Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial

Publication date: Available online 15 November 2018Source: The LancetAuthor(s): Hisham Mehanna, Max Robinson, Andrew Hartley, Anthony Kong, Bernadette Foran, Tessa Fulton-Lieuw, Matthew Dalby, Pankaj Mistry, Mehmet Sen, Lorcan O'Toole, Hoda Al Booz, Karen Dyker, Rafael Moleron, Stephen Whitaker, Sinead Brennan, Audrey Cook, Matthew Griffin, Eleanor Aynsley, Martin Rolles, Emma De WintonSummaryBackgroundThe incidence of human papillomavirus (HPV)-positive oropharyngeal cancer, a disease affecting younger patients, is rapidly increasing. Cetuximab, an epidermal growth factor receptor inhibitor, has been proposed for treatment de-escalation in this setting to reduce the toxicity of standard cisplatin treatment, but no randomised evidence exists for the efficacy of this strategy.MethodsWe did an open-label randomised controlled phase 3 trial at 32 head and neck treatment centres in Ireland, the Netherlands, and the UK, in patients aged 18 years or older with HPV-positive low-risk oropharyngeal cancer (non-smokers or lifetime smokers with a smoking history of <10 pack-years). Eligible patients were randomly assigned (1:1) to receive, in addition to radiotherapy (70 Gy in 35 fractions), either intravenous cisplatin (100 mg/m2 on days 1, 22, and 43 of radiotherapy) or intravenous cetuximab (400 mg/m2 loading dose followed by seven weekly infusions of 250 mg/m2). The primary outcome was overall severe (grade 3–5) toxicity events at 24 months from the end of treatment. The prima...
Source: The Lancet - Category: General Medicine Source Type: research