De-intensified treatment in human papillomavirus-positive oropharyngeal cancer
Ce dossier présente deux essais incluant respectivement 849 et 334 patients atteints d'un cancer oropharyngé lié au papillomavirus humain et comparant l'efficacité, du point de vue de la survie globale, ou la toxicité du cétuximab et du cisplatine en combinaison avec une radiothérapie
The recognition of human papillomavirus (HPV) infection as a risk factor for the development of oropharyngeal squamous cell carcinoma was a substantial development in the field of head and neck oncology. HPV-positive oropharyngeal squamous cell carcinoma is widely considered a potential epidemic because of its rapidly increasing incidence. Furthermore, HPV-positive oropharyngeal squamous cell carcinoma is an entirely distinct disease entity from HPV-negative oropharyngeal squamous cell carcinoma. There are differences in the oncogenesis between these two entities, which mean a much younger, healthier patient population has HPV-positive oropharyngeal squamous cell carcinoma, which frequently does not have the risk factors associated with HPV-negative oropharyngeal squamous cell carcinoma. Smoking, alcohol consumption, and the synergistic effect between the two are well recognised risk factors for development of HPV-negative oropharyngeal squamous cell carcinoma; however, these behaviours are in decline, which is reflected in the diminishing incidence of HPV-negative head and neck squamous cell carcinoma.4
By contrast, the substantial increase in incidence of HPV-positive oropharyngeal squamous cell carcinoma has been attributed to a probable increase in HPV infection. This increase could be due to changes in sexual practices within the affected population during the past four decades.
The Lancet , commentaire en libre accès, 2017