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Attempts to give HPV-positive throat cancer patients less radiation fell short: the standard dose remained better, so de-escalation is not yet routine.
HN002 (phase 2, 2021) found 60 Gy with weekly cisplatin met its acceptability threshold, but 60 Gy alone did not. HN005 (phase 2/3, presented 2025) was stopped after the de-intensified arms showed diminished progression-free survival while the 70 Gy control reached 2-year PFS of 98%. HPV status alone is an insufficient selector; ctHPV-DNA and imaging-response-adapted designs are the next approach.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
Both de-escalated arms failed non-inferiority (HR vs standard 7.42 and 5.55; non-inferiority margin HR 2.4); the trial did not proceed to phase III
Source306 patients; only the cisplatin arm met the PFS and swallowing (MDADI) criteria to advance
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| HN005: progression-free survival at 2 years (phase II non-inferiority)primary | 70 Gy + cisplatin (standard) | 136 | 98.1% | - | - | link |
| 60 Gy + cisplatin | 116 | 88.6% | ||||
| 60 Gy + nivolumab | 132 | 90.3% | ||||
| HN002: progression-free survival at 2 years (randomised phase II vs 85% historical control) | 60 Gy IMRT + weekly cisplatin | - | 90.5% | - | 0.04 (IMRT + cisplatin vs 85%) | link |
| 60 Gy IMRT alone | - | 87.6% |
Shares Caution: de-escalating radiation on HPV status alone, ctHPV-DNA-adapted de-escalation of chemoradiation, HPV-positive (p16) head and neck cancer, HPV-positive oropharyngeal cancer.
Shares HPV-positive (p16) head and neck cancer, HPV-positive oropharyngeal cancer, NRG Oncology, Head and neck squamous cell carcinoma.
Shares HPV-positive oropharyngeal cancer, Oropharyngeal cancer (tonsil and base of tongue), NRG Oncology, Head and neck squamous cell carcinoma.
Shares HPV-positive (p16) head and neck cancer, HPV-positive oropharyngeal cancer, Oropharyngeal cancer (tonsil and base of tongue), IMRT / IGRT (modern external beam).
Shares HPV-positive (p16) head and neck cancer, HPV-positive oropharyngeal cancer, Oropharyngeal cancer (tonsil and base of tongue), IMRT / IGRT (modern external beam).
Shares HPV-positive oropharyngeal cancer, Oropharyngeal cancer (tonsil and base of tongue), Head and neck squamous cell carcinoma.
Shares HPV-positive oropharyngeal cancer, Oropharyngeal cancer (tonsil and base of tongue), Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam).
Shares HPV-positive oropharyngeal cancer, Oropharyngeal cancer (tonsil and base of tongue).