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Throat cancers caused by HPV are usually cured with chemoradiation or robotic surgery, so trials now ask how much treatment can be taken away: swapping cisplatin for cetuximab failed, cutting the radiation dose has worked only after surgery so far, and blood tests for HPV DNA may pick out the patients who can safely have less.
HPV-positive oropharyngeal squamous cell carcinoma arises in the tonsils and base of tongue when high-risk human papillomavirus, almost always type 16, integrates into the crypt epithelium and its E6 and E7 proteins disable p53 and Rb. Tumours are recognised by strong p16 staining, confirmed by HPV DNA or RNA testing where available, and they present with a neck node and a small primary. The RTOG 0129 analysis by Ang and colleagues in 2010 showed three-year overall survival of 82.4 percent for HPV-positive against 57.1 percent for HPV-negative disease, with smoking history worsening the outlook, and the eighth edition of the staging system gave HPV-positive disease a staging system of its own.
Standard treatment is cisplatin chemoradiation to 70 Gy, or transoral robotic surgery with neck dissection followed by pathology-guided adjuvant treatment for smaller tumours. Two trials that replaced cisplatin with cetuximab to spare toxicity both failed: RTOG 1016 found five-year overall survival of 84.6 percent with cisplatin against 77.9 percent with cetuximab, and De-ESCALaTE found two-year survival of 97.5 against 89.4 percent, so cetuximab is reserved for patients who cannot have cisplatin. The Canadian ORATOR trial found swallowing scores slightly better after radiotherapy than after surgery, so neither route is superior for every patient.
De-escalation has worked only where selection was tight. NRG-HN002 found that 60 Gy with weekly cisplatin met its two-year progression-free survival threshold while 60 Gy alone did not; NRG-HN005 then closed early because the reduced-dose arms had worse progression-free survival than the 70 Gy control. After transoral surgery, however, ECOG-ACRIN E3311 reported two-year progression-free survival of about 95 percent with 50 Gy in intermediate-risk patients, and PATHOS is testing the same approach with swallowing and survival endpoints. Circulating tumour HPV DNA, shown by Chera and colleagues in 2020 to detect recurrence before scans, is now being used to adapt treatment, and HPV vaccination of boys and girls is expected to prevent most future cases.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Site decides cause and behaviour: HPV drives oropharyngeal cancer, EBV drives nasopharyngeal cancer, tobacco drives oral and laryngeal cancer; all drain into the neck node levels that surgeons and radiotherapists map.
Same organ: Acinic cell carcinoma of the salivary glands, Carcinoma ex pleomorphic adenoma, Multiple endocrine neoplasia type 1 (MEN1), Multiple endocrine neoplasia type 2 (MEN2A and MEN2B), Hyperparathyroidism-jaw tumour syndrome (CDC73-related parathyroid carcinoma), Oropharyngeal cancer (tonsil and base of tongue), Laryngeal and hypopharyngeal cancer, Oral cavity cancer (mouth and tongue), Head and neck squamous cell carcinoma, Nasopharyngeal carcinoma, Salivary gland cancers, Papillary thyroid cancer, Follicular thyroid cancer, Medullary thyroid cancer, Anaplastic thyroid cancer, Thyroid cancer, Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma), NUT carcinoma (midline carcinoma with NUTM1 rearrangement), Parathyroid carcinoma, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4), HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer), Recurrent or metastatic head and neck squamous cell carcinoma, Hypopharyngeal cancer, Adenoid cystic carcinoma, Salivary duct carcinoma, Mucoepidermoid carcinoma, Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Lip cancer, Locoregionally advanced nasopharyngeal carcinoma (stage III to IVA), Recurrent and metastatic nasopharyngeal carcinoma, Esthesioneuroblastoma (olfactory neuroblastoma), Sinonasal undifferentiated carcinoma (SNUC) and SWI/SNF-deficient sinonasal carcinoma
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Fine-needle biopsy of the neck node with p16 staining, HPV confirmation where p16 is equivocal, examination and imaging of the tonsils and tongue base, and PET-CT; staged with the HPV-positive system.
Transoral robotic surgery with neck dissection and pathology-guided adjuvant radiotherapy (E3311), or radiotherapy alone; choice by expected swallowing and voice.
Cisplatin chemoradiation to 70 Gy; cetuximab only for patients who cannot have cisplatin, since RTOG 1016 and De-ESCALaTE showed it inferior.
Reduced-dose or chemotherapy-free treatment only within a trial; NRG-HN005 showed that lowering the dose in definitive chemoradiation on HPV status alone loses control.
Examination and PET-CT at about three months; circulating tumour HPV DNA is emerging as a blood test for recurrence.
Pembrolizumab alone or with platinum-fluorouracil (KEYNOTE-048); HPV-positive tumours respond at least as well as HPV-negative ones.
HPV vaccination of girls and boys before exposure; catch-up vaccination of men is being argued for.
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Transoral surgery with pathology-guided reduced-dose radiotherapy is a validated de-escalation pathway for HPV-positive oropharyngeal cancer in experienced centres.
Cetuximab is not an acceptable substitute for cisplatin in HPV-positive disease; de-escalation must be tested through other routes such as dose reduction after response or surgery-based pathways.
Cisplatin chemoradiation is the standard for HPV-positive oropharyngeal cancer; cetuximab is reserved for patients who cannot receive cisplatin.
HPV-positive oropharyngeal cancer is now staged and studied separately, and this risk model underlies de-escalation trials and the eighth-edition staging system.
Query for this cancer: (TITLE:"HPV-positive oropharyngeal cancer" OR ABSTRACT:"HPV-positive oropharyngeal cancer" OR TITLE:"p16-positive oropharyngeal cancer" OR ABSTRACT:"p16-positive oropharyngeal cancer" OR TITLE:"HPV-associated oropharyngeal squamous cell carcinoma" OR ABSTRACT:"HPV-associated oropharyngeal squamous cell carcinoma" OR TITLE:"HPV-driven throat cancer" OR ABSTRACT:"HPV-driven throat cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about HPV-positive oropharyngeal cancer, not a curated reading list.
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
Reactions around the moment a drug is given: chills, fever or breathlessness from antibodies (infusion reactions), true allergy (hypersensitivity, rarely anaphylaxis), and leakage of a damaging drug into tissue around the vein (extravasation).
See all on the product pages:CetuximabCisplatinPembrolizumab·Printable cards in the navigator
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