HPV, PD-L1 move to the forefront of biomarkers for head and neck cancers

Source: www.onclive.com Author: Silas Inman The frontline treatment for patients with head and neck cancer is largely dominated by surgery and radiation therapy, with ongoing efforts to find biomarkers and other strategies to better individualize care. The leading markers used to tailor therapy are human papillomavirus (HPV) status, which typically signals the aggressiveness of the disease, and PD-L1 expression level, which may help guide selection of immune checkpoint inhibitor (ICI) therapy. These markers are gaining notice in different settings. HPV status has broad applicability across head and neck cancers, whereas the clinical utility of PD-L1 expression remains a more nuanced question. HPV-Positive Tumors Approximately 70% of head and neck cancers, specifically oropharyngeal cancers, are positive for HPV, with most cases associated with the HPV-16 subtype. These tumors appear most commonly in nonsmoking White men with a mean age of diagnosis of 60.3 years (SD, 10.8) for oropharyngeal cancer and 63.2 years (SD, 12.7) for other types of head and neck cancers.1,2 Moreover, HPV-positive tumors typically fall into a low- to intermediate-risk category, with 5-year overall survival (OS) outcomes far superior compared with rates for HPV-negative tumors, which are typically caused by smoking. For patients with HPV-associated head and neck cancers, the 5-year OS rate ranges from 75% to 80% compared with 45% to 50% for those with HPV-negative tumors.3 In many cases, although the prognosis is more favorable for patients with HPV-positive tumors, the treatment is the same as it is for HPV-negative tumors. However, with the introduction of ICIs [...]

Parsing the genetic drivers of head and neck cancers

Source: today.ucsd.edu Author: UC San Diego press release Head and neck cancer, which kills more than 400,000 persons worldwide each year, has multiple causes. The human papilloma virus (HPV), a sexually transmitted infection, is one, but the most common and lethal subtype are HPV-negative head and neck cancers, which account for 3 percent of all malignancies in the United States and 15,000 deaths annually. “Typically, head and neck cancers begin in the squamous cells that line the mucosal surfaces, such as inside the mouth and throat and there are multiple treatment options, including surgery, radiation and chemotherapy,” said Ezra Cohen, MD, co-director of the Gleiberman Head and Neck Cancer Center at Moores Cancer Center at UC San Diego Health. “But these cancers are complex and no single treatment works for every patient every time, which is why immune checkpoint inhibitors were developed, which use antibodies to make tumor cells visible to a patient’s immune system.” Immune checkpoint therapy (ICT) first emerged in the 1990s and has progressed dramatically in recent years, but drug resistance in head and neck cancer cases remains prevalent, poorly understood and largely unidentified by current biomarker tests, said Cohen. Currently available Food and Drug Administration-approved PD-1 (a protein) immune checkpoint antibody therapy produces durable responses in 15 percent of patients with head and neck squamous cancer. The remaining 85 percent receive no benefit and may, in fact, experience severe, immune-related adverse effects.  Like other types of head and neck cancer, the HPV-negative subtype has multiple risk [...]

2022-11-17T21:39:36-07:00November, 2022|Oral Cancer News|

A shift in focus for head and neck cancer treatment

Source: www.curetoday.com Author: Marijke Vroomen Durning, RN When Cindy Stemple of Westerville, Ohio, noticed a sore on her tongue, the last thing she imagined was that she may have head and neck cancer. After all, she was only 27 years old. She finally went to see her dentist when the sore wouldn’t heal. Since Stemple didn’t have any known risk factors for head and neck cancer, the dentist didn’t expect cancer either. After trying several treatments, they decided it was time for a biopsy. Stemple still wasn’t concerned. “It wasn’t even in the realm of possible things,” she says. “I didn’t even take anybody to the appointment when I got the results and found out it was cancer because it was the furthest thing from my mind.” She received a diagnosis of stage 3 oral squamous cell carcinoma — which is a cancer that occurs in the mouth and/or throat. Tremendous Change in Head and Neck Cancer Historically, head and neck cancer, the seventh most common cancer globally, was predominantly diagnosed in older individuals and was often linked to tobacco and alcohol use. As smoking rates began to decline, so did tobacco- and alcohol-related cases among older individuals. But head and neck cancer rates began rising in another group — younger and middle-aged adults — driven by HPV infections, predominantly HPV type 16, which has been shown to be a clear risk factor for head and neck cancer as well as cervical cancer. HPV-positive oropharyngeal cancers in the United States [...]

