HPV-independent vulvar squamous cell carcinoma (p53-mutant): lines of therapy

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5 standard-of-care settings across 4 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers
Early / localised	1
Locally advanced	1
Advanced, first line	1
Other settings	2

Early / localised

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Early stage	Wide local excision with attention to margins, sentinel node biopsy or inguinofemoral lymphadenectomy by the GROINSS-V criteria; adjuvant radiotherapy for close margins or positive nodes.	Sentinel lymph node biopsyLymphadenectomy (lymph node dissection)IMRT / IGRT (modern external beam)	NCCN Guidelines: Vulvar Cancer	93

Locally advanced

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Locally advanced disease	Cisplatin chemoradiotherapy with surgery for residual disease; responses are less complete than in p16-positive tumours.	CisplatinIMRT / IGRT (modern external beam)Chemoradiation (chemoradiotherapy, CRT)	NCCN Guidelines: Vulvar Cancer	93

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Recurrent or metastatic disease	Carboplatin and paclitaxel with or without bevacizumab; pembrolizumab for PD-L1-positive tumours; trials of pembrolizumab with lenvatinib, and of cadonilimab (AK104), whose trial the registry marked terminated in 2026, giving the sponsor's decision as the reason.	CarboplatinPaclitaxel / nab-paclitaxelBevacizumabPembrolizumabPembrolizumab Combination With Lenvatinib in Pts With Recurrent,Persistent,Metastatic or Locally Advanced Vulvar Cancer Not Amenable to Curative SurgeAK104 for Recurrent or Metastatic Vulvar Cancer	NCCN Guidelines: Vulvar Cancer	98

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Precursor (differentiated VIN) and lichen sclerosus	Excision of differentiated VIN; long-term potent topical corticosteroids for lichen sclerosus; low threshold for biopsy of new lesions.	Thermal ablation and cryotherapy for cervical precancer	NCCN Guidelines: Vulvar Cancer	83
All comers	Follow-up	Lifelong surveillance of the vulvar skin because new tumours arise in the lichen sclerosus field years later.	HPV-positive (p16) head and neck cancer	NCCN Guidelines: Vulvar Cancer	-

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.