OnCo
ideasIdea

ctHPV-DNA-adapted de-escalation of chemoradiation

Instead of guessing from HPV status who can get less radiation, measure the virus DNA in blood during treatment and reduce dose only when it clears fast.

HN005 showed static selection fails. Early clearance of ctHPV-DNA during induction or the first weeks of radiation identifies exceptional responders. Several phase 2 trials (including neoadjuvant chemotherapy with response-adapted radiation) are testing dynamic selection.

Hypothesis
Patients whose ctHPV-DNA clears by week 2-3 of chemoradiation can receive 60 Gy without loss of PFS, while non-clearers receive 70 Gy.
Rationale
ctHPV-DNA kinetics track tumour kill in real time and outperform baseline staging for predicting recurrence.
What would test it
Phase 2/3 with ctHPV-DNA-guided dose assignment versus uniform 70 Gy; PFS non-inferiority in clearers and quality-of-life superiority.
Maturity
early clinical

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