7th ICHNO Abstract book

7th ICHNO 7 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 14 – 16 March 2019 Barcelona, Spain __________________________________________________________________________________________ page 11

Table 1

Keynote lecture: Keynote lecture 3: TNM8: How has the dust settled one year later?

SP-013 TNM8: How has the dust settled one year later? B. O'Sullivan 1 , R. Wu 1 , s.h. Huang 1 , w. Xu 2 , V. Gregoire 3 , S. Patel 4 , J. Brierley 1 , W. Lydiatt 5 1 Princess Margaret Cancer centre / University of Toronto, Tadiation Oncology, Toronto, Canada; 2 Princess Margaret Cancer centre / University of Toronto, Tadiation Oncology, Toronto Biostatistics, Toronto, Canada; 3 Centre Léon Bérard, Radiation Oncology, Lyon, France; 4 Memorial Sloan Kettering Cancer Center, Head and Neck Service, New York, USA; 5 Methodist Estabrook Cancer Center / Creighton University, Head and Neck Surgery, Nebraska, USA Abstract text The TNM classification is an anatomic-based classification that stratifies cancer patients according to prognosis, facilitating treatment decision-making and patient discussions. It is also essential for clinical trial eligibility and stratification, research, cancer registry activities, as well as cancer control and policy development. To maintain relevance, the 8 th edition head and neck cancer (HNC) TNM (TNM8) includes important modifications. These reflect biologic and clinical behavior (e.g. HPV- mediated oropharyngeal cancer (OPC)), improvements in assessment and treatment (e.g. nasopharyngeal carcinoma), and evolving knowledge about prognostic factors (e.g. depth of invasion in oral cavity cancers (OCSCC), extra-nodal extension for non-virally mediated HNC, and size criteria for non-Merkel cell cutaneous carcinoma). One year following implementation of TNM8, we reflect on challenges and users’ experience in transitioning to the new classification. This discussion includes an ongoing international survey from an unselected population of authors (n= 206 so far) of recent HNC Medline indexed publications to appreciate understanding and adoption of TNM8, and guide implementation of future TNM updates. Notably 30% still use both TNM7 and TNM8 due to existing clinical trials and treatment guidelines, but almost all (93%) support separate systems for HPV-positive vs HPV–negative OPC. Primary concerns centred around the N-classifications generally, and implementation of depth of invasion in OCSCC and extra-nodal extension in non-viral HNC. Only 22% felt that HPV+ OPC should receive de-intensified treatment based on TNM8. Most of the survey were clinicians who felt that TNM plays a central role in clinical care but generally seemed to under-appreciate many additional purposes of staging (including research, cancer registration and global control activities). Two thirds consider that enhanced educational resources would increase understanding and adoption of the current version, and that accessibility to resources needs improvement. The operational challenges and views mentioned herein need to be considered in future changes to the HNC TNM.

Figure: Overall survival for patients with T4 or N3 disease, by trial group. N=58

The 2-year survival rate with 95% confidence interval is 93.3% (75.9% to 98.3%) in the Cisplatin and Radiotherapy arm and 67.1% (42.5% to 83.1%) in the Cetuximab and Radiotherapy arm. Log-rank p-value= 0.03; HR: 4.83, 95% CI: 1.00 to 23.31

Symposium: Symposium 1: Immuno-oncology

SP-012 Pembrolizumab in the first line treatment of recurrent and/or metastatic head and neck cancer B. Burtness USA

SP-014 Immuno-score J. Galome France

Abstract not received

Abstract not received