Even though long term use of alcohol and tobacco has been implicated as major risk factors for the development of head and neck cancers, it appears that oral HPV (Human Papilloma Virus) 16 accounts for 60% of oropharygeal cancers in the USA. The biology of HPV positive head and neck cancers is different in that it is often seen in younger individuals who do not smoke or drink and tends to originate in the orpharynx and frequently is poorly differentiated with a basaloid nonkeratinizing histopathology. These patients do better that those who are HPV negative.
In an RTOG study, HPV associated oropharynx head and neck cancers responded best to chemoradiation and several retrospective studies have demonstrated a 60% reduction in the risk of death from HPV positive head and neck cancers compared to patients with HPV negative head and neck cancers. Therefore analyzing the tumor for HPV 16 by FISH may be of value in predicting who will benefit best from chemoradiation. In fact ECOG has a study underway evaluating the optimal treatment intervention for HPV positive head and neck cancer patients with the goal of reducing treatment related morbidity but without compromising efficacy.
Armed with this information, we should be able to soon pursue a kinder and gentler approach when treating HPV positive patients with head and neck cancers.
