Annual Meeting Proceedings Part 1 - American Society of Clinical ...

372s Head and Neck Cancer
5564 General Poster Session (Board #24H), Sat, 1:15 PM-5:15 PM
Should age affect our treatment decisions for head and neck cancer?
Presenting Author: Estrella M Carballido, H. Lee Moffitt Cancer Center &
Research Institute, Tampa, FL
Background: Current opinion suggests elderly patients (pts) with head and
neck cancer, those 65 or older, do not tolerate surgery, chemotherapy, or
radiation as well as their younger counterparts. If this holds true, elderly pts
may not be offered standard treatments to prevent assumed complications.
Methods: A retrospective cohort study at our comprehensive cancer center
was conducted of newly diagnosed pts with head and neck squamous cell
carcinoma to explore differences in treatment-related complications between
older and younger groups. We included data from the first 199
eligible pts (99 younger than 65 year old and 100 older than 65) evaluated
between April 2009 and June 2010. Results: 79% of pts receiving
treatment were male with a mean age of 54.9 and 71.6 years for the
younger and older groups respectively. The older group had significantly
more comorbidities (p � 0.001). The majority of older pts presented with
oral cavity tumors (46%) while the oropharynx was the predominant site in
the younger group (45%). 55% of younger and 49% of older pts presented
with stage 4 disease across all sites. A total of 51 pts were p16 positive with
no statistical differences between the groups. Surgery was the initial
treatment for 57% of older pts (p � 0.008) while 46% of younger pts
received concurrent chemotherapy and radiation as the primary treatment
(p � 0.008). There was no statistically significant difference in surgical or
radiation complications between the groups. Although most pts receiving
chemotherapy experienced complications, older pts had slightly more
(93% vs. 78%; p�0.031). The mean survival was 24.8 months with no
statistical difference between groups. Significantly more pts in the older
group, at last follow-up, were disease free (p � 0.012). Conclusions: The
treatment of elderly pts with head and neck squamous cell carcinoma in our
experience was congruent with that of younger pts. Elderly pts did not
suffer more complications with surgery or radiation, however chemotherapy
produced somewhat more complications in the elderly pts. Elderly pts did
display less evidence of disease on follow-up. Age is always a consideration
when treating individuals, but should not preclude the curative standard.
5566 General Poster Session (Board #25B), Sat, 1:15 PM-5:15 PM
ECOG 1308: A phase II trial of induction chemotherapy followed by
cetuximab with low dose versus standard dose IMRT in patients with
HPV-associated resectable squamous cell carcinoma of the oropharynx
(OP). Presenting Author: Shanthi Marur, The Johns Hopkins University
School of Medicine, Baltimore, MD
Background: Human papillomavirus (HPV) infection is now recognized as a
risk factor of oropharyngeal squamous cell carcinoma (OPSCC) and
approximately 60% of OPSCC are HPV positive (�). ECOG 2399 using
induction chemotherapy (IC) followed by chemoradiation demonstrated
significantly improved 2-yr progression-free survival (PFS; 85% vs. 50%,
p�0.05) and overall survival (OS; 94% vs. 58%p�0.004). These results
have generated interest in development of less toxic regimens for HPV(�)
patients with lower dose radiation. Methods: Design: This is a phase II
clinical trial .The primary objective is the estimation of the 2-year PFS in
the reduced dose RT arm. Secondary objectives include toxicity, OS,
objective response, quality of life (QOL) and correlative studies of biomarkers.
Eligibility Criteria: Patients with Stage III or IV resectable HPV(�)
OPSCC. HPV(�) disease is defined as p16 IHC strongly (�) on at least 70%
of cells, and/or HPV-16 ISH (�).Treatment : Patients received IC with a
combination of paclitaxel 90mg/m2 on days 1,8, and 15, cisplatin
75mg/m2 on day 1, and cetuximab loading dose of 400 mg/m2 on day 1,
cycle 1 followed by cetuximab 250 mg/m2 weekly, thereafter. Each cycle
was 21 days for a total of 3 cycles. After completion of IC, patients were
assessed clinically with a complete head and neck exam and imaging
studies. Those with clinical CR at primary site received radiation to 54Gy
plus cetuximab. Patients with clinical PR or SD at primary site received
standard dose RT with cetuximab. Correlative Studies: The expression of
biomarkers on tumor and blood samples and QOL parameters will be
correlated with the clinical outcomes. Results: Current enrollment: Target
accrual was 83 patients. The study accrued 90 patients from March 17,
2010 to accrual on October 19, 2011. Baseline characteristics reveal;
median age 57 years, 94% male, 95% white, 47% never smokers, 10%
�10 pack year (pyr) smoking, 38% �10 pyr smoking, 84% not current
smokers, 39% node (N) stage N2b and 29% N2c, 22% tumor (T) stage T1,
52% T2, 16% T3, and 10% T4. Conclusions: Enrollment has just
completed with no data analysis available.
