Among the human papilloma virus (HPV)–related cancers on the rise is oropharyngeal cancer, a kind of throat cancer that typically begins in the squamous cells that line the throat. And whereas throat cancer was once dominated by smoking-related tumors found mostly in older populations, the HPV positive kind tends to affect younger patients who are often otherwise healthy.
But that’s not the only difference. HPV-positive throat cancers also respond better to treatment and have higher cure rates than their HPV-negative counterparts—a shift that’s reshaping the field of head and neck oncology.
That shift has prompted a new clinical trial at the University of Vermont Cancer Center, led by member Mirabelle Sajisevi, M.D., a Larner associate professor of surgery and a specialist in robotic head and neck surgery at UVM Health. The trial, formally titled “De-Intensified Adjuvant Therapy for HPV+ OPSCC,” asks a critical question: If these cancers are more responsive, can we safely dial back treatment?
“Many of these patients will live for decades after treatment,” says Sajisevi. “But the side effects—dry mouth, loss of taste, difficulty swallowing—can be long lasting and life altering. We wanted to know if we could reduce those impacts without compromising outcomes.”
The trial’s approach builds upon prior work to stratify patients by risk. Patients undergo surgery first; their pathology results guide the next steps. Some receive a lower dose of radiation to the pharyngeal constrictor muscles to reduce the risk of dysphagia. Others may skip radiation entirely. The goal is to move away from a one-size-fits-all treatment approach, instead tailoring treatment to the tumor.
Opening this trial at the UVM Cancer Center not only reduces toxicity; it can also lower barriers for patients in Vermont and northern New York, for whom long travel times to treatment centers can be a major hurdle. “We wanted to make sure patients could access this kind of care without leaving their communities,” Sajisevi says. That also meant streamlining the trial itself—minimizing extra paperwork and visits and designing it to mirror the standard care process.
Surveillance looks different too. In addition to regular exams and imaging, participants can opt for blood tests that detect circulating HPV tumor DNA—an advanced and highly sensitive method that enables earlier and more precise detection of cancer recurrence. This adds a layer of safety to the reduced treatment approach and offers clinicians an effective way to closely follow patients.
Since opening in January 2025, the trial has seen a strong enrollment. “I think this reflects patients’ desire to be part of clinical protocols that offer state-of-the-art, personalized cancer care in a practical way,” says Sajisevi. “We designed it to be easy to take part in—and that’s made all the difference for our patients.”
Learn about Patient and Caregiver Resources at the UVM Cancer Center
Research like this has contributed to the University of Vermont’s designation by the Carnegie Classification of Institutions of Higher Education as an R1 institution, placing it in the top tier of research universities in the U.S.
