Onco Wiki / Red flag

Adverse biology in head-and-neck SCC: HPV-negative oropharyngeal disease, p16-negative, s...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

Red Flag Origin

Trigger Logic

{
  "any_of": [
    {
      "all_of": [
        {
          "finding": "primary_site",
          "value": "oropharynx"
        },
        {
          "finding": "hpv_p16_status",
          "value": "negative"
        }
      ]
    },
    {
      "finding": "extranodal_extension",
      "value": true
    },
    {
      "finding": "positive_surgical_margins",
      "value": true
    },
    {
      "all_of": [
        {
          "finding": "metastatic_disease",
          "value": true
        },
        {
          "comparator": ">=",
          "finding": "pdl1_cps",
          "threshold": 20
        }
      ]
    },
    {
      "all_of": [
        {
          "finding": "hpv_p16_status",
          "value": "positive"
        },
        {
          "comparator": ">",
          "finding": "smoking_pack_years",
          "threshold": 10
        }
      ]
    }
  ],
  "type": "biomarker"
}

Notes

HPV / p16 status is the dominant prognostic biomarker in oropharyngeal SCC: HPV+ have 5-yr OS ~80% vs 50% HPV-negative. RTOG-0129 stratified HPV+ smokers (>10 pack-years) as intermediate-risk — current trials (NRG-HN005) test de-escalation only in HPV+ low-smoker patients. Extranodal extension or positive margins post-resection: indication for cisplatin + RT adjuvant (RTOG 9501, EORTC 22931 — OS benefit only in this high-risk subset). Metastatic / R/M HNSCC: PD-L1 CPS ≥20 → pembrolizumab monotherapy (KEYNOTE-048, OS 14.9 vs 10.7 mo); CPS 1–19 → pembrolizumab + 5-FU + platinum; CPS <1 → EXTREME (cetuximab + cis + 5-FU).

Used By

No reverse references found in the YAML corpus.