Role of treatment deintensification in the management of p16+ oropharyngeal cancer: ASCO provisional clinical opinion

David J. Adelstein, Nofisat Ismaila, Jamie A. Ku, Barbara Burtness, Paul L. Swiecicki, Loren Mell, Jonathan J. Beitler, Neil Gross, Christopher U. Jones, Marnie Kaufman, Quynh Thu Le, Thomas J. Semrad, Lillian L. Siu, John A. Ridge

Research output: Contribution to journalArticle

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Abstract

PURPOSE An ASCO provisional clinical opinion offers timely clinical direction to ASCO's membership after publication or presentation of potentially practice-changing data from major studies. This provisional clinical opinion addresses the role of treatment deintensification in the management of p16+ oropharyngeal cancer (OPC). CLINICAL CONTEXT For patients with p16+ OPC, current treatment approaches are well established. In the good-prognosis subset of nonsmoking p16+ patients with early-stage disease, these treatments have been highly successful, albeit with significant associated acute and late toxicity. Deintensification of surgical, radiation, and medical treatment in an effort to reduce toxicity while preserving high survival rates is an appropriate therapeutic objective currently being explored in patients who are experiencing the best treatment results. However, careful delineation of this good-risk subset is essential. While the current eighth edition of the American Joint Committee on Cancer staging system is prognostically robust, it should not be interpreted as reason to alter therapeutic decisions or justify treatment deintensification. The development of transoral surgical techniques and the adoption of intensity-modulated radiation therapy planning have been transformative in disease management and suggest potentially beneficial approaches. Recent advances in systemic treatments have been notable. The optimal integration and modification of these modalities to ameliorate toxicity has not been defined and remains an important focus of current investigation. PROVISIONAL CLINICAL OPINION The hypothesis that de-escalation of treatment intensity for patients with p16+ OPC can reduce long-term toxicity without compromising survival is compelling and necessitates careful study and the analysis of well-designed clinical trials before changing current treatment standards. Treatment deintensification for these patients should only be Undertaken in a clinical trial.

Original languageEnglish (US)
Pages (from-to)1578-1589
Number of pages12
JournalJournal of Clinical Oncology
Volume37
Issue number18
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Oropharyngeal Neoplasms
Therapeutics
Clinical Trials
Neoplasm Staging
Disease Management
Publications

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Adelstein, D. J., Ismaila, N., Ku, J. A., Burtness, B., Swiecicki, P. L., Mell, L., ... Ridge, J. A. (2019). Role of treatment deintensification in the management of p16+ oropharyngeal cancer: ASCO provisional clinical opinion. Journal of Clinical Oncology, 37(18), 1578-1589. https://doi.org/10.1200/JCO.19.00441

Role of treatment deintensification in the management of p16+ oropharyngeal cancer : ASCO provisional clinical opinion. / Adelstein, David J.; Ismaila, Nofisat; Ku, Jamie A.; Burtness, Barbara; Swiecicki, Paul L.; Mell, Loren; Beitler, Jonathan J.; Gross, Neil; Jones, Christopher U.; Kaufman, Marnie; Le, Quynh Thu; Semrad, Thomas J.; Siu, Lillian L.; Ridge, John A.

In: Journal of Clinical Oncology, Vol. 37, No. 18, 01.01.2019, p. 1578-1589.

Research output: Contribution to journalArticle

Adelstein, DJ, Ismaila, N, Ku, JA, Burtness, B, Swiecicki, PL, Mell, L, Beitler, JJ, Gross, N, Jones, CU, Kaufman, M, Le, QT, Semrad, TJ, Siu, LL & Ridge, JA 2019, 'Role of treatment deintensification in the management of p16+ oropharyngeal cancer: ASCO provisional clinical opinion', Journal of Clinical Oncology, vol. 37, no. 18, pp. 1578-1589. https://doi.org/10.1200/JCO.19.00441
Adelstein, David J. ; Ismaila, Nofisat ; Ku, Jamie A. ; Burtness, Barbara ; Swiecicki, Paul L. ; Mell, Loren ; Beitler, Jonathan J. ; Gross, Neil ; Jones, Christopher U. ; Kaufman, Marnie ; Le, Quynh Thu ; Semrad, Thomas J. ; Siu, Lillian L. ; Ridge, John A. / Role of treatment deintensification in the management of p16+ oropharyngeal cancer : ASCO provisional clinical opinion. In: Journal of Clinical Oncology. 2019 ; Vol. 37, No. 18. pp. 1578-1589.
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