2022-09-21T06:29:44-07:00September, 2022|Oral Cancer News|

OmniPathology announces the launch of its oropharyngeal HPV PCR test

Source: www.globenewswire.com Author: press release OmniPathology, an independent, physician-owned and operated pathology lab, today announced the launch of a new oral test for human papillomavirus (HPV) that can cause cancer. The Oral HPV Test is a lab-developed test (LDT) performed on a Roche cobas® 6800 and 8800 high-throughput platforms. The Oral HPV Test detects 14 high-risk strains of HPV. It is performed via a throat swab submitted to OmniPathology, a CLIA-certified laboratory in Pasadena, for testing. Patients who test positive are advised to undergo a thorough examination by an ear, nose, and throat (ENT) doctor and may require close follow-up. Detection and removal of early oral and oropharyngeal premalignant lesions can help significantly reduce the risk of progression to cancer. This test will be offered to primary care and GYN physicians, LGBTQIA+ clinics, dentists, oral surgeons, and ENT practices across the country as part of routine examinations of patients. “Launching this oropharyngeal HPV test is an exciting milestone for OmniPathology, especially since this is an underserved area for diagnostic testing. As an organization led by science and driven by service, OmniPathology continues to offer state-of-the-art molecular testing that can impact patient care and enhance the quality of the services our physician clients offer to their patients,” said Mohammad Kamal M.D., founder and CEO of OmniPathology. “We continue to build our testing menu to target sexually transmitted infections and other viral diseases.” Oral HPV has no symptoms and is spread through skin-to-skin contact. Risk factors for oral HPV include oral sex, [...]

NF-κB over-activation portends improved outcomes in HPV-associated head and neck cancer

Source: medicalxpress.com Author: staff, Impact Journals LLC A new research paper has been published in Oncotarget, titled "NF-κB over-activation portends improved outcomes in HPV-associated head and neck cancer." Head and neck squamous cell carcinoma (HNSCC) is a devastating disease that impairs fundamental tissues involved in respiration, phonation and digestion. HNSCC is primarily caused by exposure to either ethanol and tobacco or the human papillomavirus (HPV). Among patients with HPV+ HNSCC, there is a growing clinical demand to develop robust stratification tools to accurately identify patients with good or poor prognosis. According to the research, "While oncologic outcomes for HPV+ HNSCC are generally favorable, treatment paradigms developed for HPV-negative disease burden many survivors of HPV+ HNSCC with lifelong debilitating treatment-associated side effects. On the other hand, ~30% of HPV+ HNSCC patients exhibit a more aggressive disease course and suffer recurrence." Somatic mutations or deletions in TRAF3 or CYLD identified a subset of HPV+ HNSCC associated with improved outcome. A cross talk between canonical and non-canonical NF-κB signaling suggests that TRAF3 and CYLD affect both NF-κB pathways. "Herein, we demonstrate that an RNA-based classifier trained on tumors harboring these mutations may improve prognostic classification," state the researchers. To improve on genomic classification, the researchers designed the current study to provide a foundation for development of NF-κB related, RNA based classification strategies to better identify HPV+ HNSCC patients with good or poor prognosis that could potentially aid in future efforts towards treatment personalization. "This report validates and expands on our findings that significant [...]

