Monthly Archives: May 2014

New Study Shows Variable Risk in HPV-Positive Oropharyngeal Cancer

by Kate Johnson for Medscape

Deintensification of chemotherapy might not be the best option for all patients with oropharyngeal cancer whose disease is associated with human papillomavirus (HPV).

However, such an approach might be reasonable for patients with a low risk for distant recurrence; namely, those with less advanced disease and limited exposure to smoking, according to a large retrospective institutional study conducted by Brian O’Sullivan, MD, from the Princess Margaret Hospital in Toronto, Ontario, Canada, and colleagues.

The study was published in the February 10 issue of the Journal of Clinical Oncology.

The findings “provocatively suggest there is a limit to the favorable biology of HPV-associated OPSCC [oropharyngeal squamous cell carcinoma],” write Harry Quon, MD, and Arlene Forastiere, MD, from the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, Maryland, in an accompanying editorial.

“It could be that today’s treatment paradigms result in the over treatment of many patients (and the consequent late effects on swallowing function) and under treatment of a smaller subset,” they add.

There is growing concern among OPSCC experts about patients’ risks for radiation-related morbidity, particularly severe late swallowing complications, Dr. Forastiere told Medscape Medical News.

“The potential for this damage is increased when chemotherapy is added to the radiation,” she explained. “One simple strategy is to drop the chemotherapy from the treatment of those with a low risk for recurrence of tumor in the oropharynx or the regional lymph nodes in the neck.”

However, she pointed out that Dr. O’Sullivan and colleagues “have refined this ‘risk definition’ by focusing not just on local failure, but also on predictors of distant failure…. As we consider strategies to deintensify treatment, we do not want to alter chemotherapy in those at increased risk for metastatic disease.”

The researchers examined 505 patients with OPSCC (382 HPV-positive and 123 HPV-negative) who were treated from 2001 to 2009 with either radiotherapy (RT) alone or chemoradiotherapy (CRT). Median follow-up was 3.9 years.

In the two HPV groups, they compared overall survival; recurrence-free survival; local, regional, and distant control; and late toxicity.

HPV status, age, sex, tumor and node categories, smoking and alcohol consumption, and treatment modality were used in the univariate and multivariate analyses to identify predictors of outcomes.

More Favorable Outcomes, But Only for Some

As expected, HPV-positive patients had more favorable 3-year outcomes than HPV-negative patients. This included better overall survival (83% vs 49%), better recurrence-free survival (84% vs 64%), and significantly higher rates of local control (94% vs 80%; P < .01) and regional control (95% vs 82%; P < .01).

Distant control rates were similar in the HPV-positive and HPV-negative groups (90% vs 86%; P = .53), but the temporal pattern of distant relapse was different. “The HPV-positive curve continued to decline for up to 5 years, in contrast to the relatively stable HPV-negative curve beyond 2 years,” the researchers report.

Because distant metastasis “remains the predominant pattern of failure,” deintensification “might best be deployed in subgroups least likely to develop distant metastasis,” they note. (OCF emphasis)

Using recursive partitioning analysis to identify such subgroups, the researchers found that advanced-stage disease significantly increased the risk for distant metastasis in all patients.

In HPV-positive patients, those with stages T1–3 and N0–2c disease were classified as low risk (a 3-year distant control rate of 93%), and those with stages T4 and N3 disease were classified as high risk (a 3-year distant control rate of 76%).

However, even in the low-risk HPV-positive group, there was a subgroup of patients for whom deintensified treatment (RT alone) produced worse outcomes than chemoradiotherapy (CRT).

Two subgroups of patients had worse distant control when treated with RT alone (n = 150) than when treated with CRT (n = 136): those with stage N2b disease (89% vs 98%; P = .03); and those with N2c disease (73% vs 92%; P = .02).

In the RT-treated N2b subgroup, the risk increased with heavy smoking (at least 10 pack-years); distant control rate was 84%.

“It seems prudent to exclude N2c disease from deintensification strategies that do not include conventional chemotherapy,” the researchers suggest. They add that reducing the intensity of or omitting chemotherapy might also be unsuitable for N2b heavy smokers.

