Improved Survival of Patients With Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma in a Prospective Clinical Trial

Fakhry, Carole; Westra, William H.; Li, Sigui; Cmelak, Anthony J.; Ridge, John A.; Pinto, Harlan A.; Forastiere, Arlene A.; Gillison, Maura L.

doi:10.1093/jnci/djn011

Cited by 2,486 publications

(2,339 citation statements)

References 19 publications

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“…Seven years later, in 1983, we published the first evidence suggesting that a subgroup (some 20 %) of oral cancers is associated with HPV, based on detection of HPV structural proteins in these lesions using an antibody prepared against pooled HPV types [39]. We subsequently identified HPV types 11, 16 and 18 in these samples [40][41][42][43][44][45][46][47][48][49]. This concept has now been well accepted, and a growing body of evidence is supporting that approximately 20 % of oral cancers and 60-80 % of oropharyngeal cancers are caused by HPV [41][42][43][44].…”

Section: Hpv and Head And Neck Cancer (Hnscc)mentioning

confidence: 99%

“…Importantly, HPV-positive HNSCCs differ remarkably from HPV-negative HNSCCs in their clinical response and molecular properties. HPV-positive HNSCCs have a better overall-survival than HPV-negative HNSCCs [46,47]. HPV-positive HNSCCs harbor the wild-type p53, while the classical smoking-and alcohol-induced cancers have mutated p53.…”

Section: Hpv and Head And Neck Cancer (Hnscc)mentioning

confidence: 99%

“…HPV-positive HNSCCs harbor the wild-type p53, while the classical smoking-and alcohol-induced cancers have mutated p53. However, it has been recently shown that also among HPV-positive HNSCCs, the worst outcome is related to smoking [42,47,48]. Thus, these carcinogens might potentiate the transformation effect of HPV.…”

Section: Hpv and Head And Neck Cancer (Hnscc)mentioning

confidence: 99%

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Biology of Human Papillomavirus Infections in Head and Neck Carcinogenesis

Rautava

Syrjänen

2012

Head and Neck Pathol

127

135

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Section: Hpv and Head And Neck Cancer (Hnscc)mentioning

confidence: 99%

Section: Hpv and Head And Neck Cancer (Hnscc)mentioning

confidence: 99%

Section: Hpv and Head And Neck Cancer (Hnscc)mentioning

confidence: 99%

See 1 more Smart Citation

Biology of Human Papillomavirus Infections in Head and Neck Carcinogenesis

Rautava

Syrjänen

2012

Head and Neck Pathol

127

135

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“…Multiple studies have confirmed that patients with HPVrelated oropharyngeal cancer have a better prognosis than patients with tumors not associated with HPV. 15,16 To date, this has not led to any change in the treatment or staging of these malignancies, and has not been applied to a systematic method of adjusting prognosis. 17 However, future clinical trials may attempt to decrease the intensity of treatment in this subset of patients to limit morbidity, thereby taking advantage of the less aggressive biology of HPV-related tumors.…”

