Objective Global oropharyngeal cancer incidence has exhibited a persistent upward trend in recent years, accompanied by a significant epidemiological shift. While human papillomavirus negative (HPV-) cases have historically been predominant, HPV-positive (HPV+) oropharyngeal cancer is a major emerging subtype. Studies indicate that compared to HPV- oropharyngeal cancer, HPV+ tumors exhibit significantly greater sensitivity to chemoradiotherapy. Despite this observation, standard treatment regimens for both subtypes remain largely identical, leading to disproportionate treatment-related toxicity and compromised quality of life among HPV+ patients. De-escalation therapy for HPV+ oropharyngeal cancer has thus become a major research focus in recent years. This article systematically reviews multiple recent domestic and international clinical studies, outlining the current landscape, limitations, and future directions of de-escalation strategies for HPV+ oropharyngeal cancer, focusing on key approaches including radiotherapy dose optimization, reduction or substitution of systemic therapy, and the integration of immunotherapy.