it may
become a marker of treatment results. cfHPV DNA
estimation after radiotherapy (RT) or radiochemotherapy
in the relation to treatment results has been presented.
Material and Methods
Between 2012 and 2016 blood from 540 consecutive
patients with HNSCC before definitive RT/CHRT was
collected. If HPV-positive sample was identified, serial
blood collections were taken after treatment and during
follow-up. cfHPV DNA assessment was correlated with
treatment results. cfHPV DNA complete remission
(cfHPVrem) was defined as not detectable cfHPV DNA
after RT/CHRT. cfHPV DNA recurrence (cfHPVrec) was
defined as a detection of cfHPV DNA in previously cured
patients during follow-up.
Results
In 71/540 (13%) of patients cfHPV DNA was found. At the
end of treatment in all 70(98%) cured patients cfHPVrem
was found. In 1 uncured patient cfDNA was still
detectable. During follow up cfHPVrec was found in
9(13%) patients. Despite of no evidence of locoregional
recurrence of disease on physical examination nor on
imaging diagnostic (TK or MRI) PET scanning was
additionally performed in these patients. PET revealed
locoregional recurrence and metastatic disease in 5(7%)
and 4(6%) patients respectively.
Conclusion
In patients with HPV-related HNSCC the presence of cfHPV
DNA in blood reflect active cancer. Serial estimation of
cfHPV DNA in cured patients may help to diagnose early
treatment failure because cfHPVrec strongly suggest
disease recurrence.
PD-028 Prognostic and predictive impact of HPV status
in oropharyngeal cancer: the MARCH-HPV project
B. Lacas1 , P. Lassen2 , A. Trotti3, B. Zackrisson4, Q.
Zhang5, J.P. Pignon1, J. Overgaard2, P. Blanchard6
1Gustave Roussy, Ligue Nationale Contre le Cancer meta-
analysis platform - Department of Biostatistics and
Epidemiology,Villejuif,France
2Aarhus University Hospital, Department of Experimental
Clinical Oncology, Aarhus, Denmark
3Moffitt Cancer Center, Department of Radiation
Oncology,Tampa-Florida,USA
4Umeå University, Department of Radiation Sciences -
Oncology,Umeå,Sweden
5NRG Oncology, Statistics and Data Management Center,
Philadelphia,Pennsylvania, USA
6Gustave Roussy, Department of Radiotherapy, Villejuif,
France
Purpose or Objective
HPV-induced oropharyngeal cancers (OPC) have a better
prognosis compared to classical squamous cell carcinoma
of the head and neck (HNSCC). Whether HPV status is
associated with a higher sensitivity to treatment
modifications such as altered fractionation radiotherapy
remains controversial.
Material and Methods The MARCH-HPV project is based on
the first update of the Meta-Analysis of Radiotherapy in
HNSCC (MARCH), which included 33 trials and 11833
patients (Blanchard et al. Rad Oncol; 111 (Suppl 1): 32).
HPV status was determined according to p16
immunohistochemistry. The HPV analysis was restricted to
patients with OPC and performed using a Cox model
stratified by trial and adjusted on gender, age, T-stage,
N-stage, radiotherapy fractionation schedule (standard,
altered), p16 (positive, negative) and smoking status
(never/former, current). Both prognostic and predictive
effects were estimated for progression-free survival (PFS,
primary endpoint) and overall survival (OS). Only
prognostic effect was estimated for locoregional control
and OS after first failure.
Results Data and tumor tissue from 815 patients enrolled
in 4 trials (DAHANCA 6-7, RTOG 9003, ARTSCAN, RTOG
0129) was available for analysis: 350 (43%) p16 negative
and 465 (57%) p16 positive. Patients with p16-pos tumors
were significantly more likely to be younger (mean: 56 vs.
59 years, p=0.0002), have better performance (PS=0: 74%
vs. 50%, p<0.0001), smaller tumors (T1-2: 46% versus 33%,
p<0.0001), more advanced N-stage (N+: 87% versus 76%,
p<0.0001) and were more often never or former smokers
(77% versus 36%, p<0.0001) compared with the p16-neg
subgroup. p16-status had a significant prognostic effect,
with better PFS and OS in p16 positive patients: Hazard
Ratio (HR)=0.42 [95% Confidence Interval (CI): 0.34;0.51]
with a 37% absolute increase at 5 years for PFS, 0.40
[0.32;0.49] with a 39% absolute increase at 5 years for OS.
Locoregional control and OS after first failure were also
significantly better in p16 positive patients with HR of 0.31
[0.22;0.44] and 0.64 [0.47;0.87], respectively. Smoking
also independently influenced outcome and never/former
smokers had better prognosis than current smokers with
HR of 0.61 [0.50;0.75] and 0.58 [0.47;0.72] for PFS and OS,
respectively. Heterogeneity between trials was observed
for PFS (p=0.03), and OS (p=0.02). Use of random effect
model did not change conclusions. There was no statistical
significant interaction between HPV status and
fractionation schedule (p=0.45 for PFS and p=0.58, for OS)
and as such no predictive impact of HPV could be
demonstrated.
Conclusion The significant prognostic effect of HPV in OPC
was confirmed in this pooled analysis based on individual
patient data, but HPV status was not found to be
predictive of outcome after altered fractionated
radiotherapy.
Supported by PAIR-VADS.
PD-029 Causes-of-death underestimate the burden of
head and neck cancers in France (EPICORL study)
Y. Pointreau1, L. Sagaon Teyssier2, L. Geoffrois3, M. Bec4,
C. Godard 4, C. Even5, L. Lévy-Bachelot4, F. Huguet 6, S.
Témam5, M. Schwarzinger2
1Centre Jean Bernard, Oncology, Le Mans, France
2THEN Translational Health Economics Network, Public
health, Paris, France
3Institut de Cancérologie de Lorraine - Alexis Vautrin,
Medical oncology, Vandoeuvre Les Nancy, France
4MSD France, Market access, Courbevoie, France
5Institut Gustave Roussy, Head & Neck Surgical & Medical
Oncology, Villejuif, France
6Tenon Hospital, Radiation Oncology, Paris, France
Purpose or Objective: Patients with head and neck (H&N)
cancer carry the highest risk of secondary primary
cancers. Determining the underlying cause of death is
conflicting in presence of multiple primary cancer sites,
and the burden of H&N cancers may be underestimated by
causes-of-death statistics.
Material and Methods: Using the French National Hospital
Discharge (PMSI) database, we identified all adult patients
residing in metropolitan France and diagnosed with
squamous cell carcinoma at hospital (ICD-10: C00-C06;
C09-C14; C30.0; C31; C32) in 2008-2012. Among patients
who died at hospital, we considered advanced H&N cancer
(stage III/IV at diagnosis or disease progression) as a cause
of death. We recorded competing causes of death from