• 4/4/2007
  • Baltimore, MD
  • press release
  • Johns Hopkins Medicine (www.hopkinscancercenter.net)

For Dr. Maura Gillison the human papillomavirus was a smoking gun. Having proven that the virus is present in tumor cells of a subset of patients with head and neck cancer—those patients that didn’t fit the risk profile for the disease—this new faculty member has now set out to discover how this new finding will affect screening, prognosis and treatment of head and neck cancers.

There is a common factor among one quarter of all head and neck cancers. It is the sexually transmitted human papillomavirus (HPV). Maura Gillison, M.D., Ph.D., assistant professor of oncology, intrigued by evidence of HPV DNA in head and neck cancers wanted to find out what role this virus might be playing in this form of cancer. “The fact that the virus had been detected in some head and neck cancers was no secret, but most scientists attributed it to laboratory contamination. I couldn’t help but wonder what if it wasn’t,” she says.

When she began the experiment, Gillison truly expected the results to be negative, that she would not find HPV in the tumor cells. Instead her studies not only confirmed the presence of HPV, but also uncovered another interesting outcome. She was able to prove infection with the virus was associated with head and neck cancers, primarily oropharyngeal cancers, including those of the pharynx, tonsils, and base of tongue. And to her surprise, she also found that these patients typically fared better than those with non-HPV head and neck tumors.

Though she does not currently have an explanation for the better cure rates, her research findings indicate that having an HPV-caused tumor translates to a 60 percent or greater reduction in death rates. “This suggests that HPV-positive head and neck cancers may comprise a distinct molecular, clinical, and pathologic disease very different from other types of the disease,” says Gillison.

This research, the first detailed studies of the relationship between HPV and head and neck cancers, earned her the recognition and a $1.2 million grant from the Damon Runyon Cancer Research Foundation which named her as one of only five physicians worldwide to receive its inaugural Clinical Investigator Award. More recently, it has earned her CRF funding for continued research of the disease, which strikes at alarmingly high rates in Maryland’s urban communities.

Gillison is performing oral screenings in the community to determine if HPV infection can be detected before cancer develops. She suspects that HPV infection of the upper airway and oral cavity precedes cancer development, altering the cell’s ability to detoxify certain carcinogens such as alcohol and cigarettes, and putting the person at higher risk for cancer development. What she envisions is an oral pap smear. Like the cervical pap smear which detects HPV in cells of the cervix, Gillison is testing several similar methods, from oral rinses to a brush that collects cells from the tonsils, that would reveal virus in cells and allow physicians to closely monitor those who tested positive for changes that could be the onset of cancer. In addition, she is collecting blood samples from volunteers to test for antibodies that would indicate HPV exposure to see how frequently exposure to the virus leads to upper airway infection.

A key element of her research is a unique computerized questionnaire that gathers information from participants about lifestyle behaviors associated with HPV and head and neck cancers. By comparing behaviors in individuals with cancer to those without cancer, she hopes to identify exposures that lead to HPV-related cancers and other habits, such as smoking and drinking, that combine with infection to trigger cancer development

HPV infection of the oral airway may occur through oral/genital contact. In fact, other investigators, intrigued by Gillison’s findings, began tracking changes in tonsillar cancer rates, the type of cancer Gillison showed was most related to HPV. They found that tonsillar cancer rates consistently increased by 2.7% per year, particularly among African American men, between 1974 and 1995, a time period correlating with changes in sexual behavior in the United States.

Gillison anticipates a three-pronged attack against these cancers, including both public health and clinical application. She expects these studies to reveal a better understanding of the exposures that lead to HPV infection of the oral cavity, new methods for detection of infection before cancer develops, and plans to start clinical trials of immune-based therapeutic vaccines that target infected cancer cells.