Carboplatin was the easiest for me also. As we both did TPF IC, Don, the worst part is that there is no time for dosage reduction or treatment stoppage, unless you can't complete the rest of the two cycles spaced 21 days apart. By that time you already received high doses of chemo in 5 days. Mine was 160mg Cisplatin, 160mg Taxotere, and 1600mg 5-FU, plus a dozen or so of other medications, and a port put in lol. I remember the oncologist asking if I wanted my tooth extracted, and the PA behind him was shaking his head silently, eyes wide open in fear, "No!" Now I know why, somewhere along the line it was too toxic for me, so treatment was completely stopped, which is a negative aspect with TPF IC, and why it's controversial. One study said 50% didn't complete all the cycles or were unable to do CRT to follow due to the toxicities. On a postitve note, it works, very well, especially with HPV positive OPSCC.

Anyway, back to the topic, HPV-16 is a high risk HPV variant. P16 is a tumor suppressor gene, that is different than HPV-16, and is usually a negative predictor of outcome to be p16 positive with cancer, but with HPV in the oropharynx, it has better outcome being HPV-16 positive and p16 positive. They sometimes test for p16 in oropharynx for HPV first, which usually indicates being HPV positive too, but not in all cases, and the next step should be to test for HPV.

As Tammy mentioned, there are different variants of HPV-16/18. Type B seems to be more aggressive, similar to smoking related, for unknown reason, smoking history may be involved. As far as aggressiveness, I may be HPV involved, probably, so, never tested, non-smoker, moderate drinking, small T1, and had 8 recurrences, some in a month two, 6 months after a clear scan, and after each recurrence, the time frame between the two recurrences shortened. I have read this occurs with cancer. The average time for oropharynx recurrence, HPV, non HPV, is about the same, 8 months, except for distant metastases, I believe. Also, while smoking related oropharyngeal cancer levels off after 2 years, for some reason, some HPV positive cancers show failure after 3 years, 5 years, in distant areas, some usually not associated with metastases like liver, some other areas, but lungs is the most common, HPV or non HPV.