However, HPV-positive patients with T1–3 and N0–2a disease and patients with N2b disease who are heavy smokers have minimal risk for distant metastasis, irrespective of treatment approaches. In such subgroups, deintensification might be optimal, they conclude.

“Overall survival can be misleading because it includes deaths from causes unrelated to the cancer,” Dr. Forastiere told Medscape Medical News. “Individuals with non-HPV-associated cancers have comorbid conditions as a result of tobacco and alcohol use,” she said. On that basis alone, we would expect them to have worse survival. Using disease-specific survival allows for a comparison of “apples to apples,” she explained.

The editorialists emphasize that, given current knowledge, treatment of HPV-associated locoregionally advanced cancers with anything less than the standard full doses of radiotherapy and concurrent cisplatin should only occur in the context of a clinical trial.”

The study authors and the editorialists have disclosed no relevant financial relationships.

Original publication can be found  at  J Clin Oncol. 2013;31:543-550, 520-522. AbstractEditorial

This article was vetted for accuracy by the Oral Cancer Foundation science review staff.

May, 2014|Oral Cancer News|

In Some HPV-positive Head and Neck Cancers Lower Dose Radiation may be a possible future.

May 30, 2014.

2014 Annual Meeting of the American Society of Clinical Oncology (ASCO): Abstract LBA6006.

CHICAGO — Oropharyngeal cancer patients who test positive for human papillomavirus (HPV) could be treated with lower than standard doses of radiation, which reduces the risk for adverse effects, suggest results from a phase 2 study.

Patients were first treated with induction chemotherapy, and the results suggest that those who respond can safely forgo standard radiation therapy in favor of a lower dose with fewer adverse effects, according to results from the ECOG 1308 study.

This “chemoselection” can guide radiotherapy treatment strategies aimed at lowering acute and late toxicities,” researcher Anthony Cmelak, MD, professor of radiation oncology at the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, told Medscape Medical News.

This story was vetted for accuracy by the Oral Cancer Foundation scientific review staff

“The lower dose allows patients to avoid long-term dysphagia, fibrosis, xerostomia, dental problems, strictures, or long-term percutaneous endoscopic gastrostomy tubes,” Dr. Cmelak commented. “The risks of these types of complications escalate rapidly after 54 Gy intensity-modulated radiation therapy (IMRT), and become the most commonly seen long-term problems in patients when treated to the standard dose of 70 Gy.”

The study, highlighted during a press briefing here at the 2014 Annual Meeting of the American Society of Clinical Oncology® (ASCO), included 90 patients with stage III/IV HPV-positive oropharyngeal squamous carcinoma who received induction chemotherapy with paclitaxel, cisplatin, and cetuximab.

Based on having a complete clinical response to chemotherapy, meaning no signs of cancer on endoscopic exam, 62 patients were selected to receive a reduced (54 Gy) dose of IMRT, while the rest received the standard dose of 70 Gy.

At two years, overall and progression-free survival was better in the low-dose group (93% and 80% respectively) compared to the high-dose group (87% and 65% respectively), especially among minimal smokers (less than 10 pack years) who had early stage disease (96% for both).

Dr. Cmelak said despite the favorable results with chemoselection for reduced radiation dose, it would be premature to translate this into clinical practice. There has been a lot of discussion among head and neck cancer specialists about reducing the aggressiveness of treatment for patients with HPV-positive disease, because they have a better prognosis than HPV-negative patients, but at the same time there is a concern that this does not result in under treatment, he commented.

“I don’t recommend using lower doses of radiation now for these patients off-study.

Ultimately it will take a large randomized trial looking at standard approaches…and comparing those to a deintensified regimen based on response rates up-front, to safely ensure that we’re not going to be jeopardizing patient survival in order to minimize toxicity,” he said.

The study results represent “great progress”, said Gregory Masters, MD, ASCO’s expert on head and neck cancers, and director of medical oncology at the Helen F. Graham Cancer Center. “Most of what we’ve been doing in oncology is escalating doses and treatment and that’s not necessarily always the right answer. As we try to treat with more precision…this is a step in the right direction but I don’t think anyone would say we’re at the point where we know exactly how to modify the doses for HPV-positive cancer.”

