TY - JOUR
T1 - De-escalation after DE-ESCALATE and RTOG 1016
T2 - a head and neck cancer InterGroup framework for future de-escalation studies
AU - Mehanna, Hisham
AU - Rischin, Danny
AU - Wong, Stuart J
AU - Gregoire, Vincent
AU - Ferris, Robert
AU - Waldron, John
AU - Le, Quynh-Thu
AU - Forster, Martin
AU - Gillison, Maura
AU - Laskar, Sarbani
AU - Tahara, Makoto
AU - Psyrri, Amanda
AU - Vermorken, Jan
AU - Porceddu, Sandro
PY - 2020/8/1
Y1 - 2020/8/1
N2 - 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.
AB - 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.
UR - https://ascopubs.org/journal/jco
U2 - 10.1200/JCO.20.00056
DO - 10.1200/JCO.20.00056
M3 - Article
C2 - 32496903
SN - 0732-183X
VL - 38
SP - 2552
EP - 2557
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 22
ER -