Decreasing treatment burden in HPV-related OPSCC: A systematic review of clinical trials

Abstract

Introduction: Favorable outcomes are observed after treatment with standard chemoradiotherapy (CRT) for Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) patients. The consistent growing interest on treatment-related toxicity burden, potentially jeopardizing survivors' quality of life, led clinicians to investigate possible de-escalation strategies.

Materials and methods: A comprehensive systematic literature search of clinical trials was performed through the EMBASE database to provide an overview of the de-escalation strategies spectrum. Additionally, hand searching and clinicaltrials.gov were also used.

Results: Herein, we report and discuss different approaches to de-escalation of therapy, with respect to both local and systemic strategies.

Conclusions: Several promising de-escalation experiences have been published. However, while further evidence is awaited, no changes in the management nor deviation from the standard of care should be made outside of clinical trials.

Keywords: Cetuximab; Cisplatin; De-escalation; De-intensification; HPV; Oropharynx cancer; Radiotherapy; TORS.