“It is laudable to see a trial addressing a means of separating a disease into two populations, one favorable based on response that may be treated with a lower radiotherapy…and the other a potentially more adverse group with less response justifying continuation with more conventional doses of radiotherapy,” Brian O’Sullivan, MD, told Medscape Medical News.

Dr. Sullivan, an expert in head and neck cancer and professor in the Department of Radiation Oncology at the University of Toronto, recently published a paper on the nuances of de-intensifying therapy in HPV-positive oropharyngeal cancer, reported by Medscape Medical News.

He said the ECOG 1308 study “was designed in the era before there was the same appreciation of the stratification of risk in this disease,” and more recent trials take into account risk of distant metastasis, “which has emerged as one of the leading causes of death in this patient population,” to allow an even more precise stratification of risk in HPV-positive disease.

In the future, “trials should probably be designed with this in mind, potentially using the strategy illustrated by ECOG 1308 that employs an induction systemic approach emphasizing agents capable of addressing distant metastases and potentially using a less intense local treatment approach in those who respond,” he said.

The study was funded by the National Institutes of Health. Anthony Cmelak reports financial relationships with Bristol-Myers Squibb. Dr. O’Sullivan and Dr. Masters have disclosed no relevant financial relationships.

 

May, 2014|Oral Cancer News|

Recent Study reveals over two thirds of Americans harbor HPV

Source: medscape.com
Author: Pam Harrison
 

More than two thirds of healthy US residents harbor at least 1 type of human papillomavirus (HPV), most of which are undetectable by widely used commercial screening kits, a large genetic analysis shows. However, the relevance of this is at present unclear, commented an expert not connected with the study.

The study identified 109 different HPV types in tissue samples taken from 103 men and women whose tissue DNA was made available through the National Institutes of Health (NIH) Human Microbiome Project.

Only 4 individuals carried either HPV 16 or 18, considered to be among the most oncogenic HPV types and associated in particular with cervical cancer.

“There are more than 170 HPV types, so it’s a very heterogeneous virus, and current methods only detect about 20 to 30 of them,” senior investigator Zhiheng Pei, MD, PhD, associate professor of pathology, New York University School of Medicine, in New York City, told Medscape Medical News.

“[Because] non-risk or low-risk HPV types have been very understudied, we would like to see if these non-cancer-causing HPV types play a role in cancers other than cervical cancer or, conversely, if HPV infection is in fact beneficial in an asymptomatic population,” Dr. Pei commented.

The study was presented at the annual meeting of the American Society for Microbiology in Boston, Massachusetts.

Shotgun Sequencing

For the study, researchers decoded DNA assembled by a technique called shotgun sequencing.

In this method, researchers fragment long DNA strands into short fragments and then randomly sequence each small fragment, as Dr. Pei explained.

In all, DNA from 748 tissue swabs was analyzed. Tissue was taken from multiple organ sites, including the skin, vagina, mouth, and gut. Tissue was collected in 2009 at a time when HPV vaccination was not popular, as Dr. Pei observed.

All human DNA was removed, and HPV DNA was matched to an HPV reference genomic database.

This allowed researchers to see the entire community of HPV types in a healthy segment of the population.

The highest prevalence of HPV infection was found on the skin, at 61.3%. This was followed by the vagina, with a prevalence of 41.5%; the mouth, at 30%; and the gut, at 17.3%.

Multiple HPV types were also detected in 48.1% of all HPV-positive samples.

“Our study offers initial and broad evidence of a seemingly ‘normal’ HPV viral biome in people that does not necessarily cause disease and that could very well mimic the highly varied bacterial environment in the body, or microbiome, which is key to maintaining good health,” Dr. Pei said in a press release.

As researchers suggest, the overwhelming presence of so many HPV viral strains in a normal, healthy viral biome may be an indication that certain viral strains could be keeping each other in check so that other strains do not spread out of control.

On the other hand, more and more studies are identifying HPV-related cancers in body sites other than the uterine cervix, as Dr. Pei noted. In particular, there has been an increase in HPV- related oropharyngeal cancers in recent years.

