Treatment De-Intensification for Patients With HPV-Positive Head and Neck Cancers
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Cisplatin and 70 Gy of intensity-modulated radiotherapy remain the standard of care (SoC) in HPV-positive head and neck cancer, with no data to support de-escalation as a new SoC. Cetuximab compromises locoregional tumor control and overall survival without reduced toxicity, although with different toxicity. Eliminating cisplatin and reducing radiation by 10 Gy compromise progression-free survival but not overall survival, and replacement of SoC adjuvant chemoradiotherapy with low-dose radiotherapy plus docetaxel compromises progression-free survival for patients with extracapsular extension and/or multiple cervical metastases, without significantly reducing grade 3 toxicities. The current trend toward numerous, single-institution phase II trials should be minimized, because they can be difficult to interpret. Instead, to move the field forward with more definitive outcomes, focus should be placed on taking promising concepts to multicenter, randomized phase II/III studies with clear statistical endpoints.
Disclosures: Dr. Gillison has disclosed receiving consulting fees from Bayer HealthCare, Bristol-Myers Squibb Company, Eisai Inc., EMD Serono, Ipsen, Merck & Co., Inc., Nektar Therapeutics, and Roche Laboratories, Inc.; and receiving grant/research support from Bristol-Myers Squibb Company, Gilead Sciences, Inc., and Kura Oncology, Inc.
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