SCOTTSDALE, Ariz., Feb. 13, 2018 - Results of the phase II OPTIMA clinical trial indicate that patients with head and neck cancers associated with the human papillomavirus (HPV), including those with advanced nodal disease, can receive substantially lower radiation doses safely and effectively if they respond to induction chemotherapy initially. Patients who responded well to induction chemotherapy and subsequently received the lower-dose treatment experienced excellent survival--92 percent were without evidence of recurrence two years after treatment--and had improved functional outcomes with fewer side effects, compared to those who received standard chemoradiation therapy. The study will be presented today in an online news briefing and at the 2018 Multidisciplinary Head and Neck Cancers Symposium in Scottsdale, Arizona.

Compared with HPV-negative head and neck cancer, which typically is caused by smoking and alcohol consumption, HPV-positive disease is more responsive to radiation therapy and chemotherapy and is associated with significantly higher cure rates.

"Head and neck tumors that are caused by HPV respond well to therapy and can be cured reliably," said Tanguy Seiwert, MD, lead author of the study and an assistant professor of medicine at University of Chicago Medicine. "In fact, the effectiveness of combined treatment with radiation and chemotherapy has been so well documented that newer studies such as OPTIMA are focused on selecting patients who can safely receive less treatment."
Although reducing the intensity of cancer treatment offers patients potentially better quality of life, clinicians are careful to use this approach only for patients with a favorable biology for lower-dose therapy. The OPTIMA trial examined response to induction chemotherapy--which is systemic therapy given prior to radiation therapy--as a method to select patients likely to benefit from reduced treatment.

"With our approach of using induction chemotherapy to identify candidates for de-escalated radiation therapy, we achieved excellent treatment outcomes with giving 30 to 35 percent smaller radiation doses, even for patients with advanced nodal stages such as N2C. Patients experienced less toxicity and survival rates exceeded historic data, although more follow-up is needed to confirm these findings," said Dr. Seiwert.

"This degree of de-escalation with high-risk patients is novel, as is selection using induction as the key component to reduce radiation doses and subsequent toxicities to such low levels. In my opinion, treatment for HPV-positive disease should be de-escalated when possible, and induction is an ideal method to identify HPV-related head and neck cancer biology."

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