Prevalence of human papillomavirus in head and neck cancers at tertiary care centers in the United States over time

Scott‐Wittenborn, Nicholas; D’Souza, Gypsyamber; Tewari, Sakshi R.; Rooper, Lisa M.; Troy, Tanya; Drake, Virginia E.; Bigelow, Elaine; Windon, Melina J.; Ryan, William R.; Ha, Patrick K.; Kiess, Ana P.; Miles, Brett A.; Westra, William H.; Mydlarz, Wojciech K.; Eisele, David W.; Fakhry, Carole

doi:10.1002/cncr.34124

Cited by 11 publications

(8 citation statements)

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“…Consistent with prior literature, poor performance status, high neutrophil‐to‐lymphocyte ratio and short DFI predict poorer survival outcomes 8 . Our data demonstrate an increasing incidence of HPV‐related R/M HNSCC, consistent with rising rates of HPV‐related oropharyngeal cancer in previously untreated patients 40 . HPV has been shown to be a favorable prognostic factor both in the primary and recurrent settings, 4,11,41,42 and our data confirm a survival benefit in patients with R/M disease.…”

Section: Discussionsupporting

confidence: 90%

Patterns of recurrence in head and neck squamous cell carcinoma to inform personalized surveillance protocols

Haring

Kana

Dermody

et al. 2023

Cancer

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BackgroundDevelopment of evidence‐based post‐treatment surveillance guidelines in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) is limited by comprehensive documentation of patterns of recurrence and metastatic spread.MethodsA retrospective analysis of patients diagnosed with R/M HNSCC at a National Cancer Institute‐designated cancer center between 1998– 2019 was performed (n = 447). Univariate and multivariate analysis identified patterns of recurrence and predictors of survival.ResultsMedian overall survival (mOS) improved over time (6.7 months in 1998–2007 to 11.8 months in 2008–2019, p = .006). Predictors of worse mOS included human papillomavirus (HPV) negativity (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.2–2.6), high neutrophil/lymphocyte ratio (HR, 2.1 [1.4–3.0], disease‐free interval (DFI) ≤6 months (HR, 1.4 [1.02–2.0]), and poor performance status (Eastern Cooperative Oncology Group, ≥2; HR, 1.91.1–3.4). In this cohort, 50.6% of recurrences occurred within 6 months of treatment completion, 72.5% occurred within 1 year, and 88.6% occurred within 2 years. Metachronous distant metastases were more likely to occur in patients with HPV‐positive disease (odds ratio [OR], 2.3 [1.4–4.0]), DFI >6 months (OR, 2.4 [1.5–4.0]), and body mass index ≥30 (OR, 2.3 [1.1–4.8]). Oligometastatic disease treated with local ablative therapy was associated with improved survival over polymetastatic disease (HR, 0.36; 95% CI, 0.24–0.55).ConclusionThese data regarding patterns of distant metastasis in HNSCC support the clinical utility of early detection of recurrence. Patterns of recurrence in this population can be used to inform individualized surveillance programs as well as to risk‐stratify eligible patients for clinical trials.Plain Language Summary After treatment for head and neck cancer (HNC), patients are at risk of recurrence at prior sites of disease or at distant sites in the body. This study includes a large group of patients with recurrent or metastatic HNC and examines factors associated with survival outcomes and recurrence patterns. Patients with human papillomavirus (HPV)‐positive HNC have good survival outcomes, but if they recur, this may be in distant regions of the body and may occur later than HPV‐negative patients. These data argue for personalized follow‐up schedules for patients with HNC, perhaps incorporating imaging studies or novel blood tests.

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Section: Discussionsupporting

confidence: 90%

Patterns of recurrence in head and neck squamous cell carcinoma to inform personalized surveillance protocols

Haring

Kana

Dermody

et al. 2023

Cancer

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“…Less than one half of these were HPV16-specific (95 of 248 samples; Figure 1): the oncogenic type known to cause the majority of HPV-OPCs. 5 Excluding HPV16…”

Section: Resultsmentioning

confidence: 99%

“…At least one oncogenic HPV biomarker was identified in 248 (22.4%) participants; these were in oral ( n = 86), blood ( n = 179), and both oral and blood ( n = 17) samples. Less than one half of these were HPV16‐specific (95 of 248 samples; Figure 1): the oncogenic type known to cause the majority of HPV‐OPCs 5 . Excluding HPV16 E7 seropositivity, which is thought to have lower specificity and sensitivity than E6 seropositivity, 18,25,26 only 41 participants (3.7% of those screened) had HPV16‐specific biomarkers, including 20 with oral HPV16 DNA and 22 with HPV16 E6 antibodies (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…3,4 Approximately 90% of all OPCs in the United States are now caused by human papillomavirus (HPV). 5 OPC incidence has increased among men consistently by 2.7% per year in the United States over 20 years. 1 However, screening is currently not recommended for OPC.…”

