Another study evaluating the substitution of cisplatin with cetuximab in the treatment of HPV-positive oropharyngeal squamous cell carcinoma has also been published in the Lancet. This phase 2 study (NRG Oncology RTOG 1016; n=987), which did not limit recruitment to low-risk patients, found cetuximab plus radiotherapy (RT) was not non-inferior to cisplatin plus RT for overall survival (HR 1.45; one-sided 95% upper CI 1.94; p=0.5056 for non-inferiority); risks of cancer progression or death and locoregional failure were also increased.
A related comment says that although both should be considered landmark studies, the harmonising findings that are most notable – both showed substitution of cisplatin with cetuximab resulted in worse survival outcomes, without any difference in acute or late toxicity. The author notes the well documented efficacy of cetuximab in the management of HPV-negative head and neck squamous cell carcinoma, and how its lack of efficacy in HPV-positive disease may be related to the difference in EGFR expression. They recommend that cisplatin be used as the radiosensitiser of choice in all eligible patients with advanced HPV-positive oropharyngeal squamous cell carcinoma; this is pertinent as there is emerging evidence showing a substantial increase in HPV-positive disease in older patient groups (>70 years).