HPV Positive Status Increases Oropharyngeal Cancer Survival
Positive human papillomavirus (HPV) infection status is a predictor of improved survival chances in patients with oropharyngeal squamous cell carcinoma according to researchers in a newly released article in the the New England Journal of Medicine.
Maura Gillison, MD, PhD, of Ohio State University in Columbus, and colleagues conducted a retrospective analysis of the Radiation Therapy Oncology Group 0129, a randomized study testing accelerated-fractionation radiotherapy against standard-fractionation radiotherapy, each combined with cisplatin therapy, in patients with squamous-cell carcinoma of the head and neck. The researchers noted that over a median of 4.8 years of follow-up, the study found no significant differences in survival between the two types of radiation therapy.
The researchers further analyzed the data for this study, looking at the 60.1% of patients (433/721) who had oropharyngeal cancer. Oropharyngeal cancer is defined by the anatomical area which starts in the throat just behind the mouth.
Of those 433 patients, HPV status was available for 323 patients. Patients whose tumors were HPV-positive (206) were found to have increased three year survival rates – 82.4% compared with 57.1% in HPV-negative cancers.
After adjustment for age, race, tumor and nodal stage, tobacco exposure, and treatment assignment, those with HPV-positive tumors had a 58% reduction in the risk of death.
Tobacco smoking increased the risk of death by 1% for each additional pack-year smoked.
The researchers suggest future clinical trials of new treatments should be designed to stratify patients on the basis of HPV status. It needs to be determined if perhaps there are two distinct diseases which might require different treatment/preventive approaches.
Ang KK, et al "Human papillomavirus and survival of patients with oropharyngeal cancer" N Engl J Med 2010.
Lowy D, Munger K "Prognostic implications of HPV in oropharyngeal cancer" N Engl J Med 2010.