Standard chemo still most effective for throat cancers caused by HPV
Standard chemotherapy remains the most effective way to treat a particular form of throat cancer, according to new research.
Scientists from the University of Birmingham compared the effectiveness of 2 drugs in patients diagnosed with throat cancer caused by an infection with the human papillomavirus (HPV), called HPV-positive throat cancer. They also compared the severity of side effects caused by the drugs.
The study, published in The Lancet, found that patients taking either the standard chemotherapy drug cisplatin or another targeted cancer drug called cetuximab (Erbitux) experienced little difference in side effects.
But survival was significantly better in those who received the standard of care drug cisplatin. Their cancers were also less likely to return.
Dr Emma King, a Cancer Research UK expert in head and neck surgery from the University of Southampton, said studies like this are essential in making sure patients get the best treatment.
“We now know that for HPV-positive throat cancer, the standard chemotherapy treatment remains the most effective option.”
Comparing the two drugs
The phase 3 trial, funded by Cancer Research UK, looked at the survival and side effects of 334 patients across the UK, Ireland and the Netherlands.
The average age of those taking part in the study was 57 years old and 8 in 10 were men.
Around half were treated with standard treatment, a combination of radiotherapy and the chemotherapy drug cisplatin, while the second group were treated with radiotherapy and cetuximab.
Those treated with cisplatin were more likely to be alive 2 years later.
At this two-year point, the team reports that around 98 in 100 patients taking cisplatin were still alive compared to around 89 in 100 taking cetuximab.
The cancer was also around 3 times more likely to come back in the same period in those who took cetuximab compared to those taking cisplatin.
Professor Hisham Mehanna, who led the study, said she was surprised by the results.
"Many patients have been receiving cetuximab with radiotherapy on the assumption that it was as effective as cisplatin chemotherapy with radiotherapy and caused fewer side effects but there has been no head-to-head comparison of the two treatments.”
"Cetuximab did not cause less toxicity and resulted in worse overall survival and more cancer recurrence than cisplatin.”
Mehanna said patients with HPV-positive throat cancers should now be given cisplatin, and not cetuximab, where possible.
We still need to optimise treatments
According to Dr King, the next steps in improving treatment for throat cancer patients should focus on finding new ways to reduce side effects associated with both drugs.
Side effects from treatment include vomiting, nausea and a dry mouth.
"We must keep testing new alternatives to ensure patients always have access to cutting-edge and kinder treatments,” she said.
“Chemotherapy and radiotherapy can leave head and neck cancer patients with long term pain and difficulties swallowing, so we should always strive to minimise side effects."
Throat cancer on the rise
Cases of throat cancer in the UK are increasing. Records show that there were around 4,100 new cases in 2010 compared to 3,600 in 2006.
There are two types of throat cancer, HPV-positive cancers and HPV-negative cancers.
In HPV-positive cancers, cells in the throat are infected with HPV, which damages their DNA and causes them to divide and grow out of control.
A recent rise in the number of throat cancer cases has been linked to growing rates of HPV infection.
Gillison, M. L et al. (2018) Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial.The Lancet DOI: https://doi.org/10.1016/S0140-6736(18)32779-X