A Single Arm Phase II Trial in p16-positive Oropharynx Cancer of Selective Dose De-escalation of nodAl VolumEs at Minimal Risk and Primary Site Disease (SAVED)

NCT07418034 | Not Yet Recruiting Phase 2 DMC

• 1 other identifier: HP-00116955
• Study Type: interventional
• Target: 132
• Locations: 0 countries
• Sites: N/A

Brief Summary

Patients with human papillomavirus (HPV)-related oropharyngeal cancer generally have very good outcomes. Patients' treatment responses depend more on their individual cancer characteristics and personal risk factors than on the specific type of treatment they receive. However, the different treatments used for this cancer can cause significant side effects. Because outcomes are often favorable regardless of treatment type, reducing treatment-related side effects should be a priority when choosing care. Studies have reported that lowering radiation doses for some patients can reduce side effects while still effectively controlling the cancer. Patients with this type of head and neck cancer typically receive either surgery or radiation as their first treatment. For patients who receive surgery first, radiation to the surgical area and nearby neck lymph nodes is often recommended afterward. In these patients, the study will test whether lowering the radiation dose to low-risk lymph nodes on the side of the neck opposite the tumor can reduce side effects while still effectively controlling the cancer (Method A). For patients who receive radiation as their first treatment, the study will test one or both of two radiation approaches aimed at reducing both short-term and long-term side effects. These approaches include reduced lymph node radiation (Method A, described above) and a tumor dose reduction approach (Method B), which lowers the radiation dose delivered directly to the tumor. Information such as tumor size, the number of cancerous or suspicious lymph nodes, and risk factors like smoking history will be used to determine which patients may be eligible for reduced lymph node radiation (Method A), reduced tumor radiation (Method B), or both. Patients who may qualify for tumor dose reduction (Method B), either alone or combined with Method A, will need an additional blood test called a circulating tumor DNA (ctDNA) test to determine eligibility. The ctDNA test measures small amounts of tumor-related DNA in the blood, which are often elevated at the time of diagnosis. Studies have shown that cancer is more likely to return when ctDNA levels remain positive after treatment. This study will evaluate whether ctDNA levels measured before and during treatment can help identify patients who can safely receive lower radiation doses to the tumor (Method B). Overall, this study aims to safely evaluate two radiation de-escalation approaches in order to lessen short- and long-term side effects while maintaining excellent cancer control.

Conditions

Head and Neck Cancer; Head and Neck Squamous Cell Cancer; Head and Neck Squamous Cell Carcinoma; Oropharyngeal Carcinoma; Oropharyngeal Squamous Cell Carcinoma (OPSCC); Oropharyngeal Human Papillomavirus-Positive Squamous Cell Carcinoma; Oropharyngeal Squamous Cell Carcinoma; Oropharyngeal Squamous Cell Carcinoma (SCC); Oropharyngeal Squamous Cell Carcinoma (OPSCCA); Oropharyngeal Cancer; Oropharyngeal Squamous Cell Cancer; HPV Positive Oropharyngeal Squamous Cell Carcinoma; HPV (Human Papillomavirus)-Associated Carcinoma; HPV 16 Positive Oropharyngeal Tumors (OPC)

Keywords

Transoral Robotic Surgery (TORS); Head and Neck Cancer; Oropharynx Cancer; HPV p16 Oropharynx Cancer; Proton Therapy; Photon Therapy; Radiation Therapy; ctDNA; P16 positive

Outcome Measures

Primary Outcomes (2)

• Freedom From Regional Failures (FFRF)

  The efficacy of dose de-escalation to the elective nodal regions will be evaluated by ensuring a 93% freedom from regional failures (FFRF) at 2 years.

  2 years post treatment

• Freedom From Local Recurrence (FFLR)

  The efficacy of de-escalation of dose to gross disease in patients who clear ctDNA will be evaluated by ensuring a 93% Freedom From Local Recurrence (FFLR) at 2 years.

