Human papilloma virus (HPV)-associated oropharyngeal cancer (OPC) is a special entity among head and neck squamous cell carcinomas (HNSCCs) characterised by higher survival rates compared to similar stage HPV-negative OPC. Due to favorable prognosis, a significant interest in ‘’less toxic’’ therapies (de-escalating strategies) in the treatment of HPV-associated OPC had been introduced. One of the approaches included introduction of cetuximab (C225) instead of cisplatin (CDDP) in conjunction with radiotherapy as a definitive treatment option in these patients. The aim of the updated meta-analysis was to compare the efficacy of CDDP vs. C225 given concurrently with radiotherapy as definitive treatment of HPV-associated OPC, with inclusion of the latest trials investigating this specific issue. To our knowledge this is currently the largest investigation on this matter.
A systematic literature search was performed for studies published between 2006 and 2018. A total of 1490 citations were obtained and 8 studies met inclusion criteria, resulting in inclusion of 1665 patients in this meta-analysis.
Analysis of pooled studies showed no significant heterogeneity or publication bias. Two-year overall survival (OS) calculated pooled odds ratio (OR) for CDDP-based chemoradiotherapy vs. C225-based bioradiotherapy, was 0.45 (P < 0.0001). Two-year locoregional recurrence (LRR) calculated pooled OR for CDDP-based chemoradiotherapy vs. C225-based bioradiotherapy was 0.35 (P < 0.0001). Patients receiving CDDP concurrently with radiotherapy had 2.2- and 2.9-fold decreased risk for death from any cause and LRR, respectively.
According to the evidence demonstrated by our meta-analysis, CDDP-based chemoradiotherapy should remain the standard of definitive treatment of HPV-associated OPC. Further investigations are necessary in order to define optimal treatment in HPV-negative HNSCCs.
Clinical trial identification
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All authors have declared no conflicts of interest.