5565 General Poster Session (Board #25A), Sat, 1:15 PM-5:15 PM
EGFR-KRAS genotyping and EGFR-CDX2 expression in sinonasal intestinal
type adenocarcinomas: Toward a new targeted therapy? Presenting Author:
Olivier Choussy, CHU Rouen-Service ORL, Rouen, France
Background: Sinonasal carcinomas are very rare tumors which are sometimes
not eligible for curative surgery. Alternative therapies (i.e. conventional
chemotherapies/radiotherapy) are used but with poor results.
Therefore, the need for a more efficient treatment is mandatory. Aims of our
study: Comparing EGFR and KRAS genetic profiles, EGFR and CDX2
phenotypes of sinonasal intestinal type adenocarcinomas (ITAC) with
colorectal adenocarcinomas (CRC). Methods: 41 patients were treated in
our institution between 1983 and 2007. All pathological specimens were
reclassified according to the 2005 WHO classification. An immunohistochemical
(IHC) study was carried out for EGFR and CDX2 expression. We
were able to analyze 38 of the 41 specimens for KRAS and EGFR
mutations. SNaPshot multiplex system was used to determine the presence
of the most common mutations which are located in exon 18, 20 and 21 for
EGFR and in exon 2 (codon 12 and13) for KRAS. Fragment analysis
method was used for EGFR exon 19 deletions. Results: Thirty five of the 38
patients were classified as ITAC (33 men and 2 women). The mean age was
64.5 years. Exposure to wood work was found in 29 cases (85%). CDX2
expression was present in 31 (89%) cases of ITAC and absent in all non
intestinal adenocarcinomas (3 cases). EGFR was expressed in 29 ITACs
(83%) with various degrees of IHC expression: 19 (56 %) 1�, 7 (21%) 2�,
and 3 with 3� immunopositivity. No EGFR mutation was found in the
whole population; 5 ITAC patients (14%) disclosed KRAS mutations.
Conclusions: Histological, phenotype and genetic profiles of ITAC are very
similar to those of colorectal adenocarcinoma. These results suggest that
ITACs with wt KRAS could respond to anti MoAb anti-EGFR therapy in the
same way as metastatic CRC. We propose that all sinonasal tumors should
undergo: firstly, CDX2 IHC in order to confirm the ITAC histological subtype
and then KRAS genotyping to select the wt population which could benefit
from such anti EGFR targeted therapy.
5567 General Poster Session (Board #25C), Sat, 1:15 PM-5:15 PM
Young adults with squamous cell head and neck cancer: Ten years of a
single institution’s experience (1999-2008). Presenting Author: Marcos
Pantarotto Alves, Instituto Portugues Oncologia Francisco Gentil, Oporto,
Porto, Portugal
Background: Head and neck cancer of squamous cell type (SCHNC) is
characterised by its aggressiveness and strong relationship with smoking
and drinking habits. It is generally diagnosed in locally advanced stages,
mainly in middle-aged men. People younger than 35yo are rarely affected
by this disease, and little is known about its behaviour among young
Portuguese adults. Our aim was to describe the clinical and epidemiological
features of young adults with diagnosis of SCHNC in a single
oncological centre in Portugal. Methods: Retrospective cohort including
clinical registries’ databases for patients (pts) with diagnosis of SCHNC,
with 3391 eligible pts from 1999 to 2008. Pts aged �18yo and �35yo at
diagnosis with histopathological diagnosis in our Institution were included.
Pts admitted to radiation therapy with no follow-up information were
excluded. 39 pts fulfilled the criteria described, comprising the study
population. Statistical analysis was carried out using SPSS v19.0 for Mac
(IBM, 2010, EUA), with values of p�0,05 considered significant. Results:
Male sex predominance (82%) was observed. The median age of presentation
was 33 yo [22; 35], with 90% smokers with a median of 18,5
package-years [1; 48]. Alcohol consumption was mild to moderate (n�9;
23%) or heavy (n�15; 38%). The median of follow-up time was of 24
months [1;151]. Locally advanced diseased was present at diagnosis in 24
pts, where localised disease was commonest among women (57%) than in
men (29%). Median overall survival (OS) was not reached on this
population, although K-M graphs seems to show a significant difference in
survival between sexes. Alcohol consumption was the most significant
variable to influence the survival (p�0,01). Conclusions: SCHNC in young
people is a rare condition, with distinct epidemiological and clinical
features. Women seems to have greater survival rates, which may be
explained by other risk factors already reported for this gender, namely HPV
infection. The finding of an apparent relationship between alcohol consumption
and OS, and the high prevalence of alcoholic intake habits on this
parcel of the population, urge the need of development of public health
programs addressed to this specific age group.
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