Reducing treatment intensity for HPV-positive oropharyngeal cancer

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This study investigates the effectiveness of reducing radiation doses and omitting chemotherapy for patients with favorable prognosis HPV or p16-positive oropharyngeal cancer. The aim is to determine if this de-escalated treatment approach maintains a high rate of progression-free survival while minimizing long-term side effects associated with standard treatments. The study will measure outcomes such as 2-year progression-free survival rates, quality of life, and overall survival. Patients will receive definitive radiation therapy with adjusted doses targeting the tumor and high-risk areas.

Why it matters

Who can join: the full rules

Inclusion Criteria:

* Patients must be ≥ 18 years of age on the day of signing informed consent.
* Patients must have a diagnosis of p16+ and/or HPV+ squamous cell carcinoma of the oropharynx (including base of tongue, glossotonsilar sulcus, tonsil, soft palate, vallecula, and/or posterior oropharyngeal wall).
* clinical stage stage I-II (T1-2 N1 M0, or T3 N0-1 M0 ) (AJCC 8th ed.) SCCA of the oropharynx that would mandate definitive chemoradiation as current standard of care when standard radiation fractionation is applied. Debulking of the disease by resecting the exophytic portion of the tumor for biopsy/sample or symptom alleviation will be permitted, as long as gross unresected tumor is left behind.
* Subjects must agree to biopsy of areas that are FDG-avid on PET-CT scan 3-4 months after treatment.
* Patients must have Karnofsky Performance Status (KPS) ≥ 60 within 8 weeks prior to registration
* Patients must have had a neutrophil:lymphocyte ratio ≤ 5 within 8 weeks of registration.
* Patient must have had a hemoglobin count ≥ 10 within 8 weeks of registration. The patient may receive transfusion to reach this goal.
* Patients must be a current non-smoker (at least 6 months) with ≤ 15 pack-year smoking history
* Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
* Ability to understand and the willingness to sign a written informed consent.

Exclusion Criteria:

* Patients with gross involvement of level 4 lymph node level
* Endophytic T3 disease, as clinically determined by the principal investigator.
* Patients with any single lymph node \> 4cm (multiple lymph nodes including nodal conglomerates that in sum measure \>4cm is allowed)
* Patients with nodal disease clinically fixed to or radiographically invading adjacent neck musculature any single lymph node \> 4cm (multiple lymph nodes including nodal conglomerates that in sum measure \>4cm is allowed)
* Prior history of malignancy diagnosed within 2 years prior to registration, except for nonmelanomatous skin cancer that has completed treatment and the patient is deemed as being disease-free, or Gleason 6 prostate cancer undergoing active surveillance.
* Patients must not be pregnant or nursing due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants.

Where it's running

• Medstar Georgetown University Hospital
  Washington D.C., District of Columbia, United States Recruiting
• Medstar Southern Maryland Hospital Center
  Clinton, Maryland, United States Recruiting

Study contacts

• Principal investigator: Peter Ahn, MD — Georgetown University
• Study coordinator: Peter H Ahn, MD
• Email: peter.h.ahn@gunet.georgetown.edu
• Phone: 202-444-6385

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.