Are we ready for deintensification in human papillomavirus-positive oropharyngeal carcinomas?

Excellent outcomes following contemporary treatment of human papillomavirus (HPV)-positive oropharyngeal carcinoma (HPV+ OPC) have prompted the exploration of deintensification approaches to minimize treatment-related toxicities. This review describes the landscape of deintensification to date (up t...

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Bibliographic Details
Published in:	Current opinion in otolaryngology & head and neck surgery Vol. 31; no. 2; pp. 118 - 128
Main Authors:	Huang, Shao Hui, Hahn, Ezra, Salunkhe, Rohan, Barcelona, Marc Vincent N., O'Sullivan, Brian
Format:	Journal Article
Language:	English
Published:	United States Lippincott Williams & Wilkins 01-04-2023
Subjects:	Carcinoma Cetuximab Chemoradiotherapy Human Papillomavirus Viruses Humans Oropharyngeal Neoplasms - pathology Papillomavirus Infections
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Summary:	Excellent outcomes following contemporary treatment of human papillomavirus (HPV)-positive oropharyngeal carcinoma (HPV+ OPC) have prompted the exploration of deintensification approaches to minimize treatment-related toxicities. This review describes the landscape of deintensification to date (up to November 2022). Although several deintensification trials have been published, none are practice changing. Three phase III randomized-controlled trials studying cetuximab and radiation therapy vs. standard chemoradiotherapy all showed inferior outcomes. Although some phase II trials reported favourable outcomes, they are often single-arm trials without an adequate control arm, thereby limiting the ability to modify practice. Substantial effort has been expended to explore deintensification options for selected HPV+ OPC patients aiming to avoid unnecessary toxicity. Strategies have included replacing cisplatin with cetuximab, reduced chemotherapy or radiotherapy intensity, reduction of radiotherapy volumes and risk stratification after trans-oral surgery or following induction chemotherapy. Challenges remain in the current deintensification landscape, including identifying the most suitable candidates along with a choice of most appropriate deintensification strategies. Promising selection criteria included either static baseline features or kinetic characteristics of clinical-biological parameters. Practice-changing trials remain elusive, and the search continues to attempt optimization of the therapeutic ratio for these patients.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	1068-9508 1531-6998
DOI:	10.1097/MOO.0000000000000871