ESMO Congress 2026

The evidence base for dividing head and neck squamous cell carcinoma (HNSCC) by HPV status is solid: pharyngeal cancers are increasingly attributed to HPV (primarily HPV-16), the 2017 AJCC/UICC staging system incorporates information relevant to HPV-positive disease, and cetuximab is generally combined with radiation in HPV-negative disease ^[1]; a 2000 retrospective study of 253 patients detected HPV in 25% of cases, 90% of which were HPV16 ^[5]. Treatment is multimodal, and the MACH-NC meta-analysis of 93 randomised trials and 17,346 patients confirmed a survival benefit with concomitant chemotherapy (hazard ratio of death 0.88) ^[6]. In the systemic recurrent/metastatic setting, the published phase 3 KEYNOTE-048 compared 1:1:1 pembrolizumab alone, pembrolizumab plus platinum and 5-fluorouracil, versus cetuximab plus platinum and 5-fluorouracil, stratified by PD-L1 expression and p16 status ^[3] — the existing evidence anchor for the question of how much value anti-EGFR agents retain in the HPV+ population.

The posts from ESMO 2026 cover two threads. The main one is the management of HPV+ HNSCC: Dr Sandra Schmitz (Cliniques Universitaires Saint-Luc) delivered one of the best current summaries on the management of HPV+ early disease, and Dr Even presented on the systemic approach to HPV+ HNSCC; the poster's central question is whether it is time to end anti-EGFR agents in HPV+ HNSCC, or keep them as a last resource in later lines, noting that none of the major guidelines (ASCO, ESMO, NCCN) make any clear recommendation against their use. No specific data or efficacy numbers from these presentations were disclosed in the posts. The second thread is Bicara Therapeutics, which announced its presence at booth #8012, emphasising HPV-negative HNSCC as a distinct and clinically challenging subset representing the vast majority of HNSCC cases in the recurrent/metastatic setting, and inviting attendees to learn about its research and clinical development — again with no numbers disclosed.

Relative to existing knowledge, the step forward is that the question of whether anti-EGFR therapy should continue in the HPV+ population has moved from background uncertainty to an open agenda item at the meeting: KEYNOTE-048 already stratified by p16 status when comparing the cetuximab regimen against the pembrolizumab regimens ^[3], and in the disease primer cetuximab's routine position is mainly the radiation-combination setting in HPV-negative disease ^[1], yet the guidelines offer no explicit HPV+-specific position — Dr Even's presentation and the poster's follow-up question put that unresolved point on the table. Bicara's focus on the HPV-negative subtype that dominates the recurrent/metastatic setting is consistent with the HPV-based dichotomy in the literature ^[1][5]. Note that all of the above is on-site commentary and conference impressions: specific data and numbers from the two presentations were not disclosed, the guideline characterisation reflects the poster's own summary, and the company post is a meeting preview rather than a readout — conclusions await confirmation from formal conference materials.