Throat cancer survivors don’t have to sacrifice ability to swallow and taste

Source: southfloridahospitalnews.com Author: staff Tamarac resident Kenneth Goff was home shaving morning when he felt a small lump on the left side of his neck. “There was no pain, no nothing, but I could feel it by the way the razor moved,” said the 58-year-old father of five and grandfather of eight. “It wasn’t visible at all, but I could feel it right below the jaw line.” After a CT scan at Broward Health Medical Center in August 2020, Goff was diagnosed with HPV-mediated squamous cell carcinoma, a type of throat cancer. This cancer is similar to what actors Michael Douglas and Stanley Tucci have battled. The treatment of HPV-related oropharyngeal squamous cell carcinoma may include surgery, radiation, chemotherapy or combination of the treatments. Ryan H. Sobel, M.D., a head and neck surgical oncologist at Broward Health Medical Center, prescribed radiation to treat Goff’s isolated neck mass. Prior to radiation treatment, Dr. Sobel performed a submandibular, or saliva gland transfer, an intricate surgery only a handful surgeons across the country are skilled at performing. He is currently the only surgeon utilizing this technique in Broward and Palm Beach counties. Dr. Sobel strategically relocated one of Goff’s saliva glands. It was moved about three inches from the right side of his throat to under the chin to place it out of direct range of the damaging effects of radiation. Patients diagnosed with throat cancer face a difficult choice: treat the cancer with radiation and risk losing their ability to swallow and [...]

2022-02-24T15:03:37-07:00February, 2022|Oral Cancer News|

WVU Medicine Head and Neck Cancer Team works to increase tonsil cancer awareness

Source: wvumedicine.org Author: staff, WVU Medicine News Head and neck surgical oncologists at WVU Medicine, the WVU Cancer Institute, and across the country are seeing increased incidences of tonsil cancer. “The majority of tonsil cancers, nearly 70 percent, are caused by human papilloma virus (HPV),” Meghan Turner, M.D., head and neck surgeon in the WVU Medicine Department of Otolaryngology, said. “In the last 10 years, tonsil cancer caused by HPV has become more common than cervical cancer caused by the same virus.” In most cases of HPV infection, the body fights off the virus like it would the common cold. In other cases, the virus remains in the body, increasing the risk of both tonsil and cervical cancer. Unlike cervical cancer, there is no regular screening for tonsil cancer. Most commonly, tonsil cancer is first diagnosed as a nontender mass in the neck. “Another common presentation for tonsil cancer is actually recurrent or persistent tonsil pain in spite of treatment for a throat infection,” Dr. Turner said. “This happens between the ages of 50 and 60. It may seem like recurrent strep throat, but it is uncommon for people in that age range to develop recurrent strep throat. If you’re having pain that isn’t resolved after a course of antibiotics, you should ask your doctor if it could possibly be something like tonsil cancer.” It is also regularly discovered during routine dental visits, appearing as asymmetrical tonsils. Those who have had their tonsils removed by tonsillectomy are not immune to [...]

2022-02-05T10:20:45-07:00February, 2022|Oral Cancer News|

Trial underway for novel agent plus immunotherapy for HPV-related head and neck cancer

Source: www.curetoday.com Author: Brielle Benyon Results from a phase 2 clinical trial demonstrated promise for the combination of the novel agent PDS0101 plus Keytruda (pembrolizumab) in treating human papillomavirus (HPV)-associated head and neck cancer. As such, the trial will now progress to full enrollment of 54 patients who have not been previously treated with a checkpoint inhibitor. The trial, VERSATILE-002, involves two groups of HPV16-positive patients with head and neck cancer that is either metastatic or has returned after treatment. One group consists of patients who have no prior treatment with checkpoint inhibition immunotherapy, while the other group is made up of 21 patients whose disease failed checkpoint inhibition — assessment for this group is still ongoing. In the checkpoint inhibitor-naïve group, four or more of the 17 patients achieved an objective response, which was classified by a 30% or more reduction in tumor size. “The achievement of this important milestone in the VERSATILE-002 phase 2 clinical trial strengthens the evidence of our novel Versamune platform’s potential ability to induce high levels of tumor-specific CD8+ killer T-cells that attack the cancer to achieve tumor regression,” commented Dr. Lauren V. Wood, Chief Medical Officer of PDS Biotech, the developer of PFS101, in a statement. “The initial data solidifies our belief that PDS0101’s demonstrated preclinical efficacy when combined with Keytruda has the potential to significantly improve clinical outcomes for patients with advanced HPV16-positive head and neck cancers.” PDS0101 works by inducing large quantities of CD4+ helper and CD8+ killer T cells, a [...]

