{"entity":{"id":"idea-cthpv-adapted-deescalation","kind":"idea","name":"ctHPV-DNA-adapted de-escalation of chemoradiation","aka":[],"tldr":"Instead of guessing from HPV status who can get less radiation, measure the virus DNA in blood during treatment and reduce dose only when it clears fast.","summary":"The idea is to reduce the radiation dose in HPV-positive head and neck cancer only for patients whose circulating tumour HPV DNA clears quickly during treatment, rather than for everyone who is HPV-positive. NRG-HN005 showed that static selection on HPV status fails, whereas ctHPV-DNA kinetics track tumour kill in real time and outperform baseline staging for predicting recurrence. The hypothesis is that patients whose ctHPV-DNA clears by week 2 to 3 of chemoradiation can receive 60 Gy without loss of progression-free survival, while non-clearers receive the full 70 Gy. The test is a phase 2/3 trial of ctHPV-DNA-guided dose versus uniform 70 Gy, with progression-free survival and quality of life as endpoints; the idea sits on the radiotherapy roadmap.","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT03952585: NRG-HN002 & NRG-HN005 (HPV+ de-escalation)","url":"https://clinicaltrials.gov/study/NCT03952585"}],"tags":[],"related":[],"cancers":["head-and-neck"],"sections":[],"technologies":["cthpv-dna","imrt-igrt"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["hpv-p16"],"trials":["nrg-hn002-hn005"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Patients whose ctHPV-DNA clears by week 2-3 of chemoradiation can receive 60 Gy without loss of PFS, while non-clearers receive 70 Gy.","rationale":"ctHPV-DNA kinetics track tumour kill in real time and outperform baseline staging for predicting recurrence.","test":"Phase 2/3 with ctHPV-DNA-guided dose assignment versus uniform 70 Gy; PFS non-inferiority in clearers and quality-of-life superiority.","maturity":"early-clinical"},"route":"/ideas/idea-cthpv-adapted-deescalation/","neighbours":{"cancer":[{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"hpv-positive-oropharyngeal-cancer","kind":"cancer","name":"HPV-positive oropharyngeal cancer","route":"/cancers/hpv-positive-oropharyngeal-cancer/"}],"technology":[{"id":"cthpv-dna","kind":"technology","name":"Circulating tumour HPV DNA (ctHPV-DNA)","route":"/technologies/cthpv-dna/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"}],"term":[{"id":"hpv-p16","kind":"term","name":"HPV-positive (p16) head and neck cancer","route":"/terms/hpv-p16/"}],"trial":[{"id":"nrg-hn002-hn005","kind":"trial","name":"NRG-HN002 & NRG-HN005 (HPV+ de-escalation)","route":"/trials/nrg-hn002-hn005/"}],"roadmap":[{"id":"radiation-roadmap","kind":"roadmap","name":"Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH","route":"/roadmaps/radiation-roadmap/"}]}}