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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.
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.
Shares NRG-HN002 & NRG-HN005 (HPV+ de-escalation), Circulating tumour HPV DNA (ctHPV-DNA), HPV-positive (p16) head and neck cancer, HPV-positive oropharyngeal cancer.
Shares NRG-HN002 & NRG-HN005 (HPV+ de-escalation), Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam).
Shares HPV-positive (p16) head and neck cancer, HPV-positive oropharyngeal cancer, Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam).
Shares HPV-positive oropharyngeal cancer, Head and neck squamous cell carcinoma.
Shares HPV-positive (p16) head and neck cancer, HPV-positive oropharyngeal cancer, IMRT / IGRT (modern external beam).
Shares HPV-positive (p16) head and neck cancer, HPV-positive oropharyngeal cancer, IMRT / IGRT (modern external beam).
Shares HPV-positive oropharyngeal cancer, Head and neck squamous cell carcinoma.
Shares HPV-positive oropharyngeal cancer, Head and neck squamous cell carcinoma.