Treatment de‐escalation for HPV+ oropharyngeal cancer: A systematic review and meta‐analysis

Human Papillomavirus (HPV) related oropharyngeal carcinoma (OPC) carries a better prognosis compared with HPV‐counterparts, thereby pushing the adoption of de‐intensification treatment approaches as new strategies to preserve superior oncologic outcomes while minimizing toxicity. We evaluated the effect of treatment de‐intensification in terms of overall survival (OS), progression‐free survival (PFS), locoregional and distant control (LRC and DM) by selecting prospective or retrospective studies, providing outcome data with reduced intensification versus standard curative treatment in HPV+ OPC patients, with a systematic analysis till September 2020. The primary outcome of interest was OS. Secondary endpoints were PFS, LRC, and DM expressed as HR. A total of 55 studies (from 1393 screened references) were employed for quantitative synthesis for 38 929 patients. Among n = 48 studies with data available, de‐intensified treatments reduced OS in HPV+ OPCs (HR = 1.33, 95% CI 1.17–1.52; p