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. 2011 May;22(5):1071-1077.
doi: 10.1093/annonc/mdr006. Epub 2011 Feb 11.

Survival and human papillomavirus in oropharynx cancer in TAX 324: a subset analysis from an international phase III trial

M R Posner  1 , J H Lorch  2 , O Goloubeva  3 , M Tan  3 , L M Schumaker  3 , N J Sarlis  4 , R I Haddad  2 , K J Cullen  3
Affiliations

Survival and human papillomavirus in oropharynx cancer in TAX 324: a subset analysis from an international phase III trial

M R Posner et al. Ann Oncol. 2011 May.

Abstract

Background: The association between human papillomavirus (HPV) and overall survival (OS) in oropharynx cancer (OPC) was retrospectively examined in TAX 324, a phase III trial of sequential therapy for locally advanced head and neck cancer.

Methods: Accrual for TAX 324 was completed in 2003 and data updated through 2008. Pretherapy tumor biopsies were studied by PCR for human papillomavirus type 16 and linked to OS, progression-free survival (PFS) and demographics.

Results: Of 264 patients with OPC, 111 (42%) had evaluable biopsies; 56 (50%) were HPV+ and 55 (50%) were HPV-. HPV+ patients were significantly younger (54 versus 58 years, P = 0.02), had T1/T2 primary cancers (49% versus 20%, P = 0.001), and had a performance status of zero (77% versus 49%, P = 0.003). OS and PFS were better for HPV+ patients (OS, hazard ratio = 0.20, P < 0.0001). Local-regional failure was less in HPV+ patients (13% versus 42%, P = 0.0006); at 5 years, 82% of HPV+ patients were alive compared with 35% of HPV- patients (P < 0.0001).

Conclusions: HPV+ OPC has a different biology compared with HPV- OPC; 5-year OS, PFS, and local-regional control are unprecedented. These results support the possibility of selectively reducing therapy and long-term morbidity in HPV+ OPC while preserving survival and approaching HPV- disease with more aggressive treatment.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier curves for overall survival (A) and progression-free survival (B) for HPV+ and HPV− patients treated on TAX 324. HPV, human papillomavirus.
Figure 2.
Figure 2.
Kaplan-Meier curves of survival according to HPV status (HPV+ or HPV−) and treatment arm (TPF or PF). See supplemental Table S1 (available at Annals of Oncology online) for statistical comparisons. HPV, human papillomavirus.
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