Section: Introductionmentioning

confidence: 99%

“…Oropharyngeal cancer (OPC) is a relatively rare cancer with nearly 20,000 incident cases in the United States in 2021, 1,2 most (>80%) of those in men 3,4 . Approximately 90% of all OPCs in the United States are now caused by human papillomavirus (HPV) 5 . OPC incidence has increased among men consistently by 2.7% per year in the United States over 20 years 1 .…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of oral and blood oncogenic human papillomavirus biomarkers among an enriched screening population: Baseline results of the MOUTH study

D’Souza

Tewari

Troy

et al. 2023

Cancer

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Background Human papillomavirus (HPV)‐related oropharyngeal cancer screening is being explored in research studies, but strategies to identify an appropriate population are not established. The authors evaluated whether a screening population could be enriched for participants with oncogenic HPV biomarkers using risk factors for oral HPV. Methods Participants were enrolled at Johns Hopkins Hospitals and Mount Sinai Icahn School of Medicine. Eligible participants were either men aged 30 years or older who had two or more lifetime oral sex partners and a personal history of anogenital dysplasia/cancer or partners of patients who had HPV‐related cancer. Oral rinse and serum samples were tested for oncogenic HPV DNA, RNA, and E6 or E7 antibodies, respectively. Participants with any biomarker were considered at‐risk. Results Of 1108 individuals, 7.3% had any oncogenic oral HPV DNA, and 22.9% had serum antibodies for oncogenic HPV E6 or E7. Seventeen participants (1.5%) had both oral and blood biomarkers. HPV type 16 (HPV16) biomarkers were rarer, detected in 3.7% of participants, including 20 with oral HPV16 DNA and 22 with HPV16 E6 serum antibodies (n = 1 had both). In adjusted analysis, living with HIV (adjusted odds ratio, 2.65; 95% CI, 1.60–4.40) and older age (66–86 vs. 24–45 years; adjusted odds ratio, 1.70; 95% CI, 1.07–2.70) were significant predictors of being at risk. Compared with the general population, the prevalence of oral HPV16 (1.8% vs. 0.9%), any oncogenic oral HPV DNA (7.3% vs. 3.5%), and HPV16 E6 antibodies (2.2% vs. 0.3%) was significantly elevated. Conclusions Enrichment by the eligibility criteria successfully identified a population with higher biomarker prevalence, including HPV16 biomarkers, that may be considered for screening trials. Most in this group are still expected to have a low risk of oropharyngeal cancer.

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Circulating Tumor HPV DNA for Surveillance of HPV-Positive Oropharyngeal Squamous Cell Carcinoma

Lang Kuhs,

Brenner,

Holsinger

et al. 2023

JAMA Oncol

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ImportanceHuman papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma has an overall favorable prognosis, yet a subset of patients will experience devastating disease recurrence. Current surveillance standards for detection of recurrent disease are imperfect. There is growing interest in improving detection of recurrent disease through the use of plasma-based assays able to detect circulating tumor HPV DNA.ObservationsAlthough most circulating tumor HPV DNA assays remain in the research domain, the circulating tumor tissue–modified viral HPV DNA assay became commercially available in the United States in early 2020 and has been increasingly used in the clinical setting. With the rapidly increasing incidence of HPV-positive oropharyngeal squamous cell carcinoma and concomitant expansion of biomarker capabilities for this disease, it is critical to reexamine current posttreatment surveillance practices and to determine whether emerging technologies may be used to improve outcomes for a growing survivor population. However, caution is advised; it is not yet known whether biomarker-based surveillance is truly beneficial, and as is true with any intervention, it has the capacity to cause harm.Conclusions and RelevanceUsing Margaret Pepe’s classic 5 phases of biomarker development for early detection of cancer as a framework, this article reviews the current state of knowledge, highlights existing knowledge gaps, and suggests research that should be prioritized to understand the association between biomarker-based surveillance and patient outcomes. Specific attention is paid to the commercially available tumor tissue–modified viral HPV DNA assay, given its increasing clinical use. This review may serve as a road map for future research and a guide for clinicians considering its adoption in practice. Enrollment of patients into clinical trials incorporating biomarker-based surveillance should be prioritized.

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Prevalence of human papillomavirus in head and neck cancers at tertiary care centers in the United States over time

Cited by 11 publications

References 49 publications

Patterns of recurrence in head and neck squamous cell carcinoma to inform personalized surveillance protocols

Patterns of recurrence in head and neck squamous cell carcinoma to inform personalized surveillance protocols

Prevalence of oral and blood oncogenic human papillomavirus biomarkers among an enriched screening population: Baseline results of the MOUTH study

Circulating Tumor HPV DNA for Surveillance of HPV-Positive Oropharyngeal Squamous Cell Carcinoma

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