Abstract 3985
Background
Oral cavity and oropharyngeal squamous cell cancers (OC-OPSCC) display high cancer mortality. Aspiration, infection, other complications or treatment, and age- and substance-related comorbidities contribute to non-cancer mortality. This single-institution study examines cause of death in patients treated for OC-OPSCC with brachytherapy, chemotherapy, external beam radiation, surgery, or combination of modalities. We hypothesize that brachytherapy results in lower non-cancer mortality.
Methods
IRB approval was obtained. Our institution’s Tumor Registry and electronic medical record were used to identify patients with a first OC-OPSCC diagnosis between 2000-2010. Patients with a second primary cancer at diagnosis were excluded. The primary outcome was association between treatment modality and non-cancer mortality. Secondary outcomes were effects of comorbidities on death, specific causes of non-cancer mortality, and cancer mortality.
Results
Of 693 eligible patients, 460 were deceased. 84 died of the primary malignancy. Non-primary cancer cause of death was determined in 96 patients; 24 died from a second primary. 193 patients received brachytherapy. Cox proportional hazards regression was performed on treatment regimen, exposures, and non-cancer mortality, stratified by AJCC stage, race, and sex. Age, smoking, and alcohol were associated with worse survival, with HRs of 1.03 (p < 0.005), 1.36 (p < 0.11), and 2.23 (p < 0.005), respectively. Brachytherapy had a notable 0.52 HR (p < 0.005). Non-smoking OPC patients had a 76% 5-year overall survival (OS), suggesting these were largely HPV-driven cancers. In smokers with OPC, OS was 33% at 5 years, with a HR of 0.35 for brachytherapy-treated patients.
Conclusions
We report non-cancer mortality from an extensively annotated cohort of curatively treated OC-OPSCC. We show a significant correlation between receipt of brachytherapy and non-cancer survival, independent of remission status. Potential explanations include improved disease control, patient selection, and reduced exposure to external beam radiation. Although HPV status was not available, OPC in non-smokers displayed OS characteristic for HPV-associated cancer. The impact of brachytherapy in OPC was strongest in smokers.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
S. Mehra: Research grant / Funding (institution): DePuy Synthes Educational Grant for Yale Head and Neck Surgery Fellowship. B. Burtness: Advisory / Consultancy: Aduro; Advisory / Consultancy: Alligator Biosciences; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Boehringer Ingelheim; Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: Celgene; Advisory / Consultancy: Cue Biopharma; Advisory / Consultancy: Genentech/Roche; Advisory / Consultancy: Glaxo Smith Kline; Advisory / Consultancy: IDDI; Advisory / Consultancy: Merck. All other authors have declared no conflicts of interest.
Resources from the same session
2664 - Phase (Ph) II study of MBG453 + spartalizumab in patients (pts) with non-small cell lung cancer (NSCLC) and melanoma pretreated with anti–PD-1/L1 therapy
Presenter: Nicholas Mach
Session: Poster Display session 3
Resources:
Abstract
1285 - Preliminary results of STELLAR-001, a dose escalation phase I study of the anti-C5aR, IPH5401, in combination with durvalumab in advanced solid tumors.
Presenter: Christophe Massard
Session: Poster Display session 3
Resources:
Abstract
3808 - GOLFIG chemo-immunotherapy in metastatic colorectal cancer (mCRC) patients: A fifteen year retrospective analysis
Presenter: Pierpaolo Correale
Session: Poster Display session 3
Resources:
Abstract
5677 - Immune correlates in peripheral blood samples in a preoperative window of opportunity randomized trial of nivolumab with or without tadalafil in resectable squamous cell carcinoma of the head and neck (SCCHN)
Presenter: Larry Harshyne
Session: Poster Display session 3
Resources:
Abstract
4854 - Phase 1 evaluation of AB928, a novel dual adenosine receptor antagonist, combined with chemotherapy or AB122 (anti-PD-1) in patients (pts) with advanced malignancies
Presenter: John Powderly
Session: Poster Display session 3
Resources:
Abstract
4344 - Phase 1 Trial of CV301 in Combination with Anti-PD-1 Therapy in Non-squamous NSCLC
Presenter: Arun Rajan
Session: Poster Display session 3
Resources:
Abstract
4555 - Safety and efficacy results of the combination of DPX-Survivac, pembrolizumab and intermittent low dose cyclophosphamide (CPA) in subjects with advanced and metastatic solid tumors: preliminary results from the hepatocellular carcinoma (HCC), NSCLC, bladder cancer, & MSI-H cohorts
Presenter: Henry Conter
Session: Poster Display session 3
Resources:
Abstract
3012 - Excellent CBR and Prolonged PFS in Non-Squamous NSCLC with Oral CA-170, an Inhibitor of VISTA and PD-L1
Presenter: Vivek Radhakrishnan
Session: Poster Display session 3
Resources:
Abstract
2536 - Phase Ib/II trial of TG4001 (Tipapkinogene sovacivec), a therapeutic HPV-vaccine, and Avelumab in patients with recurrent/metastatic (R/M) HPV-16+ cancers
Presenter: Christophe Le Tourneau
Session: Poster Display session 3
Resources:
Abstract
1845 - Induction of tumor-infiltrating functional CD8 positive cells and PD-L1 expression in esophageal cancer by S-588410
Presenter: Takashi Kojima
Session: Poster Display session 3
Resources:
Abstract