HPV positive – Oral Cancer News

Early findings suggest clinical and lab-based approach critical to tracking head and neck cancer recurrence

Source: medicalxpress.com Author: Anna Megdell, University of Michigan Early findings of two studies from the University of Michigan Rogel Cancer Center shed light on new ways to anticipate recurrence in HPV-positive head and neck cancer sooner. The papers, published in Cancer and Oral Oncology, offer clinical and technological perspectives on how to measure if recurrence is happening earlier than current blood tests allow, and provide a framework for a new, more sensitive blood test that could help in this monitoring. "When metastatic head and neck cancer returns, it impacts their quality of life and can be disfiguring, interfering with the ability to talk, swallow, and even breathe," said Paul Swiecicki, M.D., associate medical director for the Oncology Clinical Trials Support Unit at Rogel. "As of now, there's no test to monitor for its recurrence except watching for symptoms or potentially using a blood test which may not detect cancer until shortly before it clinically recurs." The paper in Cancer aims to identify different clinical ways that providers can more strategically track for recurrence. To do this, Swiecicki and his team needed to first understand what patient population was at the highest risk to then figure out an appropriate monitoring pattern. The team examined 450 patients with metastatic head and neck cancer, including people with HPV-positive and HPV-negative cancer. HPV-positive cancer is caused by the human papillomavirus and is increasingly more common in head and neck cancer patients. The team identified some predictors of when recurrences would happen, and to what [...]

Oral Cancer Foundation News Team - A2023-09-08T05:39:02-07:00September, 2023|Oral Cancer News|

Experts release new guidelines for studies into most effective treatments for HPV-positive throat cancer

Source: en.brinkwire.com Author: provided by University of Birmingham, United Kingdom Heightened caution is needed when considering de-escalation trials for patients with Human papillomavirus (HPV)-positive oropharyngeal cancer (OPC), to ensure minimal harm to patients, new guidelines from a group of international head and neck cancer experts have suggested. HPV-positive oropharyngeal cancer is a cancer of the throat caused by the human papillomavirus—a common, but symptomless group of sexually transmitted viruses. Instances of many throat and neck cancers have declined as smoking rates have fallen, whereas HPV-positive OPC has increased, largely affecting younger patients. The standard course of treatment for this disease is a combination of cisplatin (a common chemotherapy drug) and radiotherapy. The younger age of the patient population, significantly improved prognosis, and relatively minimal morbidities caused by the standard treatment pathway have led to the popularisation of the concept of treatment de-escalation as a way to improve the quality of life of patients by reducing dosage or frequency of treatment. These new recommendations, published today in the Journal of Clinical Oncology have been created by the Head and Neck Cancer International Group, a group of experts from nineteen countries, led by the University of Birmingham, UK. The guidelines have been prompted by the recent results of the first three randomised de-escalation trials which suggested a clear detriment in survival when cisplatin is omitted or substituted to minimise side effects. After a review of available HPV-positive OPC literature, the guidelines recommend an overall need for caution when considering de-escalation options, even [...]

Oral Cancer Foundation News Team - A2020-06-09T10:19:12-07:00June, 2020|Oral Cancer News|

Health Beat: Hunting head and neck cancer cells

Source: www.wfmz.com Author: Melanie Falcon Leonard Monteith led a healthy lifestyle. That's why sudden problems with his mouth caught his attention. "I noticed that when I would stick my tongue out, it would deviate to one side, and I thought that's not right," said Monteith, 66. Doctors found an inch-wide tumor at the base of Monteith's tongue. He was diagnosed with HPV positive cancer. "The traditional treatment for head and neck cancer is really toxic and exhaustive and leads to side-effects that are very significant," said Dr. Nabil Saba, a medical oncologist at Emory University Winship Cancer Institute in Atlanta. After treatment, Monteith's cancer went away for six months, but then it came back in his lungs. Saba is a nationally-known expert in the treatment of head and neck cancers. He thought Monteith would be a good candidate for a new therapy. "Immunotherapy is really, I think, a complete game changer," said Saba. Saba said two separate immunotherapy drugs are showing real promise. A drug called Nivolumab blocks the cancer receptors, allowing the body's immune system to fight the cancer. Another drug, Pembrolizumab, also works in a similar way. Because the trials are ongoing, Saba can't say which specific drug Monteith was on. "He had very good response to the treatment, to the point where we could not see any more lung lesions on the scan," Saba said. Monteith has been improving for three years, but he knows his condition could change without warning. "I just live my life as [...]

