Decreased overall survival in black patients with HPV-associated oropharyngeal cancer

Sheth, Siddharth; Farquhar, Douglas R.; Lenze, Nicholas R.; Mazul, Angela L.; Brennan, Paul; Anantharaman, Devasena; Abedi‐Ardekani, Behnoush; Zevallos, José P.; Hayes, D. Neil; Olshan, F.

doi:10.1016/j.amjoto.2020.102780

Cited by 14 publications

(25 citation statements)

References 29 publications

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“…Risk factors for oropharyngeal carcinoma include alcohol consumption, tobacco use, and human papilloma virus (HPV) infection 5,6 . HPV status holds prognostic significance as patients with HPV positive oropharyngeal tumors have better survival than their HPV‐negative counterparts 7–10 . HPV positive cancers are most common in white male patients 7,9,10 …”

Section: Introductionmentioning

confidence: 99%

“…5,6 HPV status holds prognostic significance as patients with HPV positive oropharyngeal tumors have better survival than their HPV-negative counterparts. [7][8][9][10] HPV positive cancers are most common in white male patients. 7,9,10 Significant racial disparities exist in oropharyngeal cancer.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10] HPV positive cancers are most common in white male patients. 7,9,10 Significant racial disparities exist in oropharyngeal cancer. Black patients are more likely to seen with advanced stage disease, especially unresectable disease and distant metastasis.…”

Section: Introductionmentioning

confidence: 99%

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The role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes

Shukla

Megwalu

2021

Head & Neck

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Background To assess the role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes. Methods This was a population‐based retrospective cohort study. Data were extracted from the Surveillance, Epidemiology, and End Results 18 database. The study cohort included 11 627 patients diagnosed with oropharyngeal squamous cell carcinoma between 2010 and 2015. Results The association between black race and increased risk of unresectable disease was slightly attenuated, but persistent, after including insurance status as a covariate (odds ratio [OR] 1.34, 95%CI 1.10–1.63). Likewise, black race was no longer associated with worse disease‐specific survival (hazard ratio [HR] 1.11, 95%CI 0.99–1.26), but remained associated with worse overall survival with a slightly decreased effect size (HR 1.13, 95%CI 1.01–1.25). Conclusions Insurance status plays a significant role in, but does not completely account for, the persistent racial disparities in oropharyngeal cancer outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes

Shukla

Megwalu

2021

Head & Neck

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“…A retrospective study showed a significantly lower survival rate for black patients with HPV− OPSCC, compared to white patients with HPV− OPSCC [129]. This racial disparity has also been observed in HPV+ OPSCC [130,131]. In contrast, a metanalysis by Stein et al found no evidence of survival disparity in HPV-positive patients by race, while black patients with HPV− OPSCC still show lower survival rates compared to white patients [132].…”

Section: Race Sex and Disparity In Hpv+ And Hpv− Hnsccsmentioning

confidence: 96%

The Key Differences between Human Papillomavirus-Positive and -Negative Head and Neck Cancers: Biological and Clinical Implications

Powell

Spanos

et al. 2021

Cancers

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Head and neck squamous cell carcinoma (HNSCC) is a unique malignancy associated with two distinct risk factors: exposure to typical carcinogens and infection of human papillomavirus (HPV). HPV encodes the potent oncoproteins E6 and E7, which bypass many important oncogenic processes and result in cancer development. In contrast, HPV-negative HNSCC is developed through multiple mutations in diverse oncogenic driver genes. While the risk factors associated with HPV-positive and HPV-negative HNSCCs are discrete, HNSCC patients still show highly complex molecular signatures, immune infiltrations, and treatment responses even within the same anatomical subtypes. Here, we summarize the current understanding of biological mechanisms, treatment approaches, and clinical outcomes in comparison between HPV-positive and -negative HNSCCs.

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“…15,16 Although the potential of ICIs to improve disease control and survival is now well established, whether the benefit of ICIs can be realized at a population level remains an open question given persistent disparities in cancer diagnosis and treatment delivery for patients with advanced stage and metastatic disease. [17][18][19][20][21][22] Unfortunately, despite persistent efforts, <25% of cancer-related clinical trial participants are racial minorities. [23][24][25]26 This inclusion disparity is particularly obvious in clinical trials that led to the approval of ICIs for the treatment of NSCLC (Checkmate 017, 90% White 7 ; Checkmate 057, 91% White 6 ; Keynote 001, 82% White 9 ; OAK, 71% White 13 ; Impower 150, 82% White 14 ; Keynote 010, 73% White 10 ) and in HNSCC (Checkmate 141, 83% White 27 ; Keynote 048, 73% White 16 ).…”

Section: Introductionmentioning

confidence: 99%

Persistent racial/ethnic associated disparity in anti-tumor effectiveness of immune checkpoint inhibitors despite equal access

Florez

Kemnade

Chen

et al. 2021

Preprint

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Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of both lung cancer and head and neck squamous cell carcinoma demonstrating clear benefit over traditional chemotherapy alone in the metastatic setting. While the overwhelming majority of ICI trial participants have been White patients, results of these trials have been broadly applied to patients of all ethnic/racial backgrounds. It has, therefore, not been well defined if response to ICIs differs between ethnic/racial populations or socio-economic groups.We reviewed response to ICI of 208 patients with diagnoses of lung or head and neck cancers treated with ICI between 2015 and 2020 at one of three clinical pavilions associated with the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine in Houston, TX. Two of these pavilions (Harris Health System and the Michael E. DeBakey Veterans Affairs Medical Center) serve large minority patient populations and provide equal access of care to patients regardless of means. Of the 208 patients, 175 had a diagnosis of lung cancer [non-small cell lung carcinoma (NSCLC) or small cell lung cancer (SCLC)] and 33 had a diagnosis of head and neck squamous cell carcinoma (HNSCC); 38% self-identified as Black, 45% as non-Hispanic White, and 18% as Hispanic. The objective response rate (ORR) was similar for lung cancer (31.4%) and HNSCC patients (27.3%) (p=0.894). Statistically, the ORR for Hispanic and Black patients did not differ compared to non-Hispanic White patients (H 23.7%, B 28.6%, W 35.5%; H vs. W p=0.189; B vs. W p=0.338). When considering patients treated with ICI monotherapy, the ORR for Hispanic patients dropped to 13.3% and was significantly lower than the ORR of the non-Hispanic White patients while the ORR of Black and non-Hispanic White patients remained about the same (B 29.3% and W 34.6%, H vs. W p=0.0285; B vs. W p=0.5131). Immune related adverse events (irAEs) were the lowest in the Hispanic population occurring in only 30% of patients compared to 50% of patients exhibiting irAEs in the Black and non-Hispanic white cohorts.ICIs demonstrate comparable anti-tumor effects in lung cancer (NSCLC + SCLC) and HNSCC during routine clinical practice regardless of race or ethnicity. The significantly lower ORR observed in our cohort for Hispanic patients, particularly when used as monotherapy, is an unexpected finding and will require additional study to identify potential biological and non-biological confounders which could contribute to reduced ICI effectiveness in this patient population.

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Decreased overall survival in black patients with HPV-associated oropharyngeal cancer

Cited by 14 publications

References 29 publications

The role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes

The role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes

The Key Differences between Human Papillomavirus-Positive and -Negative Head and Neck Cancers: Biological and Clinical Implications

Persistent racial/ethnic associated disparity in anti-tumor effectiveness of immune checkpoint inhibitors despite equal access

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