It therefore could be that the so-called low-risk or nononcogenic HPV types could actually be implicated in cancers at these different sites, including oral cancer, oropharyngeal cancer, and skin cancer.

“Right now, we certainly don’t know what this high prevalence of HPV infection means in a healthy population, and more investigations are needed to understand the impact of asymptomatic HPV infection on human health,” Dr. Pei told Medscape Medical News.

“So we need to see the complete picture of HPV infection, and eventually, we will know what this high HPV prevalence means, and we can then perhaps suggest some additional HPV types that should be included in the clinical detection kit to broaden HPV detection.”

Relevance to Human Disease Is Unclear

Asked to comment on the study, Maura Gillison, MD, PhD, professor and Jeg Coughlin chair of cancer research at the Ohio State University, in Columbus, Ohio, told Medscape Medical News that it is difficult to tell to what extent the sample of only 103 individuals represents the US population as a whole.

“Based on the older methods capable of detecting 37 HPV types, the CDC [US Centers for Disease Control and Prevention] estimated that ~42.5% of US women have a cervical HPV infection at any point in time,” she noted, adding that it is “perhaps surprising” that with shotgun sequencing, only 42% of women in the Microbiome Project sample had a vaginal infection.

“I would think the estimates would be more dramatically different from one another,” Dr. Gillison added.

She concurred with investigators that although the study is interesting, “at this time, it’s of unclear relevance to human disease.”

 

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

May, 2014|Oral Cancer News|

Doxepin rinse relieves pain in patients with radiation-related oral mucositis

Source: www.onclive.com
Author: Lauren M. Green

Doxepin rinse may prove to be a viable option for the relief of pain associated with oral mucositis (OM) in patients with head and neck cancers, according to findings of a phase III trial.

head-and-neck-cancer

This randomized, double-blind, placebo-controlled trial, conducted under the auspices of the Alliance for Clinical Trials in Oncology cooperative group, enrolled 155 patients who were being treated at 26 cancer centers across the country between December 2010 and May 2012. To be eligible, patients were undergoing radiotherapy to a minimum planned dose of 50 Gy and experiencing OM-related pain ≥4 on a 0 to 10 scale.

Participants were randomized 1:1 to receive either doxepin (25 mg diluted to 5 mL with 2.5 mL of sterile or distilled water) on day 1, then crossing over to a placebo on a subsequent day (arm A), or placebo on the first day followed by the doxepin preparation (arm B). Patients in both arms were instructed to swish the solution in their mouth for 1 minute, gargle, and expectorate.

The study’s primary endpoint was a reduction in pain as measured by the pain scale’s area under the curve (AUC), using assessments based on the Oral Mucositis Daily and Weekly Questionnaires–Head and Neck Cancer, administered at baseline and at 5, 15, 30, 60, 120, and 240 minutes for each treatment arm. Patients were allowed to leave after the first hour, instructed to complete the questionnaires at 2- and 4-hour intervals, and received telephone reminders.

Researchers reported that the AUC for the mean reduction in mouth and throat pain was significantly greater with doxepin than placebo, -9.1 and -4.7, respectively (P <.001). Intrapatient changes of +4.1 for arm A and -2.8 for arm B were determined through crossover analyses, equivalent to a treatment difference of -3.5 (95% CI, -5.1 to -1.8; P <.001), for doxepin versus placebo.

As secondary outcomes, researchers also assessed any stinging or burning, unpleasant taste, and/or drowsiness resulting from the rinse, as well as whether additional analgesia was required 2 and 4 hours after administration.

Adverse effects of doxepin were typically mild and consistent with those identified in previous phase I/II studies. The AUC for stinging and burning was significantly higher with doxepin, being highest 5 minutes after rinsing. The sensations were reduced, but remained statistically significant over the 4-hour postrinse assessment.

Taste also was ranked using AUC on a 0 (acceptable) to 10 (terrible) scale; patients preferred the placebo (5.5) to the doxepin (7.7). After 5 minutes, however, both were deemed acceptable: doxepin (2.9), placebo (1.6).

