De-Escalation After DE-ESCALATE and RTOG 1016: A Head and Neck Cancer InterGroup Framework for Future De-Escalation Studies. J Clin Oncol 2020 Aug 01;38(22):2552-2557
Date
06/05/2020Pubmed ID
32496903Pubmed Central ID
PMC7392745DOI
10.1200/JCO.20.00056Scopus ID
2-s2.0-85089129881 (requires institutional sign-in at Scopus site) 66 CitationsAbstract
Human papillomavirus (HPV)-positive oropharyngeal cancer (OPC) is increasing rapidly. The younger age, significantly improved prognosis, and relative morbidity of the standard-of-care cisplatin and radiotherapy in this population have led to the popularization of the concept of treatment de-escalation. The recent results of the first 3 randomized de-escalation trials, however, have shown a clear detriment in survival when cisplatin is omitted or substituted. In view of these results, the Head and Neck Cancer International Group identified the need to issue guidance regarding future de-escalation studies for patients with HPV-positive head and neck cancer to avoid the possibility of patients being harmed. We review the current state of the literature regarding HPV de-escalation trials and present a framework and guidance on future and existing clinical trials for treatment de-escalation of HPV-positive OPC. De-escalation paradigms of HPV-positive OPC should be evaluated in phase II studies, and results should be awaited before proceeding to phase III studies. Implementation into clinical practice before high-level evidence is available should not be undertaken in this context. Finally, harm-minimization techniques should also be evaluated as an alternative to de-escalation of treatment in these patient groups.
Author List
Mehanna H, Rischin D, Wong SJ, Gregoire V, Ferris R, Waldron J, Le QT, Forster M, Gillison M, Laskar S, Tahara M, Psyrri A, Vermorken J, Porceddu SAuthor
Stuart J. Wong MD Center Director, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Combined Modality TherapyHead and Neck Neoplasms
Humans
Papillomaviridae
Papillomavirus Infections
Prognosis
