{"entity":{"id":"paper-de-escalate-lancet-2019","kind":"paper","name":"De-ESCALaTE HPV: radiotherapy plus cisplatin or cetuximab in low-risk HPV-positive oropharyngeal cancer","aka":[],"tldr":"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.\n\nSevere 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.","asOf":"2026-09-17","links":[{"label":"Lancet 2019","url":"https://doi.org/10.1016/S0140-6736(18)32752-1"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/30449623/"}],"tags":[],"related":[],"cancers":["hpv-positive-oropharyngeal-cancer","oropharyngeal-cancer"],"sections":[],"technologies":[],"targets":[],"drugs":["cetuximab","cisplatin"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["de-escalate"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["lancet"],"dependsOn":[],"notes":[],"journal":"The Lancet","year":2019,"doi":"10.1016/S0140-6736(18)32752-1","pmid":"30449623","authors":"Mehanna H, Robinson M, Hartley A, et al.","paperType":"rct","findings":["Two-year overall survival 97.5 percent (cisplatin) vs 89.4 percent (cetuximab).","Two-year recurrence 6.0 percent vs 16.1 percent."],"whatItMeans":"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."],"changedPractice":true,"participants":334},"route":"/key-papers/paper-de-escalate-lancet-2019/","neighbours":{"cancer":[{"id":"hpv-positive-oropharyngeal-cancer","kind":"cancer","name":"HPV-positive oropharyngeal cancer","route":"/cancers/hpv-positive-oropharyngeal-cancer/"},{"id":"oropharyngeal-cancer","kind":"cancer","name":"Oropharyngeal cancer (tonsil and base of tongue)","route":"/cancers/oropharyngeal-cancer/"}],"drug":[{"id":"cetuximab","kind":"drug","name":"Cetuximab","route":"/drugs/cetuximab/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"}],"trial":[{"id":"de-escalate","kind":"trial","name":"De-ESCALaTE HPV","route":"/trials/de-escalate/"}],"journal":[{"id":"lancet","kind":"journal","name":"The Lancet","route":"/journals/lancet/"}]}}