Oral Cancer Foundation News Team - A2017-05-22T07:29:34-07:00May, 2017|Oral Cancer News|

Expert says Nivolumab Poised to Change Standard of Care in SCCHN

Source: www.onclive.com Author: Laura Panjwani Nivolumab (Opdivo) is a game-changing agent for the treatment of patients with squamous cell carcinoma of the head and neck (SCCHN), according to Robert L. Ferris, MD, PhD. “Recent findings have shown us that this agent is really the new standard-of-care option for all platinum-refractory patients with head and neck cancer,” says Ferris, vice chair for Clinical Operations, associate director for Translational Research, and co-leader of the Cancer Immunology Program at the University of Pittsburgh Cancer Institute. “This is regardless of whether patients are PD-L1–positive or negative or whether they are HPV-positive or negative.” The PD-L1 inhibitor received a priority review designation by the FDA in July 2016 based on the CheckMate-141 study, which demonstrated a median overall survival (OS) with nivolumab of 7.5 months compared with 5.1 months with investigator's choice of therapy (HR, 0.70; 95% CI, 0.51-0.96; P = .0101) in patients with recurrent or metastatic SCCHN. The objective response rate (ORR) was 13.3% with nivolumab and 5.8% for investigator's choice. The FDA is scheduled to make a decision on the application for the PD-1 inhibitor by November 11, 2016, as part of the Prescription Drug User Fee Act. Ferris was the lead author on an analysis that further evaluated preliminary data from CheckMate-141, which was presented at the 2016 ASCO Annual Meeting. In an interview with OncLive, he discusses the findings of this study, potential biomarkers for nivolumab, and questions that remain regarding the use of the immunotherapy in SCCHN. OncLive: What [...]

Charlotte Parker2016-08-24T13:28:58-07:00August, 2016|Oral Cancer News|

Less Is More for HPV Oropharyngeal Cancer Reduced-intensity regimen clears disease in 86% of cases

Source: www.medpagetoday.comAuthor: Charles Bankhead SAN ANTONIO -- Less intense treatment of low-risk human papillomavirus (HPV)-related oropharyngeal cancer achieved a high rate of pathologic complete response (pCR) and favorable patient-reported outcomes, a preliminary trial showed. Overall, 37 of 43 (86%) patients achieved pCR with deintensified chemoradiation, including all but one evaluable primary tumor. The pCR rate was virtually identical to historical rates achieved with standard regimens, according to Bhishamjit Chera, MD, of the University of North Carolina (UNC) at Chapel Hill, and colleagues. Selected patient-reported adverse events peaked during the first 6 to 8 weeks and then declined thereafter. About 40% of patients required feeding tubes for a median duration of 15 weeks, but no patients required permanent feeding tubes, they reported here at the American Society for Radiation Oncology meeting. The regimen consists of lower doses of radiotherapy and concurrent cisplatin, administered over 6 weeks. With high-dose therapy, the radiation protocol requires an additional week. "Though we have limited follow-up, the pathological complete response rate with this reduced-intensity chemoradiotherapy regimen is very high in patients with favorable-risk oropharyngeal squamous-cell carcinoma," Chera said. "The early quality-of-life measurements are encouraging, particularly the data on swallowing. We are optimistic that these results with reduced-intensity treatment will translate into good long-term disease control with less toxicity." The study reflects the current trend and momentum in the management of HPV-positive oropharyngeal cancer, said Zain Husain, MD, of Yale Cancer Center in New Haven, Conn. "This is the second study to show that de-escalation of therapy might [...]

