# De-ESCALaTE HPV: radiotherapy plus cisplatin or cetuximab in low-risk HPV-positive oropharyngeal cancer

Source: https://onco.cc/key-papers/paper-de-escalate-lancet-2019/  
OnCo record `paper-de-escalate-lancet-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

This European trial, like its American counterpart, found that replacing cisplatin with cetuximab in low-risk HPV-positive oropharyngeal cancer caused more recurrences and deaths without reducing severe toxicity.

## Summary

Phase 3 trial of 334 patients with low-risk HPV-positive oropharyngeal cancer (non-smokers or light smokers) randomised to radiotherapy 70 Gy with cisplatin or with cetuximab, with severe toxicity as the primary endpoint.

Severe toxicity did not differ, while two-year overall survival was 97.5 percent with cisplatin against 89.4 percent with cetuximab (hazard ratio 5.0) and recurrence was 6.0 versus 16.1 percent.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet
- Year: 2019
- DOI: 10.1016/S0140-6736(18)32752-1
- Authors: Mehanna H, Robinson M, Hartley A, et al.
- Findings: Two-year overall survival 97.5 percent (cisplatin) vs 89.4 percent (cetuximab).; Two-year recurrence 6.0 percent vs 16.1 percent.
- What it means: 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.
- Caveats: Small trial powered for toxicity rather than survival.

## Sources

- Lancet 2019: https://doi.org/10.1016/S0140-6736(18)32752-1
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30449623/

## Connected records

- cancers: [HPV-positive oropharyngeal cancer](https://onco.cc/cancers/hpv-positive-oropharyngeal-cancer/), [Oropharyngeal cancer (tonsil and base of tongue)](https://onco.cc/cancers/oropharyngeal-cancer/)
- drugs: [Cetuximab](https://onco.cc/drugs/cetuximab/), [Cisplatin](https://onco.cc/drugs/cisplatin/)
- trials: [De-ESCALaTE HPV](https://onco.cc/trials/de-escalate/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

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