We know omission of cisplatin concurrent to radiation for largely unselected patients with HPV+ oropharyngeal cancer isn’t smart. The single arm phase 1 IChoice-01 trial used induction chemo to identify which of these patients can safely move forward with dose-reduced radiation alone. We know, we know, are we really back to induction chemo? Here all 48 enrollees received 2 cycles of cisplatin + docetaxel upfront, and those with at least a 50% reduction at both primary site and nodes (n=26) proceeded to definitive radiation alone to 60 Gy while the rest (n=22) received standard chemoradiation to 70 Gy with concurrent cisplatin. The primary endpoint of progression-free survival at 2 years was 100% versus 60%, respectively, and overall survival was 100% and 83%. Most failures among the non-responders to induction chemo were distant mets, highlighting the effectiveness of induction chemo as a bio-selector.
- Lu, ASCO 2022