2022-02-03T10:51:38-07:00February, 2022|Oral Cancer News|

New MSK radiation approach means fewer side effects for more patients with HPV-related head and neck cancer

Source: www.mskcc.org Author: Memorial Sloan Kettering Cancer Center Robert Rosenfeld thought the lump he felt in his neck in late 2018 was just a symptom of a cold that wouldn’t go away. He visited an ear, nose, and throat specialist who saw nothing upon first examination, but Robert knew something was wrong and asked for a CT scan. The specialist called him with the bad news: It was almost certainly cancer. A biopsy confirmed he had stage 2 cancer at the base of his tongue and 2 nearby lymph nodes. The tumor was positive for the human papillomavirus (HPV). Robert, then a 69-year-old car salesman on Long Island, met with cancer doctors near his hometown of Hauppauge, New York, to learn about treatment options. He realized he faced a tough road: Standard treatment would be 7 weeks of radiation, during which he also would receive 3 rounds of chemotherapy. The standard radiation dose would likely cause mouth sores, difficulty swallowing, dry mouth (from damage to salivary glands), loss of taste, and nausea. Robert wanted a second opinion, and his medical oncologist strongly recommended Memorial Sloan Kettering Cancer Center. When Robert called, he was able to get in to see radiation oncologist C. Jillian Tsai the very next day. “When I met Dr. Tsai, she was amazing,” Robert says. “She told me what I was up against but also that the cancer I had was curable.” There was another major plus: Dr. Tsai was able to offer a significantly reduced radiation [...]

Molecular profiling identifies potential prognostic biomarker for treatment response in HNSCC

Source: www.ajmc.com Author: Matthew Gavidia Human papillomavirus surrogate marker p16 was identified as a potential prognostic biomarker for standard-of-care immune checkpoint blockade therapy response in non-oropharyngeal head and neck squamous cell carcinoma. Real-world overall survival among patients with oropharyngeal squamous cell carcinoma (OPSCC) and non-OP head and neck squamous cell carcinoma (HNSCC) differed significantly based on the presence of the human papillomavirus (HPV) surrogate marker p16, with further implications identified regarding time on treatment with immune checkpoint blockade (ICB) therapies. Findings were published in Cancers. Identified as the sixth most common cancer worldwide with incidence expected to increase by 32% in the next 2 decades, patients with recurrent and/or metastatic HNSCC typically have a poor prognosis. Although diagnosis of HNSCC is typically related to tobacco and alcohol use, incidence of HPV-associated HNSCC has risen substantially, in which those positive for the virus whose HNSCC stems in the oropharynx have exhibited better survival outcomes. Researchers sought to further investigate the association of HPV and/or its surrogate marker p16 with response to standard-of-care ICB therapies in patients with OPSCC and non-oropharyngeal (non-OP) HNSCC. “We also investigated other potential biomarkers and mutations that may predict improved response to ICB in both HPV-positive and -negative patients with HNSCC,” they added. Patients registered in the Caris Life Sciences CODEai database with non-OP HNSCC and OPSCC were recruited and identified by comprehensive molecular profiling to be positive or negative for p16. In total, 2905 HNSCC (OPSCC, n = 948) cases were identified. Of those tested for [...]

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