Charlotte Parker2015-10-21T14:59:53-07:00October, 2015|Oral Cancer News|

HPV Persistence Predicts Poor Prognosis in Head/Neck Cancer

Source: www.medscape.comAuthor: Roxanne Nelson, RN, BSN Among patients with human papillomavirus–positive oropharyngeal cancer (HPV-OPC), persistence of HPV following treatment is associated with a poorer prognosis. Results of a new study show that the persistence of HPV16 DNA, detected in oral rinses after treatment has ended, may be predictive of disease recurrence. In a cohort of 124 patients with HPV-OPC, HPV16 DNA was detected in oral rinses from 54% (n = 67) of patients at the time of their diagnosis. Following treatment, it was detected in only six patients after treatment, including five patients with persistent oral HPV16 DNA that was also detected at diagnosis. All five patients with persistent HPV16 experienced disease recurrence, with three eventually dying of their cancer. Conversely, only nine of 119 patients without persistent oral HPV16 DNA developed recurrent disease. "Our findings indicate that persistent HPV16 DNA in oral rinses may be a useful early marker of disease that has either recurred or never fully responded to treatment," said first author Eleni Rettig, MD, of the Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. "In the clinical setting, this could one day be a part of routine surveillance after treatment for HPV-positive oropharyngeal cancers, in addition to clinical examination and imaging," she told Medscape Medical News. The study was published online July 30 in JAMA Oncology. Biomarker Potential? In an accompanying editorial, Julie E. Bauman, MD, MPH, and Robert L. Ferris, MD, PhD, both of the University of Pittsburgh, in Pennsylvania, [...]

Oral Cancer Foundation News Team - A2015-07-30T17:19:55-07:00July, 2015|OCF In The News, Oral Cancer News|

Integrative and Comparative Genomic Analysis of HPV-Positive and HPV-Negative Head and Neck Squamous Cell Carcinomas

Source: http://clincancerres.aacrjournals.org/Authors: Tanguy Y. Seiwert, Zhixiang Zuo, Michaela K. Keck, Arun Khattri, Chandra S. Pedamallu, Thomas Stricker, Christopher Brown, Trevor J. Pugh, Petar Stojanov, Juok Cho, Michael S. Lawrence, Gad Getz, Johannes Brägelmann, Rebecca DeBoer, Ralph R. Weichselbau, Alexander Langerman, Louis Portugal, Elizabeth Blair, Kerstin Stenson, Mark W. Lingen, Ezra E.W. Cohen, Everett E. Vokes, Kevin P. White, and Peter S. Hammerman Abstract Purpose: The genetic differences between human papilloma virus (HPV)–positive and –negative head and neck squamous cell carcinomas (HNSCC) remain largely unknown. To identify differential biology and novel therapeutic targets for both entities, we determined mutations and copy-number aberrations in a large cohort of locoregionally advanced HNSCC. Experimental Design: We performed massively parallel sequencing of 617 cancer-associated genes in 120 matched tumor/normal samples (42.5% HPV-positive). Mutations and copy-number aberrations were determined and results validated with a secondary method. Results: The overall mutational burden in HPV-negative and HPV-positive HNSCC was similar with an average of 15.2 versus 14.4 somatic exonic mutations in the targeted cancer-associated genes. HPV-negative tumors showed a mutational spectrum concordant with published lung squamous cell carcinoma analyses with enrichment for mutations in TP53, CDKN2A, MLL2, CUL3, NSD1, PIK3CA, and NOTCH genes. HPV-positive tumors showed unique mutations in DDX3X, FGFR2/3 and aberrations in PIK3CA, KRAS, MLL2/3, and NOTCH1 were enriched in HPV-positive tumors. Currently targetable genomic alterations were identified in FGFR1, DDR2, EGFR, FGFR2/3, EPHA2, and PIK3CA. EGFR, CCND1, and FGFR1 amplifications occurred in HPV-negative tumors, whereas 17.6% of HPV-positive tumors harbored mutations in fibroblast growth factor receptor [...]

