De-ESCALaTE HPV: radiotherapy plus cisplatin or cetuximab in low-risk HPV-positive oropharyngeal cancer
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.
Overview
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.
- Two-year overall survival 97.5 percent (cisplatin) vs 89.4 percent (cetuximab).
- Two-year recurrence 6.0 percent vs 16.1 percent.
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.
- Small trial powered for toxicity rather than survival.
Similar pages
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