What is the general approach for HPV+ OPSCC who present with distant metastases?

It depends in part on the extent of the distant disease. In a true oligometastatic with one or two lesions, I would still take a curative approach with the appropriate management of the metastatic site. We would likely have a discussion on whether it is M1 to start with induction therapy, but I thin...

I agree with the superb answers thus far. Patients with synchronous metastases need control of their micrometastatic as well as gross disease, and thus starting with systemic therapy (IO/chemotherapy) has been our standard. This approach also provides an opportunity to assess treatment sensitivity, ...

This is a great question with a lot of variances in practice, I feel.

So, for what my two pennies are worth:

Regardless of HPV status, I often favor an upfront definitive local H&N regimen in many patients that p/w limited DMs; primarily since the morbidity of future airway-related issues/mortality ...

The patient has metastatic disease. Thus, any radiation therapy is an adjunct to chemotherapy. Unless the primary is exceptionally large and symptomatic, I would recommend upfront chemotherapy. Further treatment will depend on the response to treatment chemotherapy. I will treat the head and neck ev...