  2 years post treatment

Secondary Outcomes (6)

• Progression-free Survival (PFS)

  2 year post treatment

• Overall Survival (OS)

  2 year post treatment

• Freedom from Distant Metastases (FFDM)

  2 years post treatment

• Number of participants with grade 2/3 xerostomia

  [Time Frame: 1-year following completion of treatment]

• Patient scores from the questionnaire called The Monroe Dunaway Anderson Dysphagia Inventory (MDADI)

  1-year following completion of treatment

Study Arms (1)

Selective dose de-escalation of nodAl VolumEs at minimal Risk and primary site Disease

EXPERIMENTAL

Radiation: Dose de-escalation to contralateral neck.; Radiation: Dose de-escalation to gross disease to contralateral neck; Radiation: Dose de-escalation to gross disease; Diagnostic Test: Circulating Tumor DNA test (ctDNA test)

Interventions

Dose de-escalation to contralateral neck. RADIATION

Dose de-escalation of elective treatment volumes including the SAVER-defined volume reduction in the contralateral neck. These patients can be treated in the definitive or adjuvant setting, and have c/pT1-4, N0-1,3 (AJCC 8th ed) disease with a recommendation to treat the contralateral neck. They will undergo treatment with sequential planning of 30Gy to the gross disease and elective neck volumes (using SAVER defined volumes of the contralateral neck) and a subsequent boost to 70Gy for definitive treatment and 50Gy for adjuvant treatment. Chemotherapy will be incorporated per SOC guidelines and based on multi-disciplinary recommendations.

Also known as: SAVER volume reduction

Selective dose de-escalation of nodAl VolumEs at minimal Risk and primary site Disease

Dose de-escalation to gross disease to contralateral neck RADIATION

Dose de-escalation to gross disease for patients treated with definitive chemoRT who meet eligibility for NRG HN 005 (cT1-2N0-2, cT3N0-1 \[AJCC 8th ed\], ≤ 10 Smoking Pack years). Additionally, these patients will require pre-treat positive ctDNA. They will undergo treatment with sequential planning of 30Gy to gross disease and elective neck volumes (using SAVER defined volumes of the contralateral neck). A subsequent boost will be initiated to gross disease. At 4 weeks of treatment, patients will undergo ctDNA analysis. If a patient's ctDNA decreases by ≥95%, final dose will be decreased from SOC dosing for 70Gy to 60Gy (HN-002 dosing). If ctDNA dosing is not resulted by the time patients reach 60Gy, they will continue SOC treatment up to a maximum of 70Gy or until the ctDNA results are available. If there is a ≥95% reduction in ctDNA, treatment will be stopped prior to 70Gy.

Selective dose de-escalation of nodAl VolumEs at minimal Risk and primary site Disease

Dose de-escalation to gross disease RADIATION

Dose de-escalation to the gross disease for patients treated with definitive chemoRT who meet eligibility criteria for NRG HN 005 (cT1-2N0-2, cT3N0-1 \[AJCC 8th ed\], ≤ 10 Smoking Pack years). Additionally, these patients will require pre-treatment positive ctDNA levels. At 4 weeks of treatment (after fraction 19 and before fraction 22), patients will undergo ctDNA analysis. If a patient's ctDNA decreases by ≥95%, final dose will be decreased from SOC dosing for 70Gy to 60Gy (HN-002 dosing). If ctDNA dosing is not resulted by the time patients reach 60Gy, they will continue SOC treatment up to a maximum of 70Gy or until the ctDNA results are available. If there is a ≥95% reduction in ctDNA, treatment will be stopped prior to 70Gy.

Selective dose de-escalation of nodAl VolumEs at minimal Risk and primary site Disease

Circulating Tumor DNA test (ctDNA test) DIAGNOSTIC_TEST

Blood test for diagnostic and surveillance purposes measuring expression of Cell free HPV tumor DNA (ctDNA) in the blood. Patients who are eligible for dose de-escalation to gross disease, whether they are also eligible for dose de-escalation of contralateral neck or not, will undergo ctDNA evaluation pretreatment, at 4 weeks of treatment, and then at 3, 6, and 12 months post treatment.

Selective dose de-escalation of nodAl VolumEs at minimal Risk and primary site Disease

