Packing it on.

Top Line: We all know HPV-status is a huge prognostic factor of outcomes for head and neck cancers, but smoking status is a bit more nebulous.

The Study: We’ve all become familiar with the RTOG 0129's secondary analysis—and in particular its risk flowchart in Figure 2A—that so clearly highlights divergent outcomes based on HPV-status. In fact, this has so shaped our treatment paradigms that we sometimes forget that smoking status, in particular < versus ≥10 pack-years, was another major determinant. But remember, this was referring to prognosis for survival and not  specifically cancer outcomes. This look back at patients receiving definitive chemoradiation for head and neck cancer in Buffalo, NY aimed to better understand the impact of smoking status on treatment outcomes. Across 518 patients, there was a continuous worsening of not only overall but also progression-free survival with increasing pack-years of smoking. Interestingly, they found the most predictive binary cutoff to be ≤ versus >22 pack-years (aka heavy smoking). Those with heavy smoking histories not only had worse overall and progression-free survival, but more specifically they were more likely to fail distantly. Another interesting tidbit is that being a current smoker negatively impacted outcomes only among HPV-positive tumors.

TBL: In this large series, a history of smoking more than 22 pack-years portended a higher risk of developing distant mets and worse survival following definitive chemoradiation for head and neck cancer. | Ma, JAMA Netw Open 2022