MARCHing to the beat of the same old drum.

The emergence of a growing association of HPV with oropharyngeal cancer threw decades of head and neck (H&N) cancer outcomes on its head. We know patients with HPV-associated oropharyngeal cancer do better with current therapies, but it still isn’t clear if patients preferentially respond to particular therapies based on HPV status. So let’s reanalyze a question that never dies in H&N cancer: the role of altered fractionation (i.e., delivering radiation differently than standard daily regimens). The updated MARCH meta-analysis published earlier this year in Lancet confirmed that altered fractionation improves survival when delivering definitive radiation alone (sans chemo). In a new subset analysis (MARCH-HPV), patients with HPV-associated oropharyngeal cancer benefited from altered fractionation, but no more than HPV-negative patients. There’s a time and place for altered fractionation, but we’ll have to find a new instrument to play if we’re looking to drastically improve outcomes for our HPV-negative H&N cancers.