Section: Oncologic Prognosismentioning

confidence: 99%

Human papillomavirus status in head and neck cancer

Shuman

Wolf

2010

Cancer

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Human papillomavirus (HPV) is an emerging causative factor for squamous carcinoma of the oropharynx and perhaps other head and neck cancers. There is a great deal of uncertainty regarding the clinical significance and implications of HPV status in this patient population. As a result, there is no established protocol for informing patients of the potential link between viral infection and their cancer. This paper discusses some of the ethical issues involved with informing head and neck cancer patients of their HPV status, recognizing the dilemma posed by unresolved clinical questions and the need to respect the autonomy of patients by disclosing relevant information. Cancer 2010;116:4221-6. V C 2010 American Cancer Society.KEYWORDS: human papillomavirus, head and neck cancer, oropharynx, disclosure, patient autonomy.An increasing volume of data have linked infection with human papillomavirus (HPV), a sexually transmitted pathogen, with head and neck cancer. 1,2 HPV infection may explain the increasing incidence and changing demographics of these cancers, particularly squamous cell carcinomas of the oropharynx. 3,4 Patients with HPV-related tumors often lack the classic risk factors for these malignancies, such as a history of tobacco or alcohol abuse, and often present at younger ages. 5 Currently, there are no conclusive data suggesting that treatment modalities or other aspects of care should differ for head and neck cancer patients based on their HPV status.The issue of discussing the relationship of HPV status and the development of head and neck cancer poses a dilemma. Clinicians aspire to keep their patients duly informed, but may not know which patients might have HPVrelated infections, nor can they make further definitive statements regarding etiology or outcome based on the limited knowledge of this clinical entity. In general, we know that the association of HPV infection in a nonsmoking head and neck cancer patient is a favorable prognostic factor; however, the literature addressing HPV-related head and neck cancers is growing exponentially. This paper does not attempt to provide a comprehensive review of the topic, but will discuss the ethical issues surrounding the disclosure and discussion of HPV status among head and neck cancer patients. Ethical Tenets of Honesty and TransparencyContemporary medical ethics is based on a foundation in which patients and their healthcare providers are partners. Patients and their designated decision-makers are charged with using the expertise and recommendations of their physicians to make informed and reasoned decisions. Rather than make paternalistic judgments concerning what patients should know or must do, physicians are obligated to present all relevant and pertinent information in a way that is accurate and honest, and allow their patients to act autonomously. One model of this process involves the implementation of both informal conversational ethics and formal deliberative ethics. 6 The former process centers on the creation of a partnership between physic...

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“…Patients with HPV-positive OSCC are on average 5 years younger than HPV-negative patients, have higher lifetime number of vaginal-sex and oral-sex partners, higher prevalence of oral HPV infection, and lower incidence of alcohol and tobacco use [8]. HPV status in OSCC is also a powerful prognostic indicator with HPV-positive OSCC patients having a 58 % reduction in the risk of death when compared to patients with HPV-negative OSCC [2,9]. Pathologically, most HPV-positive OSCCs exhibit non-keratinizing or basaloid morphology [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Human Papillomavirus-16 Associated Adenocarcinoma NOS of Base of Tongue

Perez-Ordoñez

Irish

et al. 2012

Head and Neck Pathol

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The causative role of human papillomavirus (HPV) in a subset of squamous cell carcinomas of the oropharynx (OSCC) is now well established with HPV-16 being detected in approximately 92 % of HPV-positive OSCC in North America. Recently HPV has also been found in some non-squamous oropharyngeal carcinomas including adenosquamous carcinomas, neuroendocrine carcinomas, and undifferentiated ''lymphoepithelioma-like'' carcinomas. Herein, we report a HPV-16 positive adenocarcinoma NOS arising in the base of the tongue of a non-smoker, 64 yearold male. To our knowledge, this is the first time this association has been clearly documented. The adenocarcinoma was diffusely positive for p16 and HPV-16 was demonstrated by in situ hybridization and linear array analysis. Q-PCR demonstrated a viral load of 4 copies per cancer cell, whereas qRT-PCR for E6/E7 transcript levels were 30 copies per 1,000 human ribosomal protein large P0 (RPLP0) reference gene. The presence of HPV in non-squamous oropharyngeal carcinomas raises the possibility that HPV is also involved in the carcinogenesis of some uncommon carcinomas of the region.

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Improved Survival of Patients With Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma in a Prospective Clinical Trial

Abstract: For patients with HNSCC of the oropharynx, tumor HPV status is strongly associated with therapeutic response and survival.

Cited by 2,486 publications

References 19 publications

Biology of Human Papillomavirus Infections in Head and Neck Carcinogenesis

Biology of Human Papillomavirus Infections in Head and Neck Carcinogenesis

Human papillomavirus status in head and neck cancer

Human Papillomavirus-16 Associated Adenocarcinoma NOS of Base of Tongue

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