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Head & neck: Oropharynx de-escalation — RTOG 1016 locoregional control

Free question published 18 October 2026

Head & neckOropharynx de-escalation — RTOG 1016 locoregional control

A 55-year-old man with p16-positive oropharyngeal cancer is platinum-eligible. He is anxious about cisplatin-related toxicity and asks whether cetuximab would control his cancer just as well in the neck. Which statement about locoregional control is most accurate?

  1. ACetuximab produced superior progression-free survival despite similar locoregional control
  2. BLocoregional failure was significantly higher with cetuximab than with cisplatin
  3. CLocoregional control was identical between the two arms, with the difference confined to distant metastases
  4. DCetuximab met the pre-specified non-inferiority margin for overall survival
  5. ECetuximab and cisplatin gave equivalent 5-year overall survival of about 85% in each arm

Why B is correct

In RTOG 1016, radiotherapy plus cetuximab failed to meet non-inferiority: 5-year overall survival was 77.9% with cetuximab versus 84.6% with cisplatin, and locoregional failure was higher in the cetuximab group (17.3% vs 9.9%). Cetuximab should not be substituted for cisplatin in platinum-eligible HPV-positive patients.

And why the others are not

  • AWrong — progression-free survival was worse with cetuximab (67.3% vs 78.4%, HR 1.72).
  • CWrong — locoregional control differed between the arms; the deficit was not confined to distant disease.
  • DWrong — radiotherapy plus cetuximab did not meet the non-inferiority margin for overall survival.
  • EWrong — 5-year overall survival was 77.9% with cetuximab versus 84.6% with cisplatin, not equivalent.

Source NRG Oncology RTOG 1016 — radiotherapy plus cetuximab or cisplatin in HPV-positive oropharyngeal cancer — Gillison ML, Trotti AM, Harris J, et al. Lancet 2019;393(10166):40-50. DOI 10.1016/S0140-6736(18)32779-X.

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