Treatment De-Escalation of HPV-Positive Oropharyngeal Cancer—Lessons Learnt from Recent Trials

Abstract

AbstractHPV-positive oropharyngeal cancer demonstrates better outcomes with significantly longer survival outcomes than HPV-negative disease, leading to calls and trials on de-escalation of treatment, in an attempt to reduce morbidity of treatment. However, the results of recent trials show that de-escalation, especially the removal or replacement of cisplatin, may have detrimental effects on survival. We discuss the lessons learnt from the first de-escalation trials, including the need for highly-regulated phase II trials when testing new de-escalation strategies, before proceeding to phase III trials, and the exploration of ‘harm-minimisation’ techniques and paradigms, eg proton therapy or reduced treatment volumes, rather than reduction in treatment, as means of reducing treatment toxicity. Recently a framework for de-intensification of treatment for HPV-positive OPC patients has been published by the Head and Neck Cancer International Group to provide guidance for these efforts.