TY - JOUR
T1 - Role of treatment deintensification in the management of p16+ oropharyngeal cancer
T2 - ASCO provisional clinical opinion
AU - Adelstein, David J.
AU - Ismaila, Nofisat
AU - Ku, Jamie A.
AU - Burtness, Barbara
AU - Swiecicki, Paul L.
AU - Mell, Loren
AU - Beitler, Jonathan J.
AU - Gross, Neil
AU - Jones, Christopher U.
AU - Kaufman, Marnie
AU - Le, Quynh Thu
AU - Semrad, Thomas J.
AU - Siu, Lillian L.
AU - Ridge, John A.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85068428866&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068428866&partnerID=8YFLogxK
U2 - 10.1200/JCO.19.00441
DO - 10.1200/JCO.19.00441
M3 - Article
C2 - 31021656
AN - SCOPUS:85068428866
SN - 0732-183X
VL - 37
SP - 1578
EP - 1589
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 18
ER -