Emerging insights into recurrent and metastatic human papillomavirus‐related oropharyngeal squamous cell carcinoma

Abstract

ObjectiveTo review recent literature on human papillomavirus‐related (HPV‐positive) oropharyngeal squamous cell carcinoma (OPC) and focus on implications of recurrent and metastatic disease.MethodsPrimary articles from 1990 to 2016 indexed in MEDLINE (1) pertaining to the epidemiology of HPV‐positive OPC and (2) providing clinical insight into recurrent and metastatic OPC.ResultsThe incidence of HPV‐positive OPC is increasing globally. HPV‐positive OPC is a subtype with distinct molecular and clinical features including enhanced treatment response and improved overall survival. While disease recurrence is less common in patients with HPV‐positive OPC, up to 36% of patients experience treatment failure within eight years. Recurrent and metastatic OPC has historically signified poor prognosis, however recent data are challenging this dogma. Here, we discuss recurrent and metastatic OPC in the context of HPV tumor status.ConclusionHPV‐positive OPC exhibits distinct genetic, cellular, epidemiological, and clinical features from HPV‐negative OPC. HPV tumor status is emerging as a marker indicative of improved prognosis after disease progression in both locoregionally recurrent and distant metastatic OPC.Level of EvidenceN/A.

The prevalence of human papillomavirus in oropharyngeal cancer is increasing regardless of sex or race, and the influence of sex and race on survival is modified by human papillomavirus tumor status

“…Unfortunately, HPV tumor status is not available in SEER or other population-based datasets from which incidence is estimated, and the accepted proxy has been anatomic site. 1,24,25 Analogous to the United States, these trends may change in the future. It remains to be seen whether this rise in proportion of OPCs that are HPV-positive among women and nonwhites also heralds a reversal in incidence trends for OPC among these populations in coming decades.…”

“…1,22,23 However, it is important to note that there is significant geographic heterogeneity in estimates of HPV prevalence. 1,24,25 Analogous to the United States, these trends may change in the future. These results highlight the importance of continually examining the dynamic epidemiology of HPV-positive OPC.…”

Tumor‐infiltrating lymphocyte quantification stratifies early‐stage human papillomavirus oropharynx cancer prognosis

“…Human papillomavirus-positive oropharyngeal carcinoma (HPV-OPC) has emerged as a distinct molecular and clinical subtype of head and neck squamous cell carcinoma (HNSCC) with advantageous prognostic implications. [1][2][3] These findings are the basis for HPV-OPC as a distinct entity with its own staging system independent of human papillomavirus (HPV)-negative cancers of the same anatomic site, and have raised concerns that a subset of HPV-OPC patients may be overtreated. [3][4][5][6] The rising prevalence of long-term survivors and high cumulative burden of treatment-related toxicity 7,8 renders therapeutic deintensification an exciting opportunity.…”

Retropharyngeal Lymph Node Involvement in Oropharyngeal Carcinoma: Impact upon Risk of Distant Metastases and Survival Outcomes

“…The development of distant metastases remains a concern, even in apparently favourable prognosis disease [7]. Rates of distant metastases appear similar for HPV-positive and -negative disease, with controversy over whether HPV status influences the pattern of distant metastases [7][8][9][10].…”