(A527) Completion of Definitive Treatment after Induction Chemotherapy for OPSCC at a Safety Net Hospital

Introduction: Induction chemotherapy (IC) given before chemoradiotherapy (CRT) is used in select patients with advanced oropharyngeal squamous cell carcinoma (OPSCC) and has been shown to confer increased toxicity which can be treatment limiting. This study aims to elucidate the effect IC has on the ability of patients to complete treatment in a low-resource setting.

Methods: This retrospective cohort study evaluated all patients treated at a tertiary care county hospital in Houston, Texas from 2016-2024 with OPSCC who received curative intent IC followed by CRT. Data was collected from electronic medical health record. Demographic, disease, and treatment related data were extracted for analysis. The primary outcome is the completion of treatment, with disease free survival (DFS) and overall survival (OS) as secondary outcomes.

Results: A total of 7 patients were identified over the study period; just one was insured at the time of diagnosis. 6 patients reported a history of smoking, with a median exposure of 20 pack-years. The ECOG performance status was excellent with all patients being scored a 1 or less. 5 patients had p16 positive tumors. TNM staging ranged from T1 to T4 and N2 to N3b. Induction therapy was completed by 6 patients; the 7th patient did not complete treatment due to disease progression. Definitive CRT was similarly completed by 6 out of 7 subjects. Adverse events requiring hospitalization were reported in 2 out of 7 patients during IC and in 2 out of 7 individuals during CRT. 2 patients had no disease free interval after completion of their treatment. One of these patients was lost to follow up and another died from disease related complications. 1 patient had a distant recurrence in the mediastinal lymph nodes after 24 months. The mean survival was 26.4 months (range 6.1-80.8).

Conclusions: IC has considerable toxicities with many patients requiring hospitalization during their treatment course. Despite this, nearly all of our patients are able to complete their prescribed treatment course, despite socioeconomic, language, and health-literacy barriers.