Using CircuLating Tumor DNA to Risk Adapt Post-Operative Therapy for HPV-associated Oropharyngeal Cancer

The film gives the main points. The full list below is copied from the registry; the study team makes the final decision.

• Age18 Years to no maximum
• SexAll
• Healthy volunteersNo

You may be able to join if

• AJCC 8th edition T0-3N0-2 p16-positive oropharyngeal (tonsil, base of tongue, glossotonsillar sulcus, soft palate, oropharyngeal wall) squamous cell carcinoma or squamous cell carcinoma of unknown primary involving the cervical lymph nodes. Cytologic diagnosis from a cervical lymph node is sufficient for diagnosis in the presence of clinical evidence of a primary tumor in the oropharynx.
• For patients with pT0 tumors (unknown primary), there must be at least one metastatic lymph node present in cervical level II.
• p16 is strongly positive by immunohistochemistry or high-risk HPV is detected by in-situ hybridization.
• Have undergone or will undergo gross total resection of all known disease in the head and neck via transoral robotic surgery. For patients with clinical unknown primary tumors, a patient must undergo both ipsilateral tonsillectomy and base of tongue resection unless the primary is identified clinically or pathologically at the time of surgery. If the primary is identified, then only resection of the primary site is required. If the primary tumor is resected with negative margins with a non-robotic surgery, such as a diagnostic tonsillectomy, this is considered acceptable and further robotic surgery is not necessary.
• Have undergone or will undergo neck dissection.
• Have at least one of the following after surgery:
• Pathologic stage T3
• 2 or more positive lymph nodes
• At least one lymph node >3cm
• Contralateral lymph node involvement
• Lymphovascular invasion
• Perineural invasion
• Extranodal extension
• Close/positive margins: Close margins are considered ≤3mm from the peripheral margins and ≤1mm from the deep margin on the en bloc specimen, unless the area of close margin is re-resected and without carcinoma.
• Patients consented preoperatively are required to have detectable cTTMV-HPV DNA based on pre-operative NavDx testing. For patients consented post-operatively, NavDx testing should be performed on the tumor tissue to ensure detectable HPV DNA and for HPV subtyping.
• Age ≥ 18 years old
• ECOG performance status 0 or 2 within 56 days of start of chemoradiation.
• Women of childbearing potential require a negative serum or urine pregnancy test within 28 days prior to start of chemoradiation.
• Written informed consent obtained from subject and ability for subject to comply with the requirements of the study.
• Adequate hematologic and renal function within 56 days of start of chemoradiation, defined as:
• Hemoglobin ≥ 9.0 g/dL
• Platelets ≥ 100, 000 cells/mm3
• ANC ≥ 1.5 X 109/L
• Total bilirubin ≤ 1.5 x upper limit of normal (ULN)
• Aspartate aminotransferase/alanine aminotransferase ≤ 3.0 x upper limit of normal (ULN)
• Serum creatinine ≤1.5 x upper limit of normal (ULN) OR a calculated creatinine clearance ≥50 mL/min estimated using the following Cockcroft-Gault equation

You cannot join if

• AJCC 8th edition pT4 or cN3 disease.
• Radiologic or clinical evidence of distant metastasis.
• Recurrent disease.
• Inability to achieve gross total resection at time of surgery.
• Greater than 56 days (8 weeks) after surgical resection of the primary site.
• Prior radiation to the head and neck > 30 Gy.
• Prior active invasive (not in situ) malignancy within the prior 2 years, excluding cutaneous basal cell or squamous cell carcinoma, low or intermediate risk prostate cancer, papillary thyroid cancer, stage T1aN0 kidney cancer, low-grade T1-2N0 salivary cancer, AJCC 8th edition stage I-II breast cancer, well-differentiated neuroendocrine tumors (e.g., carcinoid tumors), low grade non-Hodgkin lymphoma, or Stage 0, I, and III cutaneous melanomas. Patients with synchronous or multifocal oropharyngeal cancers are not excluded, as long as at least one of these tumors meet inclusion criteria for the trial.
• Severe, active co-morbidity, defined as follows:
• Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months
• Transmural myocardial infarction within the last 6 months
• Acute bacterial or fungal infection requiring intravenous antibiotics at the time of enrollment
• Hepatic insufficiency resulting in clinical jaundice and/or known coagulation defects
• Moderate to severe hearing loss.
• Active connective tissue disease (e.g. systemic lupus erythematous, scleroderma) requiring immunosuppression.
• Pregnant or breast-feeding women.
• Prior allergic reaction to cisplatin.
• Live vaccines within 30 days prior to the first dose of chemoradiation. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, chicken pox, yellow fever, rabies, BCG, and typhoid (oral vaccine). Season influenza vaccines for injection are generally killed virus vaccines and are allowed; however intranasal influenza vaccines (e.g. Flu-Mist®) are live attenuated vaccines and are not allowed.

