Intensification or de-escalation? What is the standard treatment for human papillomavirus-related oropharyngeal cancers in 2025?

Abstract

The incidence of human papillomavirus-related oropharyngeal cancers has been increasing steadily for several decades. They have a better prognosis than alcohol- and tobacco-related oropharyngeal cancers because they are more sensitive to radiotherapy and chemotherapy and patients have fewer comorbidities. However, some tumours have a high risk of recurrence, for which intensified therapy may be considered. On the other hand, for forms with a good prognosis, numerous therapeutic de-escalation strategies have been considered. The aim of this article is to review the standard of care in 2025, the various de-escalation strategies, the potential benefits of immunotherapy, and the impact of human papillomavirus on surveillance and screening of these cancers.