Oropharyngeal cancer, HPV-positive
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| Section editor | Page editor | ||
|---|---|---|---|
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Jennifer H. Choe, MD, PhD Vanderbilt University Nashville, TN, USA |
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C. Beau Hilton, MD Vanderbilt University Nashville, TN, USA |
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.
1 regimens on this page
2 variants on this page
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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 PubMed
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 PubMed
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 superior 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 | Superior 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 contains dosing details in abstract link to PMC article PubMed 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 contains dosing details in abstract link to PMC article PubMed ISRCTN33522080