Is treatment de-escalation a reality in HPV related oropharyngeal cancer?

Oosthuizen, J C; Kinsella, John

doi:10.1016/j.surge.2016.04.002

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…16 These tumors are being recognized as a distinct clinical entity with unique biological behavior, and because of their significantly superior sensitivity to, and hence better prognosis after, chemoradiation, there has been growing enthusiasm for investigating the feasibility and safety of the de-escalation of treatment for HPVrelated cancer in the head and neck region. [17][18][19] As mentioned, HPV-related OPSCC with p16 overexpression is significantly more radiosensitive and carries a better prognosis compared with its non-HPVrelated counterpart. Because of the close proximity of the nasopharynx to the oropharynx, the possible role of HPV in NPC and its potential effect on treatment outcome has drawn much attention.…”

Section: Discussionmentioning

confidence: 96%

“…Up to 70% of patients with oropharyngeal cancer have HPV detected in the genomic DNA of the tumor cells, and 90% of these are associated with the high‐risk HPV types, particularly type 16 . These tumors are being recognized as a distinct clinical entity with unique biological behavior, and because of their significantly superior sensitivity to, and hence better prognosis after, chemoradiation, there has been growing enthusiasm for investigating the feasibility and safety of the de‐escalation of treatment for HPV‐related cancer in the head and neck region …”

Section: Discussionmentioning

confidence: 99%

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Human papillomavirus and World Health Organization type III nasopharyngeal carcinoma: Multicenter study from an endemic area in Southern China

Huang

Chan

Liu

2017

Cancer

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Human papillomavirus and World Health Organization type III nasopharyngeal carcinoma: Multicenter study from an endemic area in Southern China

Huang

Chan

Liu

2017

Cancer

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“…The ECOG 3311 is a phase II trial de-escalating adjuvant radiotherapy (50 Gy compared to 60 Gy) in the case of intermediate risk including patients with less than 1 mm extracapsular extension and 2–4 positive lymph node metastases or close margins [24]. So far, there are no worldwide recommendations for reduction of therapy agents and we need to anticipate the results of the de-escalation trials to adjust the therapy for oropharyngeal cancer patients [26]. …”

Section: Discussionmentioning

confidence: 99%

A 5‑year update of patients with HPV positive versus negative oropharyngeal cancer after radiochemotherapy in Austria

Lill

Bachtiary

Mittlböck

et al. 2017

Wien Klin Wochenschr

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SummaryBackgroundAfter publishing promising results for the treatment of patients with human papilloma virus (HPV) positive oropharyngeal cancer with radiochemotherapy regarding 2‑year survival, we present an update of the disease-specific and disease-free survival after 5 years.Patients and methodsA total of 29 patients of which 18 were HPV negative and 11 HPV positive with squamous cell carcinoma of the oropharynx received radiation therapy with or without chemotherapy (cisplatin) or immunotherapy (cetuximab) between 2007 and 2009. At time of the present analysis, six patients are still alive including four with HPV positive and two with HPV negative oropharyngeal carcinoma, while 15 out of 16 patients with HPV negative tumors died and 1 died of another cause with evidence of disease.ResultsSince the 2‑year disease-specific survival of patients with HPV positive cancer of the oropharynx was published with 100% versus 30.4% in HPV negative tumors, we now present the 5‑year disease-specific survival after treatment, which was 85.7% in HPV positive versus 11.1% in HPV negative patients.ConclusionWe present the results of patients receiving radiochemo(immuno)therapy for oropharyngeal cancer regarding the HPV status, which is still promising.

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“…However, an additional ramification from this work is that male Appalachian or other populations with multi-factorial oropharyngeal tobacco exposure may actually be under-staged using current AJCC-8 guidelines. This is an important consideration, since National Comprehensive Cancer Network (NCCN) guidelines recommend staging and treatment dependent on p16 status 52 , 54 , where treatment de-escalation of HPV-associated oropharyngeal cancers continues to be evaluated 55 – 57 . Future efforts towards definitively determining the extent of HPV involvement in Appalachian OC/P and oropharynx through comprehensive p16 staining and PCR 58 will be required to better clarify the predominant factors underlying oropharynx-driven, stage-based disparities in past and future Appalachian cohorts.…”

Section: Discussionmentioning

confidence: 99%

Disparate survival of late-stage male oropharyngeal cancer in Appalachia

Papenberg

Allen

Markwell

et al. 2020

Sci Rep

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the United States Appalachian region harbors a higher cancer burden than the rest of the nation, with disparate incidence of head and neck squamous cell carcinomas (HnScc), including oral cavity and pharynx (oc/p) cancers. Whether elevated HnScc incidence generates survival disparities within Appalachia is unknown. To address this, HNSCC survival data for 259,737 tumors from the North American Association for Central Cancer Registries 2007-2013 cohort were evaluated, with ageadjusted relative survival (RS) calculated based on staging, race, sex, and Appalachian residence. tobacco use, a primary HnScc risk factor, was evaluated through the Behavioral Risk factor Surveillance System from Appalachian states. Decreased oc/p RS was found in stage iV Appalachian white males within a subset of states. The survival disparity was confined to human papillomavirus (HPV)-associated oropharyngeal cancers, specifically the oropharynx subsite. This correlated with significantly higher smoking and male smokeless tobacco use in most Appalachian disparity states. Lower survival of Appalachian males with advanced-stage HpV-associated oropharyngeal cancers suggests pervasive tobacco consumption likely generates more aggressive tumors at HpV-associated oropharynx subsites than national averages. comprehensive tobacco and HpV status should therefore be evaluated prior to considering treatment de-intensification regimens for HPV-associated oropharyngeal cancers in populations with high tobacco consumption. HNSCC involves the epithelium of the oral cavity, pharynx and larynx. OC/P cancers are a major HNSCC subset, with nearly 11,000 deaths predicted in the US in 2020 1. Risk factors include tobacco and alcohol use, and highrisk human papillomavirus (HPV) infection 2,3. OC/P cancers are subdivided into HPV-associated oropharynx (HPV-associated) and non-HPV-associated oral cavity, hypopharynx, and nasopharynx (non-HPV-associated) cancers 4. These designations are supported by studies indicating that non-HPV-associated cancers are primarily tobacco/alcohol induced, whereas HPV-associated cancers are predominantly caused by HPV infection 5. Furthermore, HPV-negative or non-HPV-associated cancers consistently have poorer outcomes than HPV-positive or HPV-associated cancers, segregating these cancers as distinct diseases with differential clinical management 6,7. While national incidence of non-HPV-associated cancers is decreasing due to tobacco cessation, HPV-associated cancers are increasing due to rising infection rates 8. Regarding race, blacks with HNSCC present with more advanced disease, are older and have worse survival than whites, denoting a racial disparity 9-11. Increased screening for HPV coupled with subsite analysis indicates that blacks with HNSCC have less HPV-positive cancer than whites, explaining differences in survival 12,13. Consistent with this, HPV-associated cancers continue to increase in white males and in rural areas 4,14,15. The Appalachian region encompasses 205,000 square miles across 420 counties in 13 contiguo...

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Is treatment de-escalation a reality in HPV related oropharyngeal cancer?

Cited by 6 publications

References 18 publications

Human papillomavirus and World Health Organization type III nasopharyngeal carcinoma: Multicenter study from an endemic area in Southern China

Human papillomavirus and World Health Organization type III nasopharyngeal carcinoma: Multicenter study from an endemic area in Southern China

A 5‑year update of patients with HPV positive versus negative oropharyngeal cancer after radiochemotherapy in Austria

Disparate survival of late-stage male oropharyngeal cancer in Appalachia

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