Treatment of p16 (HPV)-Negative Squamous Cell Carcinoma of the Tonsil — Locally Advanced Stage
This protocol applies to squamous cell carcinoma arising in the tonsil (oropharynx) confirmed as p16-negative by immunohistochemistry, presenting at locally advanced clinical stages T3–4a, N0–1 or T1–4a, N2–3.
Clinical Scenario
Squamous cell carcinoma of the tonsil (oropharynx); p16 (HPV)-negative tumor confirmed by p16 IHC testing. Locally advanced clinical stage: T3–4a, N0–1 or T1–4a, N2–3.
Tumor HPV testing by p16 IHC is required to place patients on this pathway.
Treatment Approach (Overview)
For recurrent, unresectable, or metastatic disease when surgery and radiotherapy are not options, first-line systemic therapy is indicated. Pembrolizumab is among the regimens considered, with eligibility dependent on biomarker testing results.
Full selection criteria, preferred combinations, and sequencing are detailed in the complete protocol.
References
- Base of Tongue/Tonsil/Posterior Pharyngeal Wall/Soft Palate
- Tumor human papillomavirus (HPV) testing by p16 IHC required
- p16-negative
- T3–4a, N0–1
- T1–4a, N2–3
- Pembrolizumab (for tumors that express PD-L1 with CPS ≥1)
- Cisplatin/Infusional Fluorouracil + Pembrolizumab
- Carboplatin/Infusional Fluorouracil + Pembrolizumab
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