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

4.1 Step 1 Registration 4.1.1 Step 1 Inclusion (Y) 1. Is there pathologically (histologically or cytologically) proven diagnosis of squamous cell carcinoma (including the histological variants papillary squamous cell carcinoma and basaloid squamous cell carcinoma) of the oropharynx or squamous cell carcinoma unknown primary? Note: specimen from cervical lymph nodes with a well-defined primary site documented clinically or radiologically is acceptable; in patients with carcinoma of unknown primary this will be sufficient for pathologic confirmation without a clinically or radiographically defined primary site. (Y) 2. Is the patient ≥ 18 years of age? (Y) 3. Did the patient provide study specific informed consent prior to study entry, including consent for mandatory submission of tissue for required p16 review? (Y) 4. Clinical TNM staging criteria by cohort (AJCC 8th edition): TORS candidate patients must be: • cT0-4 and N0, N1, N3 Non-TORS candidate patients must be either: * cT1-4 N0, N1, N3 * cT1-3 N2 with \< 10 pack years 4.1.2 Step 1 Exclusion (N) 1. Patient who are clinical N2 and have ≥10 pack years smoking history (N) 2. Patients who are clinical T4N2 (N) 3. Patients with distant metastasis (M1) 4.2 Step 2 Registration 4.2.1 Step 2 inclusion (Y) 1. Does the patient have pathologically (histologically or cytologically) proven P16+ status? (Y) 2. Does the patient have appropriate imaging (PET/CT preferred, CT neck with IV contrast and CT chest without contrast as recommended alternative to PET/CT) completed within 90 days of enrollment? (Y) 3. Does the patient have clinical or pathological M0 staging? (Y) 4. Patients who have undergone TORS must have pathological stage pT1-4 N0, N1 or N3. TORS patients found to be clinical N2 post TORS or have contralteral neck dissection and positive nodes will be excluded. (Y) 5. Is the patient a candidate for bilateral radiation based on evaluation by ENT, Rad Onc, or Med Onc and review at multi-disciplinary tumor board? (Y) 6. Non-TORS patients who are cT1-3 N0, N1, N2 and have \<10 PY must have completed a ctDNA evaluation prior to Step 2 enrollment. (Y) 7. Non-TORS patients who are cT1-3 N2 must have a positive ctDNA result prior to Step 2 enrollment. (Y) 8. Was a general history and physical examination performed by a radiation oncologist, medical oncologist, or head and neck surgeon within 60 days prior to registration? (Y) 9. Was the patient's Zubrod Performance Status 0-1 within 30 days prior to registration? (Y) 10. If a woman of child-bearing potential or sexually active male, is the patient willing to use effective contraception throughout their participation in the treatment phase of the study and at least 180 days following the last study treatment. 4.2.2 Step 2 Exclusion (N) 1. Does the patient have cancer considered to be from an oral cavity site (oral tongue, floor mouth, alveolar ridge, buccal or lip), nasopharynx, hypopharynx, or larynx? (N) 2. Does the patient have distant metastasis? (N) 3. Does the patient have prior invasive malignancy (except non-melanomatous skin cancer and low/intermediate risk prostate cancer) unless disease free for a minimum of 3 years? (N) 4. Did the patient have prior systemic chemotherapy for the study cancer (prior chemotherapy for a different cancer is allowable)? (N) 5. Did the patient have prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields? (N) 6. Did the patient have prior cancer-related surgeries of curative intent of the head and neck excluding superficial removal of cutaneous skin malignancies? (N) 7. Does the patient have any co-morbid condition or concern that may interfere with follow up per experimental arm? (N) 8. Does the patient have an active drug or alcohol dependency that in the opinion of the investigator would limit compliance with study requirements? (N) 9. Is the patient pregnant or nursing (an exception will be made for nursing patients that are not receiving chemotherapy)?

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• University of Maryland, Baltimore: lead

MeSH Terms

Conditions

Head and Neck Neoplasms; Squamous Cell Carcinoma of Head and Neck; Oropharyngeal Neoplasms; Papillomavirus Infections

Condition Hierarchy (Ancestors)

Neoplasms by Site; Neoplasms; Carcinoma, Squamous Cell; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Pharyngeal Neoplasms; Otorhinolaryngologic Neoplasms; Pharyngeal Diseases; Stomatognathic Diseases; Otorhinolaryngologic Diseases; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Communicable Diseases; Infections; DNA Virus Infections; Virus Diseases; Tumor Virus Infections; Genital Diseases; Urogenital Diseases; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Jason K Molitoris

  University of Maryland/Maryland Proton Treatment Center

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Jason K Molitoris

CONTACT

410-328-6080; jmolitoris@umm.edu

Kelly Kitzmiller

CONTACT

410-369-5264; kelly.kitzmiller@umm.edu

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: February 10, 2026
• First Posted: February 18, 2026
• Study Start: May 1, 2026
• Primary Completion (Estimated): May 1, 2031
• Study Completion (Estimated): May 1, 2033
• Last Updated: February 18, 2026

Record last verified: 2026-02