No significant differences were reported in the use of additional analgesics following use of the rinse versus placebo. Drowsiness was associated more with doxepin, a known adverse effect of the agent; however, differences with placebo did not reach statistical significance until assessment at 2 hours (3.9 for doxepin vs 2.8 for placebo; P = .02), based on a scale of 0 (no drowsiness) to 10 (extreme drowsiness resulting in sleep). The researchers noted that some patients deemed the rinse’s sedative effect beneficial as a sleep aid.

Notably, the researchers reported that 63% of patients (n = 81) chose to continue using the doxepin rinse at the conclusion of the trial, with more patients in arm A indicating a desire to continue treatment than those in arm B. Of those who continued the treatment, 14 (17%) subsequently stopped, most often citing burning discomfort and increased drowsiness.

The authors noted that their research represents “the largest placebo-controlled trial to date specifically testing the efficacy of a rinse agent in controlling established mucositis pain and the only such trial with positive results.”

Cannabinoids may offer hope for patients with oral cancer pain

Source: www.elements4health.com

Even the strongest available pain medications are largely ineffective for many cancer patients, particularly those with oral cancers. One of the nation’s leading oral cancer treating clinicians, speaking at the American Pain Society’s annual meeting, said he believes that while prospects for major treatment advances remain bleak, a new cannabinoid-based medication may have some promise for providing meaningful pain relief.

Brian Schmidt, DDS, MD, PhD, professor, New York University College of Dentistry and School of Medicine, delivered the Global Year Against Pain Lecture and reported that today, more than 100 years since President Ulysses S. Grant died from oral cancer, there is only modest improvement in patient survival. Grant is the only American president to die from cancer.

“Oral cancer is one of the most painful and debilitating of all malignancies,” said Schmidt, “ and opioids, the strongest pain medications we have, are an imperfect solution. They become dramatically less effective as tolerance to these drugs develops.”

Now considered to be the fastest increasing cancer in the United States, oral and oropharyngeal malignancies usually begin in the tongue. Human papillomavirus transmitted through oral sex, tobacco use and excessive alcohol consumption are the leading causes of this increase in oropharyngeal cancer. In the United States, some 43,000 new cases of oral cancer are diagnosed every year and the disease is more widespread worldwide with 640,000 new cases a year.

Schmidt said oral cancer patients often undergo multiple surgeries as tumors recur and also are treated with radiation and chemotherapy. The disease is difficult to diagnose at early stages and spreads quickly, leaving patients in gruesome pain and unable to speak or swallow. “Our inability to effectively treat oral cancer stems from lack of knowledge. We know that cancer pain is caused by a unique biological mechanism, but more research is needed to develop medications that are effective in treating oral cancer pain,” Schmidt said.

“The only way we can hope to reduce the devastating impact of oral cancer pain is to fund more research to help those who suffer or will suffer from this ruthless disease,” Schmidt told the APS audience. He added that half of oral cancer patients do not survive five years after diagnosis.

Schmidt noted that perhaps some good news is on the horizon, as clinical trials proceed for a drug produced directly from a marijuana plants (Sativex). It is administered as an oral spray and shows promise for treating cancer pain. The drug is available in Canada and Europe for treating spasticity from multiple sclerosis and is in Phase 3 clinical trials in the United States for treatment of cancer pain. Schmidt is a clinical investigator for Sativex trials.

“While it’s too early to conclude the cannabinoid medication will provide effective cancer pain relief, we do know that humans possess numerous cannabinoid receptors in the brain and body which regulate a significant amount of human physiology. So, there is hope that cannabinoid-based medications can become effective pain relievers for cancer patients.”

Early nutrition intervention creates proactive approach for treating head and neck cancer patients

Author: Megan Brooks
Source: medscape.com 
 

Oncologists treating patients with head and neck cancer are taking a proactive approach when it comes to home enteral nutrition support, a new study suggests.

The study of 172 patients with gastrostomy tubes found that half had the feeding tubes placed prior to beginning treatment for head or neck cancer. Most of these patients were put on home enteral nutrition support to help them maintain their current weight during treatment, as opposed to being put on it after treatment to try to regain lost weight, researchers found.

The study was presented at the Oncology Nursing Society 39th Annual Congress in Anaheim, California.

