De-escalation after DE-ESCALATE and RTOG 1016: a head and neck cancer InterGroup framework for future de-escalation studies

Research output: Contribution to journalArticlepeer-review


  • Danny Rischin
  • Stuart J Wong
  • Vincent Gregoire
  • Robert Ferris
  • John Waldron
  • Quynh-Thu Le
  • Martin Forster
  • Maura Gillison
  • Sarbani Laskar
  • Makoto Tahara
  • Amanda Psyrri
  • Jan Vermorken
  • Sandro Porceddu


Human papillomavirus (HPV)-positive oropharyngeal cancer (OPC) is increasing rapidly. The younger age, significantly improved prognosis, and relative morbidity of the standard-of-care cisplatin and radiotherapy in this population have led to the popularization of the concept of treatment de-escalation. The recent results of the first 3 randomized de-escalation trials, however, have shown a clear detriment in survival when cisplatin is omitted or substituted. In view of these results, the Head and Neck Cancer International Group identified the need to issue guidance regarding future de-escalation studies for patients with HPV-positive head and neck cancer to avoid the possibility of patients being harmed. We review the current state of the literature regarding HPV de-escalation trials and present a framework and guidance on future and existing clinical trials for treatment de-escalation of HPV-positive OPC. De-escalation paradigms of HPV-positive OPC should be evaluated in phase II studies, and results should be awaited before proceeding to phase III studies. Implementation into clinical practice before high-level evidence is available should not be undertaken in this context. Finally, harm-minimization techniques should also be evaluated as an alternative to de-escalation of treatment in these patient groups.


Original languageEnglish
Pages (from-to)2552-2557
Number of pages7
JournalJournal of Clinical Oncology
Issue number22
Early online date4 Jun 2020
Publication statusPublished - 1 Aug 2020