Treatment of Tonsillar Cancer in p16 (HPV)-Negative Squamous Cell Carcinoma of the Tonsil — T1–2, N0–1
This protocol addresses first-line systemic management of squamous cell carcinoma of the tonsil (oropharynx) in patients whose tumors are confirmed p16 (HPV)-negative at clinical stages T1–2, N0–1.
Clinical Scenario
- Primary site: tonsil / oropharynx
- Histology: squamous cell carcinoma
- p16 immunohistochemistry negative — HPV-negative tumor
- Clinical stage: T1–2, N0–1
First-Line Protocol
Treatment Approach
When disease is recurrent, unresectable, or metastatic with no remaining surgical or radiation option, first-line systemic therapy is indicated. The protocol incorporates immunotherapy-based regimens, with selection guided in part by PD-L1 expression status.
The full structured protocol defines which specific regimen applies based on tumor PD-L1 CPS and individual patient factors — details are available in the complete evidence-based protocol below.
References
Condition:
- Base of Tongue/Tonsil/Posterior Pharyngeal Wall/Soft Palate
- Tumor human papillomavirus (HPV) testing by p16 IHC required
- p16-negative
- T1–2, N0–1
Treatment:
- Pembrolizumab (for tumors that express PD-L1 with CPS ≥1)
- Cisplatin/Infusional Fluorouracil + Pembrolizumab
- Carboplatin/Infusional Fluorouracil + Pembrolizumab
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