Oropharyngeal cancer, HPV-positive

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Note: this page has regimens which are specific to oropharyngeal cancer that is human papilloma virus (HPV) positive. Please see the head and neck cancer page for other regimens.
Last updated on 2024-07-23:1 regimens on this page
2 variants on this page
=Guidelines=
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
==ASCO==
*2019: Adelstein et al. Role of Treatment Deintensification in the Management of p16+ Oropharyngeal Cancer: ASCO Provisional Clinical Opinion EuroPMC
==ASTRO==
*2024: Margalit et al. Radiation Therapy for HPV-Positive Oropharyngeal Squamous Cell Carcinoma: An ASTRO Clinical Practice Guideline EuroPMC
==EHNS/ESMO/ESTRO==
*2020: Machiels et al. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up EuroPMC
==NCCN==
*NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - Head and Neck Cancers.
=Definitive therapy=
==Cisplatin & RT==
Cisplatin & RT: Cisplatin & Radiation Therapy
===Regimen variant #1, 100 mg/m2 q3wk x 2===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Gillison et al. 2018 (RTOG 1016)	2011-2014 	Phase 3 (C)	Cetuximab & RT	Seems to have longer OS
====Chemotherapy====
*Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1 & 22
====Radiotherapy====
*Concurrent radiation therapy 200 cGy fractions x 35 fractions (total dose: 7000 cGy), given 6 times per week
6-week course
===Regimen variant #2, 100 mg/m2 q3wk x 3===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Mehanna et al. 2018 (De-ESCALaTE HPV)	2012-2016 	Phase 3 (C)	Cetuximab & RT	Longer OS
====Chemotherapy====
*Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1, 22, 43
====Radiotherapy====
*Concurrent radiation therapy 200 cGy fractions x 35 fractions (total dose: 7000 cGy), given 6 times per week 
9-week course
===References===
# RTOG 1016: Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, Sturgis EM, Burtness B, Ridge JA, Ringash J, Galvin J, Yao M, Koyfman SA, Blakaj DM, Razaq MA, Colevas AD, Beitler JJ, Jones CU, Dunlap NE, Seaward SA, Spencer S, Galloway TJ, Phan J, Dignam JJ, Le QT. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet. 2019 Jan 5;393(10166):40-50. Epub 2018 Nov 15. Erratum in: Lancet. 2020 Mar 7;395(10226):784. link to original article dosing details in abstract have been reviewed by our editors link to PMC article EuroPMC NCT01302834
# De-ESCALaTE HPV: Mehanna H, Robinson M, Hartley A, Kong A, Foran B, Fulton-Lieuw T, Dalby M, Mistry P, Sen M, O'Toole L, Al Booz H, Dyker K, Moleron R, Whitaker S, Brennan S, Cook A, Griffin M, Aynsley E, Rolles M, De Winton E, Chan A, Srinivasan D, Nixon I, Grumett J, Leemans CR, Buter J, Henderson J, Harrington K, McConkey C, Gray A, Dunn J; De-ESCALaTE HPV Trial Group. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet. 2019 Jan 5;393(10166):51-60. Epub 2018 Nov 15. link to original article dosing details in abstract have been reviewed by our editors link to PMC article EuroPMC ISRCTN33522080
Category:Head and neck cancer regimens
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Category:Head and neck cancers