African-American patients with oropharyngeal squamous cell carcinoma (OPSCC) have significantly shorter overall survival (OS) than European-American OPSCC patients, even when the groups have similar access to medical care, according to a study published in JCO Oncology Practice.
The study followed a cohort of 440 patients who received treatment for OPSCC between 2010 and 2017 at University Hospitals Seidman Cancer Center in Cleveland.
The researchers controlled for possible racial disparities in access to medical care by measuring time to treatment initiation (TTI), which counted the number of days between pathological diagnosis and the start of treatment.
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No statistically significant difference was found in the TTI between African-American and European-American patients, which the study authors interpreted as an indication that both groups had similar access to medical care.
Among patients with p16+ disease, the median OS was 5.038 years in African-American patients and longer than 8.65 years in European-American patients (P =.003).
The researchers found the discrepancy in median OS particularly notable in the p16+ group, as disease associated with human papillomavirus (HPV) generally has been linked to a better prognosis and to more favorable responses to treatment.
In patients who had p16– OPSCC, the discrepancy persisted. The median OS was 1.85 years for the African-American patients and 5.74 years for the European-American patients (P =.03).
A multivariate Cox regression analysis showed that race was an independent prognostic marker and “the most impactful covariant” for OS (P =.001), according to the study authors.
These findings could have far-reaching implications for the treatment of African-American patients with OPSCC, leading the authors to suggest that clinicians may need to tailor treatment plans to address this high-risk group.
The authors postulated that the lower median OS rates seen among the African- American patients with favorable p16+ disease could be due to overreliance on HPV16 probes to determine HPV status in patients with OPSCC.
Per the study’s authors, OPSCC studies have consisted largely of European-American patients and commonly use HPV16 as a marker for HPV-positive OPSCC.
However, other studies have shown that African-American patients with OPSCC have a higher frequency of HPV18 than European Americans do, therefore leading to falsely negative HPV status in minority patients when only HPV16 probes are used.
The study authors also hypothesized that the tumor biology may differ in patients with an HPV genotype other than HPV16.
The study’s limitations included insufficient information regarding treatment plans, leaving the authors unable to determine if treatment plans fully followed established guidelines or dosages.
The authors also recognized that TTI could not fully represent the socioeconomic disparities that may affect patient outcomes.
“Our findings argue that AA [African-American] patients with p16+ OPSCC are poor candidates for treatment de-escalation and add to the growing evidence that data from EA [European-American]-majority studies should not be used to guide clinical management of diverse patient populations,” the authors wrote. “It is becoming increasingly clear that a one-size-fits-all approach to the management of OPSCC does a disservice to our AA patients. Research needs to be prioritized to better understand the distinct biology and clinical needs of the AA OPSCC population.”
Disclosures: This research was supported by Bristol Myers Squibb Foundation. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
O’Neill WQ, Wasman J, Thuener J, et al. African Americans with p16+ and p16− oropharyngeal squamous cell carcinomas have distinctly poor treatment outcomes independent of medical care. JCO Oncol Pract. 2021;17(5)e695-e702. doi:10.1200/OP.20.01105
