Deintensification of treatment for human papillomavirus-related oropharyngeal cancer: Current state and future directions

Bigelow, Elaine; Seiwert, Tanguy Y.; Fakhry, Carole

doi:10.1016/j.oraloncology.2020.104652

Cited by 66 publications

(55 citation statements)

References 63 publications

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“…Despite improved outcomes compared to HPV− HNSCC, still 20% to 30% of patients fail to respond to initial therapies or recur, 5 and the factors that contribute to the progression of this disease are not well understood. Given the high morbidity of HNSCC treatment, there is a push in the field to de‐escalate treatment for patients at low risk of disease recurrence 36 . However, the biomarkers for response to treatment are not well developed yet, which makes stratifying patients difficult.…”

Section: Discussionmentioning

confidence: 99%

Association of human papillomavirus integration with better patient outcomes in oropharyngeal squamous cell carcinoma

et al. 2020

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Background: The molecular drivers of human papillomavirus-related head and neck squamous cell carcinoma (HPV + HNSCC) are not entirely understood. This study evaluated the relationship between HPV integration, expression of E6/E7, and patient outcomes in p16+ HNSCCs. Methods: HPV type was determined by HPV PCR-MassArray, and integration was called using detection of integrated papillomavirus sequences polymerase chain reaction (PCR). We investigated whether fusion transcripts were produced by reverse transcriptase polymerase chain reaction (RT-PCR). E6/E7 expression was assessed by quantitative RT-PCR. We assessed if there was a relationship between integration and E6/E7 expression, clinical variables, or patient outcomes. Results: Most samples demonstrated HPV integration, which sometimes resulted in a fusion transcript. HPV integration was positively correlated with age at diagnosis and E6/E7 expression. There was a significant difference in survival between patients with vs without integration. Conclusions: Contrary to previous reports, HPV integration was associated with improved patient survival. Therefore, HPV integration may act as a molecular marker of good prognosis. K E Y W O R D S head and neck squamous cell carcinoma (HNSCC), human papillomavirus (HPV), integration, oropharynx, survival

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Section: Discussionmentioning

confidence: 99%

Association of human papillomavirus integration with better patient outcomes in oropharyngeal squamous cell carcinoma

et al. 2020

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“…Advances in minimally invasive surgery for HNSCC as well systemic therapy options will be discussed below. Additionally, the excellent prognosis of HPV-positive OPSCC has spurred multiple treatment de-intensification trials aiming to identify the optimal treatment paradigms to balance oncologic outcomes and treatment toxicity [37].…”

Section: Treatmentmentioning

confidence: 99%

“…As HPV-positive patients are generally younger and have a more favorable prognostic outcome than HPV-negative HNSCC patients, attention has been turned toward treatment de-intensification regimens to preserve oncologic outcomes and reduce treatment-related toxicities [37,62]. Multiple trials have de-intensified therapy by reducing both RT and/or chemotherapy dosing in the definitive CRT setting, post-surgical adjuvant setting, or following induction chemotherapy.…”

Section: Treatment De-intensification In Hpv-positive Opsccmentioning

confidence: 99%

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020

Yan

Knochelmann

Morgan

et al. 2020

Cancers

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Cancers that arise in the head and neck region are comprised of a heterogeneous group of malignancies that include carcinogen- and human papillomavirus (HPV)-driven mucosal squamous cell carcinoma as well as skin cancers such as cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma. These malignancies develop in critical areas for eating, talking, and breathing and are associated with substantial morbidity and mortality despite advances in treatment. Understanding of advances in the management of these various cancers is important for all multidisciplinary providers who care for patients across the cancer care continuum. Additionally, the recent Coronavirus Disease 2019 (COVID-19) pandemic has necessitated adaptations to head and neck cancer care to accommodate the mitigation of COVID-19 risk and ensure timely treatment. This review explores advances in diagnostic criteria, prognostic factors, and management for subsites including head and neck squamous cell carcinoma and the various forms of skin cancer (basal cell carcinoma, cutaneous squamous cell carcinoma, Merkel cell carcinoma, and melanoma). Then, this review summarizes emerging developments in immunotherapy, radiation therapy, cancer survivorship, and the delivery of care during the COVID-19 era.

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“…Alongside these observations, there is now robust evidence that patients with HPV‐associated OpSCC have significantly improved overall and disease‐specific survival compared to site and stage‐matched HPV negative tumours 2 . The improved survival of HPV positive OpSCC has led to several recent international developments: (a) the World Health Organisation have recognized these tumours as a separate entity, 3 (b) international staging systems for OpSCC are now defined according to p16 immunohistochemistry, a surrogate marker for HR HPV positivity 4,5 and (c) several ongoing clinical trials to evaluate treatment de‐intensification for HPV positive OpSCC 6 …”

Section: Introductionmentioning

confidence: 99%

RNA in situ hybridization for human papillomavirus testing in oropharyngeal squamous cell carcinoma on a routine clinical diagnostic platform

Henley-Smith

Santambrogio

Andoniadou

et al. 2020

J Oral Pathology Medicine

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Background The current diagnostic standard for detection of high‐risk human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is via a two‐stage algorithm, namely p16 immunohistochemistry followed by HPV DNA in situ hybridization in p16 positive cases. This study evaluated the feasibility of automated RNA in situ hybridization on a clinical platform as a single‐step alternative to the two‐stage algorithm within a routine diagnostic histopathology setting. Methods Thirty‐eight cases positive for both p16 and DNA in situ hybridization, 42 p16 negative cases and 20 cases positive for p16 but negative for DNA in situ hybridization were randomly selected. High‐risk HPV RNA in situ hybridization was undertaken on all cases on an automated clinical platform. Manufacturer‐recommended and on‐slide additional p16/HPV positive and negative controls were used. Test quality assurance and diagnostic RNA in situ hybridization were independently assessed by two observers. A consensus diagnosis was reached in the presence of a third observer on discordant cases. All RNA in situ hybridization results were then correlated against p16 and DNA ISH status. Results Inter‐slide RNA in situ hybridization staining variation was observed in control sections. RNA in situ hybridization demonstrated a high inter‐observer agreement rate (κ = .897, P < .001). Following consensus review, there was full concordance between RNA in situ hybridization and the current standard. Conclusion Human papillomavirus testing by standalone automated RNA in situ hybridization on a clinical diagnostic platform currently available in routine diagnostic histopathology laboratories is a feasible alternative to the two‐step algorithm of p16 and DNA in situ hybridization. Control tissue staining procedures need to be adapted to achieve the most accurate results.

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Deintensification of treatment for human papillomavirus-related oropharyngeal cancer: Current state and future directions

Cited by 66 publications

References 63 publications

Association of human papillomavirus integration with better patient outcomes in oropharyngeal squamous cell carcinoma

Association of human papillomavirus integration with better patient outcomes in oropharyngeal squamous cell carcinoma

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020

RNA in situ hybridization for human papillomavirus testing in oropharyngeal squamous cell carcinoma on a routine clinical diagnostic platform

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