Neoadjuvant chemotherapy followed by surgery for HPV‐associated locoregionally advanced oropharynx cancer

Abstract Background Neoadjuvant chemotherapy followed by surgery (NAC + S), a paradigm based on systemic escalation coupled with surgery‐based de‐escalation, is under investigation for treatment of HPV‐associated oropharynx cancer (OPC). Methods Prospective cohort of patients with non‐metastatic, p16 positive OPC enrolled in a clinical trial of NAC + S was compared to a historic cohort of patients undergoing concurrent chemoradiation (CCRT) to compare disease‐free survival (DFS). Results Fifty‐five patients were treated with NAC + S and 142 with CCRT. Stage‐matched patients undergoing CCRT had higher frequency of smoking and alcohol consumption. 5‐year DFS in the NAC + S group was 96.1% (95% CI 90.8‐100) compared to 67.6% (95% CI 50.7‐84.5) for CCRT ( P = .01). At 12 months from treatment, 24.5% of patients undergoing CCRT and none of the patients in the NAC + S were feeding tube dependent ( P < .0001). Conclusion NAC + S may be a novel approach for HPV‐associated OPC as it provides lower feeding tube dependence and improved survival compared to stage‐matched patients undergoing CCRT.