An estimated 55,000 people in the United States develop head and neck cancers each year.

“These patients have many nutritional concerns because of the location of the cancer, which often causes trouble swallowing,” said investigator Noreen Luszcz, RD, MBA, CNSC, nutrition program director for Walgreens Infusion Services. “They can’t eat, won’t eat, or can’t eat enough,” she told Medscape Medical News.

Many of these patients have impaired nutrition status at the time of diagnosis, she noted. In addition to losing weight prior to the diagnosis, they can lose 10% of their pretherapy body weight during treatment.

Enteral nutrition can help head and neck cancer patients minimize weight loss, maintain quality of life, manage symptoms, and improve tolerance to treatment, Luszcz said. Home enteral nutrition coordinated by a multidisciplinary nutrition support team has been shown to be safe and beneficial in these patients, she added.

Early Screening, Assessment Key

To gather more information on home enteral nutrition in the head and neck cancer population, Luszcz and a colleague took a look back at 121 men and 51 women (mean age, 63 years) with head and neck cancer who received enteral nutrition support from their service from July 2012 to June 2013.

They found that 50% of the patients had their feeding tubes placed before radiation and chemotherapy, which suggests that “clinicians are thinking about nutrition ahead of time. Studies have shown positive results when there is early use of enteral feeding,” Luszcz explained.

Only 8% of patients were considered severely malnourished at the start of their cancer treatment; malnutrition was mild in 55%, moderate in 17%, and not known in 20%. “This finding also speaks to the fact that physicians are thinking about nutrition early on,” Luszcz said.

The initial goals of therapy were gaining weight for 27% of patients and maintaining weight for 64%. Goals were not known for the other 9%.

For the 62 patients who completed enteral therapy, the average length of therapy was 131 days; 46% of these patients met their initial goal. Of patients remaining on enteral nutrition, 70% were progressing toward their goal.

The head and neck cancer population has “red flags” for nutrition, Luszcz said, and “early screening and assessment of nutrition risk and early nutrition intervention is key.”

“It’s been well documented that having a multidisciplinary team approach — the nurse, pharmacist, dietitian, and physician working together — results in positive outcomes,” she added.

“There are multiple home infusion service companies — like PromptCare, Coram, Home Solutions — in the market that we use for home enteral patients,” said Harpinder Sandhu, FNP-BC, a nurse practitioner in the GI/Clinical Nutrition Services Department at the Memorial Sloan-Kettering Cancer Center in New York City.

“The servicing company depends on patients’ insurance and where they live. Case management takes cares of that. Patients call us if they have issues with delivery of enteral formula or supplies,” he told Medscape Medical News. “We work closely with representatives from these companies to make sure that our patients are provided with formula and supplies that they need.”

“The only concerns are that, recently, Medicare patients have needed to switch companies, owing to some companies losing the bid and therefore not being able to provide services for those patients,” Sandhu said.

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

 

May, 2014|Oral Cancer News|

Aspirin may stop deafness caused by chemotherapy

Source:  www.bbc.com
Author: staff

Aspirin could save the hearing of cancer patients receiving chemotherapy, scientists in Cardiff hope.

A trial will be launched at the city’s Velindre Hospital to see if high doses of the drug can prevent permanent loss.

Conditions ranging from tinnitus to deafness are a common side effect for patients given the chemotherapy drug cisplatin.

The trial, called Coast, has recruited 88 adults prescribed cisplatin in Cardiff and other UK hospitals.

It is used to treat testicular cancer, germ cell cancer, head and neck cancer, bladder cancer, cervical cancer, non-small cell lung cancer and some types of children’s cancer.

‘Shock it was cancer’
Father-of-four Andrew Millington, 66, was given cisplatin after a tumour was found at the base of his tongue.

“I had a persistent sore throat and earache, and I went to see my GP last spring,” he said.

“I was referred to a consultant and had an MRI scan. It was a shock to be told it was cancer but… it was generally curable, which was such a relief to hear. I was offered cisplatin and, after hearing about the possible side effects, I was more than happy to take part in the Coast trial.”

