Top Line: Should you be treating HPV+ oropharyngeal cancer any different than a decade ago?
The Study: Long story short: not really. Hot off the press are ASTRO’s newest consensus guidelines on this subject, which are largely a reminder that all the old ways are still recommended as we await phase 3 confirmatory trials on promising novel strategies to de-escalate radiation in this setting. Figure 1 sums up the treatment algorithm for definitive radiation and Figure 2 for post-operative radiation. Indications and concurrent chemo should all look about the same as it has for nearly 20 years. There are some recent nuances in concurrent systemic therapy to note such as weekly cisplatin at 40 mg/m2 as a proven alternative to q3-week high-dose cisplatin 100 mg/m2. Cisplatin-ineligble patients appear to benefit from the addition of carboplatin/fluorouracil or cetuximab versus nothing but we still have no head-to-head comparison of the two against one another nor against commonly used taxane regimens. Table 6 reviews treatment volumes and prescriptions and is a good reminder that accelerated fractionation is preferred when delivering radiation alone, particularly for locally-advanced disease, but also for early-stage disease that doesn’t merit chemo. Most intriguing is a look to the very near future: “The competing therapeutic ratios of definitive radiation versus surgery are continuously evolving, as de-escalation approaches may constantly alter the relative risks and benefits of one local therapy over another.”
TBL: This is an excellent one-stop reference for current gold-standard treatment strategies for HPV+ oropharyngeal cancer. | Margalit, Pract Radiat Oncol 2024
The Study: Long story short: not really. Hot off the press are ASTRO’s newest consensus guidelines on this subject, which are largely a reminder that all the old ways are still recommended as we await phase 3 confirmatory trials on promising novel strategies to de-escalate radiation in this setting. Figure 1 sums up the treatment algorithm for definitive radiation and Figure 2 for post-operative radiation. Indications and concurrent chemo should all look about the same as it has for nearly 20 years. There are some recent nuances in concurrent systemic therapy to note such as weekly cisplatin at 40 mg/m2 as a proven alternative to q3-week high-dose cisplatin 100 mg/m2. Cisplatin-ineligble patients appear to benefit from the addition of carboplatin/fluorouracil or cetuximab versus nothing but we still have no head-to-head comparison of the two against one another nor against commonly used taxane regimens. Table 6 reviews treatment volumes and prescriptions and is a good reminder that accelerated fractionation is preferred when delivering radiation alone, particularly for locally-advanced disease, but also for early-stage disease that doesn’t merit chemo. Most intriguing is a look to the very near future: “The competing therapeutic ratios of definitive radiation versus surgery are continuously evolving, as de-escalation approaches may constantly alter the relative risks and benefits of one local therapy over another.”
TBL: This is an excellent one-stop reference for current gold-standard treatment strategies for HPV+ oropharyngeal cancer. | Margalit, Pract Radiat Oncol 2024