Caitlin R Mayhew* and Naveed Basheeth
MidCentral DHB, Palmerston North Hospital, New ZealandFulltext PDF
Purpose: HPV-positive OPSCC is now known to have different clinicopathologic factors compared to traditional OPSCC. It tends to affect younger patients and has been shown to be chemoradiosensitive with an excellent prognosis in contrast to HPV-negative OPSCC. In view of this, multiple different treatment de-escalation strategies have been proposed, with the aim to reduce morbidity typically associated with treatment. The current available evidence on these de-escalation policies is discussed in this retrospective literature review.
Methods: A literature search was performed on Pubmed, NCBI, Cochrane, Medline and CINAHL to identify current literature looking at de-escalation strategies for HPV related OPSCC. The identified de-escalation trials were used to discuss currently proposed de-escalation strategies. 45 papers published from 1985 to 2021 were studied. Inclusion criteria included completed and
ongoing trials on management of OPSCC published in English literature. Exclusion criteria included management of oropharyngeal cancers without discussion on completed or ongoing trials. 39 papers satisfied criteria and were reviewed individually by all authors and information collated to avoid interpretation bias.
Results: ECOG 1,308 has shown de-escalation with ICT followed by cetuximab-low dose RT to be superior. NRG-HN002 found low dose Cisplatin-RT superior to AXF. De-ESCALATE and RTOG 1,016 both found Cetuximab-RT to be inferior to Cisplatin-RT with significantly worse outcomes and no significant difference in severe toxicity. ECOG 3,311 supports reducing the dose of RT after surgery.
Conclusion: The results of several clinical trials are awaited; however, the available results are not promising for de-escalation in HPV-positive OPSCC. Further validation through randomized control trials is needed prior to widespread changes in practice.
Mayhew CR, Basheeth N. Everything You Need to Know about HPV Related OPSCC So Far…. Clin Oncol. 2022;7:1891..