This is how the treatment is meant to work. Whether it helps, and how safe it is, is what this trial is testing.

Albumin-binding Cisplatin Prodrug BTP-114. A proprietary, albumin-binding platinum (Pt)-based complex containing a prodrug form of the platinum compound cisplatin and a maleimide moiety, with an ability to strongly and selectively bind human serum albumin (HSA), and with potential antineoplastic activity. Upon intravenous administration, the maleimide group of BTP-114 rapidly conjugates with HSA in the bloodstream; this prolongs the blood circulation, enhances the half-life, and alters the biodistribution of BTP-114, as compared to cisplatin alone. Thus, BTP-114 demonstrates enhanced extravasation to the tumor, an increased accumulation in the tumor tissue and enhanced uptake by cancer cells. The prodrug form is reduced in the hypoxic tumor cell environment, which releases the highly cytotoxic active metabolite cisplatin. Once inside the tumor cell, cisplatin binds to nucleophilic groups, such as GC-rich sites, in DNA and induces intrastrand and interstrand DNA cross-links, resulting in apoptosis and cell growth inhibition. Compared to cisplatin alone, BTP-114 has improved selectivity towards tumor tissue, thereby enhancing efficacy while reducing systemic toxicities. NCI Drug Dictionary

Treatments listed in the registry

• Cisplatin (Drug): Low risk pathology with post-op HPV DNA (-): cisplatin-based chemoradiation with 30 Gy in 15 fractions and 3 cycles of weekly cisplatin 40mg/m2 IV on Days 1, 8, and 15 of radiation. Low risk pathology with post-op HPV DNA (+): cisplatin-based chemoradiation with 40 Gy in 20 fractions and 4 cycles of weekly cisplatin 40mg/m2 IV on Days 1, 8, 15, and 22 of radiation. High risk pathology with post-op HPV DNA (-), excluding patients with both 5 LN+ and ENE+ or pre-op HPV DNA≤12 copies/mL: cisplatin-based radiation with 40 Gy in 20 fractions and 4 cycles of weekly cisplatin 40mg/m2 IV on Days 1, 8, 15, and 22 of radiation. High risk pathology with post-op HPV DNA (+) OR pre-op HPV DNA≤12 copies/mL OR both 5 or more LN+ and ENE+: cisplatin-based radiation with 50 Gy in 25 fractions with 5 cycles of weekly cisplatin 40mg/m2 IV on Days 1, 8, 15, 22, and 29 of radiation.

Na · Single Group · masking: None

As the registry describes them. Requirements to join, such as a tissue sample, are in the eligibility list above even when on-study procedures are optional. Ask the study team which steps apply to you.

• surgery: Part of the study plan
• radiation: Part of the study plan

Main goals

• 2-year progression-free (PFS) (2 Years)

Other goals

• Overall Survival (OS)
• Locoregional Control
• Distant Control
• Cause-Specific Survival
• Mean change in patient-reported outcomes using Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)
• Mean change in patient-reported outcomes using Hearing Handicap Inventory for Adults (HHIA-S)
• Mean change in patient-reported outcomes using European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30)
• Mean change in patient-reported outcomes using the MD Anderson Dysphagia Inventory (MDADI)
• Mean change in patient-reported outcomes using University of Michigan Xerostomia-Related Quality of Life Scale (XeQoLS)
• Mean change in patient-reported outcomes using 5-level version of the EuroQol five dimensional instrument EQ-5D-5L
• Mean change in Dysphagia using MDADI
• Mean change in Dysphagia using Modified Barium Swallow
• 2-year Progression-Free Survival

Planned enrollment: 50 (estimated).

• Cedars-Sinai Cancer at Beverly Hills (THO), Beverly Hills, California
• Cedars Sinai Medical Center, Los Angeles, California
• CS Cancer at Valley Oncology Medical Group, Tarzana, California
• CS Cancer at the Hunt Cancer Center, Torrance, California

Site status as of Oct 30, 2026. Check the live record before contacting a site.

• ClinicalTrials.gov NCT06445114
• NCI Drug Dictionary: C376

Registry record reviewed as fetched Oct 30, 2026, last updated by the sponsor Aug 4, 2026. Public record; not medical advice.