Latest revision as of 12:00, 6 July 2024

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Section editor		Page editor
	Jennifer H. Choe, MD, PhD Vanderbilt University Nashville, TN, USA LinkedIn		C. Beau Hilton, MD Vanderbilt University Nashville, TN, USA LinkedIn

Note: this page has regimens which are specific to oropharyngeal cancer that is human papilloma virus (HPV) positive. Please see the head and neck cancer page for other regimens.

1 regimens on this page 2 variants on this page

Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

ASCO

2019: Adelstein et al. Role of Treatment Deintensification in the Management of p16+ Oropharyngeal Cancer: ASCO Provisional Clinical Opinion PubMed

EHNS/ESMO/ESTRO

2020: Machiels et al. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up PubMed

NCCN

NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - Head and Neck Cancers.

Definitive therapy

Cisplatin & RT

Cisplatin & RT: Cisplatin & Radiation Therapy

Regimen variant #1, 100 mg/m² q3wk x 2

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Gillison et al. 2018 (RTOG 1016)	2011-2014	Phase 3 (C)	Cetuximab & RT	Seems to have superior OS

Chemotherapy

Cisplatin (Platinol) 100 mg/m² IV once per day on days 1 & 22

Radiotherapy

Concurrent radiation therapy 200 cGy fractions x 35 fractions (total dose: 7000 cGy), given 6 times per week

6-week course

Regimen variant #2, 100 mg/m² q3wk x 3

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Mehanna et al. 2018 (De-ESCALaTE HPV)	2012-2016	Phase 3 (C)	Cetuximab & RT	Superior OS

Chemotherapy

Cisplatin (Platinol) 100 mg/m² IV once per day on days 1, 22, 43

Radiotherapy

Concurrent radiation therapy 200 cGy fractions x 35 fractions (total dose: 7000 cGy), given 6 times per week

9-week course

References

RTOG 1016: Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, Sturgis EM, Burtness B, Ridge JA, Ringash J, Galvin J, Yao M, Koyfman SA, Blakaj DM, Razaq MA, Colevas AD, Beitler JJ, Jones CU, Dunlap NE, Seaward SA, Spencer S, Galloway TJ, Phan J, Dignam JJ, Le QT. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet. 2019 Jan 5;393(10166):40-50. Epub 2018 Nov 15. Erratum in: Lancet. 2020 Mar 7;395(10226):784. link to original article contains dosing details in abstract link to PMC article PubMed NCT01302834
De-ESCALaTE HPV: Mehanna H, Robinson M, Hartley A, Kong A, Foran B, Fulton-Lieuw T, Dalby M, Mistry P, Sen M, O'Toole L, Al Booz H, Dyker K, Moleron R, Whitaker S, Brennan S, Cook A, Griffin M, Aynsley E, Rolles M, De Winton E, Chan A, Srinivasan D, Nixon I, Grumett J, Leemans CR, Buter J, Henderson J, Harrington K, McConkey C, Gray A, Dunn J; De-ESCALaTE HPV Trial Group. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet. 2019 Jan 5;393(10166):51-60. Epub 2018 Nov 15. link to original article contains dosing details in abstract link to PMC article PubMed ISRCTN33522080