Around 18,500 cancer patients receive cisplatin every year and around half suffer some form of permanent hearing loss.

Ahead of the trial’s launch on Thursday, professor Emma King, chief investigator and Cancer Research UK surgeon at the University of Southampton, said: “Aspirin can have serious side effects, including internal bleeding, so it’s important to stress that aspirin is not suitable for all cancer patients.

“To help prevent these problems we’ll be giving patients specially coated aspirin tablets, that only release the drug once it reaches the small intestine, and also using another drug that reduces digestive juices, to prevent bleeding in the stomach.

“If this trial is successful, then a larger trial will follow within two years that could potentially see aspirin become a routine part of cisplatin treatment for many thousands of cancer patients.”

High-Risk HPV Prevalent in Oropharyngeal Cancers

Author: Roxanne Nelson
Source: medscape.com
 

A larger percentage of oropharyngeal cancers might be related to human papillomavirus (HPV) than previously thought. The Centers for Disease Control and Prevention (CDC) reports that in a large sample of invasive oropharyngeal squamous cell carcinomas, 72% were positive for HPV and 62% were positive for high-risk HPV types 16 and 18, which are covered by the 2 commercially available vaccines (Gardasil, Merck & Co.;Cervarix, GlaxoSmithKline).

On the basis of these data, the CDC researchers suggest that vaccines could prevent most oropharyngeal cancers in the United States.

The vaccines are marketed mainly for the prevention of cervical cancer, but there is hope, and some evidence, that the vaccines might also protect against oropharyngeal cancer. For example, last year, the Costa Rica HPV Vaccine Trial found that the Cervarix vaccine reduced oral HPV infections in women by more than 90%.

However, the effect of the vaccines could vary by demographic factors; HPV prevalence differed by sex and race/ethnicity, the researchers note.

In their study, Martin Steinau, PhD, senior scientist at the CDC, and colleagues report that the current global incidence of oropharyngeal cancers is estimated to be 85,000 annually, although there is considerable geographic variation. In the United States, there are about 12,000 new cases diagnosed every year, and most are classified histologically as squamous cell carcinoma (OPSCC).

The retrospective analysis was published in the May issue of Emerging Infectious Diseases.

Study Details

Dr. Steinau and colleagues sought to determine prevalence of HPV types detected in oropharyngeal cancers in the American population, and to establish a prevaccine baseline for monitoring the impact of vaccination.

They examined oropharyngeal tumors from 588 patients.

HPV was detected in 403 of the 557 patients with OPSCC (72.4%), and 396 (71.1%) were positive for only 1 or no high-risk types. A single HPV type was detected in 68.4% of cases, and 3.9% of samples contained 2 types. In 7 cases, only low-risk HPV types were detected. High-risk HPV16 was present in 337 (60.5%) cases, HPV18 was present in 14 (2.5%) cases, and 331 (59.4%) cases were exclusively positive for these 2 types.

Other high-risk types, including HPV31, 33, 35, 39, 45, and 52, were found at low frequency, the researchers point out.

There were differences in prevalence based on sex and race/ethnicity. The prevalence of the high-risk HPV16 and HPV18 was lower in women than in men (53%vs 66%), and in non-Hispanic black than other racial/ethnic groups (31% vs 68% to 80%).

When the researchers conducted a multivariate analysis for high-risk HPV, only race/ethnicity emerged as a significant independent factor (P = .003). The odds for high-risk HPV infections were significantly higher for all other race groups than for non-Hispanic black patients (P < .001).

When only HPV16/18 detection was considered, there were significant differences between those infected and those not infected for sex (P = .009) and race/ethnicity (P < .001), but not for age (P = .063).

“Future assessments are needed to monitor general prevalence and possible type-specific shifts,” the researchers conclude. “Data from the present and future studies will provide a baseline for early assessment of vaccine effects.”

This project was supported in part by CDC grants and federal funds for Residual Tissue Repositories from the National Cancer Institute SEER Population-based Registry Program, National Institutes of Health, Department of Health and Human Services. Coauthor Brenda Y. Hernandez reports receiving consultation and speaker fees from Merck and Co.

 

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

May, 2014|Oral Cancer News|