Hisham Mehanna, PhD, BMedSc, MBChB, FRCS, chair, Head and Neck Surgery, director, Institute of Head and Neck Studies and Education at the Institute of Cancer and Genomic Sciences, University of Birmingham, discusses the design of the De-ESCALaTE trial in patients with HPV-positive head and neck cancer.

For the randomized phase III De-ESCALaTE trial, investigators compared the use of chemoradiotherapy plus cetuximab to chemoradiotherapy plus cisplatin in patients with low-risk HPV oropharyngeal cancer. Although chemoradiotherapy is the standard of care for these patients, the addition of cisplatin doubles the rate of acute toxicity and heightens any long-term toxicities, says Mehanna. Younger patients tend to have a positive prognosis and can live for many years. Therefore, the trial was designed to see if supplanting cisplatin with cetuximab could lower the rate of unnecessary toxicity.

One strategy that has been put forward as a way to spare patients from unnecessary toxicity is the use of cetuximab, says Mehanna. Cetuximab is currently approved by the FDA as well as the EMA. The initial registration study showed that the addition of cetuximab resulted in a comparable safety profile to that of radiotherapy alone. Moreover, some studies have suggested that patients with HPV-positive head and neck cancer do better overall with the use of cetuximab.

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Dr. Mehanna on the Design of the De-ESCALaTE Trial in HPV+ Head and Neck Cancer

Hisham Mehanna, PhD, BMedSc, MBChB, FRCS, chair, Head and Neck Surgery director, Institute of Head and Neck Studies and Education at the School of Cancer Studies, University of Birmingham, discusses goals of the updated staging system in HPV-positive head and neck cancer.

In 2018, several updates were made to the staging of head and neck cancer following the release of the eighth edition of the 

. There were several goals of these changes, explains Mehanna. These changes were made to more accurately reflect the prognosis of the disease, which according to Mehanna is better than other malignancies. Prior to the update, a diagnosis of stage IV disease did not reflect that.

Secondly, a better prognostication system allows physicians to isolate more specific subgroups in which to test new therapies. However, until those therapies are established, patients should remain on the same treatment, regardless of whether the new staging system reclassified the stage of their disease, states Mehanna.

Dr. Mehanna on Goals of the Updated Staging System in HPV+ Head and Neck Cancer

Hisham Mehanna, PhD, BMedSc, MBChB, FRCS, chair, Head and Neck Surgery director, Institute of Head and Neck Studies and Education at the School of Cancer Studies, University of Birmingham, discusses the implications of the updated staging system for patients with HPV-positive head and neck cancer.

In 2018, 3 changes were made to the staging of head and neck cancer following the release of the eighth edition of the 

. Based on the new system, there are 2 sections: 1 that accounts for staging prior to diagnosis and 1 that accounts for staging following initial treatment.

Previously, the clinical staging system for nodal disease was very similar to the pathologic staging system. Now, these 2 systems are separate entities, explains Mehanna. Adjusting to the newly defined staging system will take time, he adds. It is important to note that even though the stages were reclassified, the treatment should remain the same. If a patient had stage IV disease in the old system and now has stage II disease according to the new system, the patient should remain on the same treatment, concludes Mehanna.

Dr. Mehanna on Implications of the Updated Staging System for HPV+ Head and Neck Cancer

Hisham Mehanna, PhD, BMedSc, MBChB, FRCS, chair, Head and Neck Surgery director, Institute of Head and Neck Studies and Education at the School of Cancer Studies, University of Birmingham, discusses the new staging system for patients with HPV-positive head and neck cancer.

The staging system for the treatment of patients with head and neck cancer has been revised, as the previous one did not correctly reflect the prognosis of each stage, according to Mehanna. There are 2 parts to this new system—staging before a patient has recieved treatment, and then staging for those who have received surgery and need further treatment.

Before treatment, the nodal staging has become more simplified, Mehanna says. It has now been simplified to N0, N1, N2 or N3. Additionally, patients are categorized as having either unilateral or bilateral disease of more than 6 cm or less than 6 cm.

The staging groups have changed, as well. Patients who used to be deemed stage 4, have now because of their positive HPV status, been moved to stage 2. Mehanna says that due to the good prognosis that HPV has, the system has been changed.

Hisham Mehanna, PhD, BMedSc, MBChB, FRCS, chair, Head and Neck Surgery director, Institute of Head and Neck Studies and Education at the School of Cancer Studies, University of Birmingham, discusses the new staging system for patients with HPV-positive head and neck cancer.
 

Hisham Mehanna, PhD, BMedSc, MBChB, FRCS

Articles

Dr. Mehanna on the Design of the De-ESCALaTE Trial in HPV+ Head and Neck Cancer

Dr. Mehanna on Goals of the Updated Staging System in HPV+ Head and Neck Cancer

Dr. Mehanna on Implications of the Updated Staging System for HPV+ Head and Neck Cancer

Dr. Mehanna on the Updated Staging System for HPV+ Head and Neck Cancer