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-{| class="wikitable" style="text-align:center; width:50%;"
+{{#lst:Editorial board transclusions|hn}}
-!colspan="2" align="center" style="color:white; font-size:125%; background-color:#08519c"|'''Section editor'''
+'''Note: this page has regimens which are specific to oropharyngeal cancer that is human papilloma virus (HPV) positive. Please see the [[head and neck cancer]] page for other regimens.'''
-|-
-|style="background-color:#F0F0F0"|[[File:Michaelgibson.jpg|frameless|upright=0.3|center]]
-|<big>[[User:Michaelgibson|Michael K. Gibson, MD, PhD, FACP]]<br>Vanderbilt University<br>Nashville, TN</big><br>[[File:Social-twitter-icon.png|frameless|upright=0.1]] [https://twitter.com/mgibson21212 mgibson21212]<br>[https://www.linkedin.com/in/michael-gibson-65137032/ LinkedIn]
-|-
-|}
-<big>'''Note: this page has regimens which are specific to oropharyngeal cancer that is human papilloma virus (HPV) positive. Please see the [[head and neck cancer]] page for other regimens.'''</big>
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 {{TOC limit|limit=3}}
 =Guidelines=
+'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
+==ASCO==
+*'''2019:''' Adelstein et al. [https://doi.org/10.1200/jco.19.00441 Role of Treatment Deintensification in the Management of p16+ Oropharyngeal Cancer: ASCO Provisional Clinical Opinion] [https://pubmed.ncbi.nlm.nih.gov/31021656/ PubMed]
 ==EHNS/ESMO/ESTRO==
-*'''2020:''' Machiels et al. [https://doi.org/10.1016/j.annonc.2020.07.011 Squamous cell carcinoma of the oral cavity, larynx, '''oropharynx''' and hypopharynx: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up]
+*'''2020:''' Machiels et al. [https://doi.org/10.1016/j.annonc.2020.07.011 Squamous cell carcinoma of the oral cavity, larynx, '''oropharynx''' and hypopharynx: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up] [https://pubmed.ncbi.nlm.nih.gov/33239190 PubMed]
-==[https://www.nccn.org/ NCCN]==
-*[https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf NCCN Guidelines - Head and Neck Cancers]
+==NCCN==
+*''NCCN does not currently have guidelines at this granular level; please see [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437 NCCN Guidelines - Head and Neck Cancers].''
 =Definitive therapy=
 ==Cisplatin & RT {{#subobject:c7061f|Regimen=1}}==
@@ Line 37: / Line 37: @@
 |2011-2014
 |style="background-color:#1a9851"|Phase 3 (C)
-|[[#Cetuximab_.26_RT_99|Cetuximab & RT]]
+|[[#Cetuximab_.26_RT_999|Cetuximab & RT]]
 | style="background-color:#91cf60" |Seems to have superior OS
 |-
@@ Line 43: / Line 43: @@
 <div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
-*[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV once on day 1
+*[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV once per day on days 1 & 22
-'''21-day cycle for 2 cycles'''
 ====Radiotherapy====
-*Concurrent [[External_beam_radiotherapy|radiation therapy]] 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 6 times per week
+*Concurrent [[External_beam_radiotherapy|radiation therapy]] 200 cGy fractions x 35 fractions (total dose: 7000 cGy), given 6 times per week
 '''6-week course'''
 </div></div><br>
@@ Line 61: / Line 60: @@
 |2012-2016
 |style="background-color:#1a9851"|Phase 3 (C)
-|[[#Cetuximab_.26_RT_99|Cetuximab & RT]]
+|[[#Cetuximab_.26_RT_999|Cetuximab & RT]]
 | style="background-color:#1a9850" |Superior OS
 |-
@@ Line 67: / Line 66: @@
 <div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
-*[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV once on day 1
+*[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV once per day on days 1, 22, 43
-'''21-day cycle for 3 cycles'''
 ====Radiotherapy====
-*Concurrent [[External_beam_radiotherapy|radiation therapy]] 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 6 times per week
+*Concurrent [[External_beam_radiotherapy|radiation therapy]] 200 cGy fractions x 35 fractions (total dose: 7000 cGy), given 6 times per week
-'''6-week course'''
+'''9-week course'''
 </div></div>
 ===References===
-# '''RTOG 1016:''' Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, Sturgis EM, Burtness B, Ridge JA, Ringash J, Galvin J, Yao M, Koyfman SA, Blakaj DM, Razaq MA, Colevas AD, Beitler JJ, Jones CU, Dunlap NE, Seaward SA, Spencer S, Galloway TJ, Phan J, Dignam JJ, Le QT. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet. 2019 Jan 5;393(10166):40-50. Epub 2018 Nov 15. Erratum in: Lancet. 2020 Mar 7;395(10226):784. [https://doi.org/10.1016/S0140-6736(18)32779-X link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6541928/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/30449625 PubMed] NCT01302834
+# '''RTOG 1016:''' Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, Sturgis EM, Burtness B, Ridge JA, Ringash J, Galvin J, Yao M, Koyfman SA, Blakaj DM, Razaq MA, Colevas AD, Beitler JJ, Jones CU, Dunlap NE, Seaward SA, Spencer S, Galloway TJ, Phan J, Dignam JJ, Le QT. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet. 2019 Jan 5;393(10166):40-50. Epub 2018 Nov 15. Erratum in: Lancet. 2020 Mar 7;395(10226):784. [https://doi.org/10.1016/S0140-6736(18)32779-X link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6541928/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/30449625/ PubMed] [https://clinicaltrials.gov/study/NCT01302834 NCT01302834]
 # '''De-ESCALaTE HPV:''' Mehanna H, Robinson M, Hartley A, Kong A, Foran B, Fulton-Lieuw T, Dalby M, Mistry P, Sen M, O'Toole L, Al Booz H, Dyker K, Moleron R, Whitaker S, Brennan S, Cook A, Griffin M, Aynsley E, Rolles M, De Winton E, Chan A, Srinivasan D, Nixon I, Grumett J, Leemans CR, Buter J, Henderson J, Harrington K, McConkey C, Gray A, Dunn J; De-ESCALaTE HPV Trial Group. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet. 2019 Jan 5;393(10166):51-60. Epub 2018 Nov 15. [https://doi.org/10.1016/S0140-6736(18)32752-1 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6319250/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/30449623/ PubMed] ISRCTN33522080
 [[Category:Head and neck cancer regimens]]
 [[Category:Biomarker-specific pages]]
 [[Category:Head and neck cancers]]

Difference between revisions of "Oropharyngeal cancer, HPV-positive"

Latest revision as of 12:00, 6 July 2024

Contents

Guidelines

ASCO

EHNS/ESMO/ESTRO

NCCN

Definitive therapy

Cisplatin & RT

Regimen variant #1, 100 mg/m² q3wk x 2

Chemotherapy

Radiotherapy

Regimen variant #2, 100 mg/m² q3wk x 3

Chemotherapy

Radiotherapy

References

Navigation menu

Search

Difference between revisions of "Oropharyngeal cancer, HPV-positive"

Latest revision as of 12:00, 6 July 2024

Guidelines

ASCO

EHNS/ESMO/ESTRO

NCCN

Definitive therapy

Cisplatin & RT

Regimen variant #1, 100 mg/m2 q3wk x 2

Chemotherapy

Radiotherapy

Regimen variant #2, 100 mg/m2 q3wk x 3

Chemotherapy

Radiotherapy

References

Navigation menu

Search

Regimen variant #1, 100 mg/m² q3wk x 2

Regimen variant #2, 100 mg/m² q3wk x 3