Head, neck cancer treatment of less benefit for HIV patients
PHOENIX -- Conventional therapy for head and neck cancer appeared more toxic and less effective for patients with co-existing HIV infection, according to data presented here.
After a four-year median follow-up, a cohort of 71 HIV-positive patients had a locoregional control rate of 69% and overall survival of 55%.
Disease control was about 15% lower and survival about 20% lower than what might be expected in a similar group of HIV-negative patients, Waleed F. Mourad, MD, of Beth Israel Medical Center in New York, told MedPage Today.
All of the patients developed dysphagia, dysgeusia, xerostomia, and acute skin desquamation (grades 1-3), and 80% had grade 1-3 mucositis. The patients had a median weight loss of 20 lbs.
"Due to the advances in highly active antiretroviral therapy, which prolongs HIV patients' survival, the likelihood to develop HIV-related malignancy increases," Mourad said during a press briefing.
"It is of paramount importance to establish better-tolerated treatment strategies to improve tolerance, toxicity, and outcomes in this growing patient population."
Scant data have documented long-term outcomes in patients with head and neck cancer and co-existing HIV disease. The retrospective study by Mourad and colleagues constituted one of the largest single-center clinical experiences reported to date.
Patients in the study had a median age of 51 at the time of radiation therapy. Their median age at HIV diagnosis was 34, and they had been HIV seropositive for a median of 11 years.
A majority of the patients had primary cancer sites in the oropharynx (32%) and larynx (35%), followed by oral cavity (13%), hypopharynx (7%), nasopharynx (4%), nasal cavity (3%), and submandibular area (1%). Additionally, three patients (4%) had occult primary tumors. Almost 80% of the patients had stage III-IV disease at diagnosis.
The 69% rate of local control represented a wide range of control rates across tumor sites. Patients with involvement of the oropharynx, larynx, or oral cavity had control rates of 70% to 78%. In contrast, all five patients with the hypopharynx as the primary site had locoregional failure. Seven patients developed second primary cancers.
Duration of radiation therapy correlated significantly with local control (P<0.001) and with trends toward less weight loss and no second malignancies.
"Local control and survival varies substantially according to the primary tumor site, the institution, the treating physician, and other factors," Mourad said in response to a question about local control rate and survival in HIV-negative patients.
"Because of that, it's difficult to give a single number. However, the data for this group of patients with HIV disease suggest treatment has been less effective than what we have seen in similar patients without HIV disease."
The toxicity data showed no treatment-related deaths. A third of the patients required treatment breaks of at least five to 1o days. Two patients required hospitalization for treatment-related adverse events: one for severe mucositis associated with fever and one for osteoradionecrosis of the jaw.
At late follow-up, all patients continued to have problems eating, including 11% who had grade 4 dysphagia (requirement for a feeding tube). Additionally, all patients had xerostomia at late follow-up.
Treatment of head and neck cancer led to a decline in CD4 counts and a rebound in HIV viral load during the first 10 to 12 weeks. From then on, CD4 counts rose steadily toward baseline values and viral load declined steadily.
Mourad and co-investigators had no relevant disclosures.
By Charles Bankhead
Primary source: Multidisciplinary Head and Neck Cancer Symposium
Source reference:
Mourad WF, et al "Outcome of HIV head and neck squamous cell carcinoma with RT and chemotherapy" MHNCS 2012; Abstract 135.
Additional source: Multidisciplinary Head and Neck Cancer Symposium
Source reference:
Mourad WF, et al "Tolerance and toxicity of concurrent chemoradiotherapy in HIV seropositive patients with head and neck squamous cell carcinoma" MHNCS 2012; Abstract 158.
MedPage Today
http://www.medpagetoday.com/MeetingCoverage/MHNCS/30879
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