Charlotte Parker2015-02-05T14:34:06-07:00February, 2015|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 [...]

Charlotte Parker2014-05-30T22:22:29-07:00May, 2014|Oral Cancer News|

Study: Recurrence of SCCOP may differ in HPV-positive and HPV-negative patients

Source: News MedicalPublished: February 21, 2014 Patients with HPV-positive squamous cell carcinoma of the oropharynx (SCCOP) had a longer time to development of distant metastasis (DM) after initial treatment, and had more metastatic sites in more atypical locations compared to HPV-negative patients, according to research presented today at the 2014 Multidisciplinary Head and Neck Cancer Symposium. Culled from records of an IRB-approved registry, the study reviewed 285 patients with stage III-IV SCCOP (originally thought to be a smoking-related head and neck cancer) treated with chemotherapy and radiation from 2002 to 2013. HPV status was determined by in situ hybridization for HPV DNA and/or by strong and diffuse (>75 percent) staining for p16 immunohistochemistry. There were 245 HPV-positive and 40 HPV-negative patients. Twenty-seven HPV-positive and eight HPV-negative patients failed with DM and were the subjects for more detailed evaluation. Radiation therapy (RT) was either 3-D RT (HPV-positive = 15/27; HPV-negative = 4/8) or intensity modulated radiation therapy (IMRT) (HPV-positive = 12/27; HPV-negative = 4/8) with doses from 66-79 Gy. Patients received concurrent chemotherapy of cisplatin (HPV-positive = 9/27; HPV-negative = 2/8), cisplatin/5 fluorouracil (FU) (HPV-positive = 10/27; HPV-negative = 3/8) or cetuximab (HPV-positive = 8/27; HPV-negative = 2/8). One HPV-negative patient received cisplatin/paclitaxel chemotherapy. One patient in each group was treated with adjuvant chemoradiotherapy after initial resection. Student t-tests were used to compare the difference between the means of the samples. Both HPV-positive and HPV-negative patients were found to have similar rates of DM, however the mean time to develop DM [...]

Charlotte Parker2014-02-24T17:27:06-07:00February, 2014|Oral Cancer News|

Five genetic subgroups revealed in head and neck tumor analysis

Source: www.onclive.com Author: Ben Leach Oncologists who treat patients with head and neck cancer are aware that those whose disease has been caused by human papillomavirus (HPV) have significantly better outcomes than those whose disease is caused by other factors such as smoking. However, new research suggests that there may be five distinct subgroups in which specific genetic profiles may be utilized to guide treatment decisions in patients. “Currently, we treat all patients with head and neck cancer in essentially the same way,” said Ezra E. W. Cohen, MD, co-director of the Head and Neck Cancer Program at the University of Chicago Medical Center. “But we do know that the prognosis for patients who are HPV-positive is much better.” To determine whether patients’ genetic profiles differed, Cohen and his colleagues at the University of Chicago, led by researcher Tanguy Seiwert, MD, took approximately 130 tumor samples from patients with stage IV squamous cell carcinoma of the head and neck and performed gene expression (mRNA) analysis. The samples were gathered before patients received therapy, and all of the participants subsequently were treated with a 5-fluorouracil, hydroxyurea, and concurrent radiation (FHX)-based regimen. This way, the researchers could determine the outcome as a function of gene expression in the groups identified through the analysis, since patients received the same treatment across all the subgroups eventually identified. Cohen said that patients were enrolled regardless of whether they were HPV-positive or HPV-negative. Based on these findings, the University of Chicago team was able to classify [...]

Oral Cancer Foundation News Team - A2013-03-01T15:37:52-07:00March, 2013|Oral Cancer News|