HPV-associated oropharyngeal cancer de-escalation strategies and trials: Past failures and future promise

HPV-associated oropharynx squamous cell carcinomas are radiosensitive and chemosensitive, thus, portending a favorable prognosis. Treatment de-intensification strategies aim to reduce toxicity while maintaining efficacy. Although approaches that have substituted cisplatin with cetuximab or omitted chemotherapy have not been successful, Transoral Robotic Surgery with de-intensified adjuvant therapy has been promising. Additionally, personalized approaches are taking advantage of tumor biology and utilizing tumor reduction or hypoxia on imaging as a predictive marker to successfully de-escalate radiotherapy and chemotherapy.

Automated summary

HPV-related oropharynx squamous cell carcinomas are sensitive to radiotherapy and chemotherapy, with treatment de-intensification aiming to reduce toxicity while maintaining efficacy. While substituting cisplatin with cetuximab or omitting chemotherapy have not been successful, Transoral Robotic Surgery with de-intensified adjuvant therapy has shown promise. Personalized approaches utilizing tumor biology and predictive markers on imaging have successfully reduced the intensity of radiotherapy and chemotherapy.