Dr Mehra on the Implications of the E3311 Trial in HPV+ Oropharynx Cancer

Ranee Mehra, MD, professor, medicine, medical oncology; director, Head and Neck Medical Oncology, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical System, discusses the implications of the long-term follow-up data from the phase 2 E3311 trial (NCT01898494) investigating transoral surgery followed by adjuvant therapy in patients with human papillomavirus (HPV)–associated oropharynx cancer, as well as future research directions that these findings may prompt.

At a median follow-up of 52.4 months, the 54-month progression-free survival and overall survival rates in the entire population (n = 359) were 90.6% (90% CI, 87.2%-93.1%) and 95.3% (90% CI, 93.0%-96.9%), respectively. Among patients with a smoking history of 10 or fewer pack years (n = 252), these respective rates were 89.9% (90% CI, 85.9%-92.9%) and 95.5% (90% CI, 92.7%-97.2%). Among patients with a smoking history of more than 10 pack years (n = 104), these respective rates were 91.7% (90% CI, 83.9%-95.9%) and 94.6% (90% CI, 89.1%-97.4%; P = .052).

Findings from this trial confirm the importance of determining optimal treatment approaches for all patients with HPV-positive oropharynx cancer, Mehra says. One important finding from this trial was that smoking history was not prognostic among patients who underwent surgery followed by risk-adapted adjuvant therapy, Mehra emphasizes, adding that future research may further clarify this finding in this patient population. Other research avenues to evaluate the effects of surgery and adjuvant therapy in patients with oropharynx cancer may include larger, randomized studies that draw on the expertise of oncology professionals across disciplines, Mehra explains.

The E3311 trial was a multidisciplinary effort that included medical oncologists, surgeons, and radiation oncologists, spotlighting the importance of high-level collaboration when treating patients with head and neck cancer, according to Mehra. Importantly, this was also one of the first trials to use a surgical credentialing system to standardize the quality of surgery used in the study, Mehra concludes.