New Strategies in Human Papillomavirus–Related Oropharynx Cancer: Effecting Advances in Treatment for a Growing Epidemic

Abstract

The past two decades have been witness to a steadily increasing incidence of oropharynx cancer, specifically related to human papillomavirus (HPV), primarily affecting middle-aged Caucasian men, in North America and Europe. The ever-increasing incidence, now clearly an epidemic, of this unique clinicopathologic entity demands new perspectives in diagnosis and staging and presents unique challenges in clinical research, given the excellent prognosis afforded by chemoradiation for the majority of these patients. To reduce the morbidity of late toxicity in survivors without compromising the high rates of survival currently enjoyed, and simultaneously address the poor prognosis of those with recurrence, it is critical to capitalize on the viral etiology and translate discoveries in genomics, target/drug discovery, viral oncogenesis, and immunbiology to improved outcomes for patients. Herein, we review ongoing and planned clinical research for HPV-related oropharynx cancer, the basis for which is constituted by prior clinical observations, knowledge of the genomic alterations and altered biology associated with HPV-related oncogenesis, and hope that molecularly targeted and immunomodulatory therapies can be harnessed. Clin Cancer Res; 21(17); 3821-8. Ó2015 AACR. Disclosure of Potential Conflicts of Interest Editor's DisclosuresThe following editor(s) reported relevant financial relationships: J.L. Abbruzzese is a consultant/advisory board member for Celgene and Halozyme. Learning ObjectivesUpon completion of this activity, the participant should have increased knowledge regarding the epidemiology and clinical presentation of HPV-related oropharynx cancer, understand the rationale for deintensification and be familiar with clinical research strategies to reduce late effects in curative-intent treatment, and be aware of the biologic rationale for strategies targeting the immune system and molecular alterations in treatment of relapsed and refractory cancer.

The Landscape of Somatic Copy Number Alterations in Head and Neck Squamous Cell Carcinoma

“…The distinctive copy number alterations of this group of samples include 3q gain and lack of 3p loss. Human papillomavirus infection has been identified in strong association with oropharyngeal and tonsillar cancers (73)(74)(75). However, our cluster analysis showed an enrichment of HPV+ samples in nasopharynx tumors, which was not explicitly noted before.…”

Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma

“…It is now well‐recognized that human papillomavirus (HPV)‐associated oropharyngeal carcinoma (OPC) is occurring at an unprecedented rate. Patients with this distinct subtype of head and neck cancer (HNC) have a relatively favorable prognosis, and so are living longer . This has created a situation for healthcare teams managing HNC patients that necessitates careful consideration of treatment endpoints, including not only survival measures, but also survivor function.…”

Transoral Robotic Surgical Proficiency Via Real‐Time Tactile Collision Awareness System

“…21 Before the rise of HPV-related cancer, oropharyngeal tumors were already preferentially treated with 2D radiation therapy, and contemporaneous with TORS was the success of the 3D intensity-modulated radiation therapy, reporting dramatic improvements in the toxicity profile of nonsurgical therapy. 22 Overall, watching the excellent cure rates and improving functional rates of nonsurgical therapy, there should have been no great surplus of patients demanding an improved alternative treatment option. In fact, according to a National Cancer Database analysis between 2010 and 2014, 23 the vast majority of resectable oropharyngeal cancers were still receiving 11 and National Cancer Database, 13 both demonstrating the consistent rise of TORS adoption.…”