Deescalation After De-ESCALaTE and RTOG 1016: A Head and Neck Cancer InterGroup (HNCIG) Framework for Future Deescalation Studies

Research output: Contribution to journalArticle


Colleges, School and Institutes

External organisations

  • University of Melbourne
  • Medical College of Wisconsin
  • Department of Radiation Oncology, Centre Léon Bérard, 28 Rue Laennec, 69373 Lyon, France.


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 popularisation of the concept of treatment de-escalation.
The recent results of the first three randomised 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 felt 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.

Methods and results:
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-minimisation techniques should also be evaluated, as an alternative to de-escalation of treatment in these patient groups.


Original languageEnglish
JournalJournal of Clinical Oncology
Publication statusAccepted/In press - 28 Feb 2020