HPV as a Carcinomic Driver in Head and Neck Cancer: a De-escalated Future?

• Published in: Current treatment options in oncology Vol. 23; no. 3; pp. 325 - 332
• Main Authors: Bates, James E., Steuer, Conor E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2022; Springer Nature B.V
• Subjects: Carcinoma, Squamous Cell - etiology; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemotherapy; Head & neck cancer; Head and Neck Cancer (PL Swiecicki; Head and neck carcinoma; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - etiology; Head and Neck Neoplasms - therapy; Human papillomavirus; Humans; Immunotherapy; Medicine; Medicine & Public Health; Oncology; Oropharyngeal Neoplasms - diagnosis; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - therapy; Oropharynx; Papillomavirus Infections; Patients; Radiation; Radiation therapy; Risk factors; Robotic surgery; Section Editor; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck - therapy; Throat cancer; Topical Collection on Head and Neck Cancer; Toxicity; Tumors; Oropharynx cancer; Head and neck cancer; Human papillomavirus; Radiation therapy; Immunotherapy; Transoral robotic surgery
• ISSN: 1527-2729; 1534-6277; 1534-5277
• DOI: 10.1007/s11864-022-00950-8

Opinion statement Patients with HPV-associated oropharyngeal squamous cell carcinoma have improved prognosis relatively to those with tumors not driven by HPV. Both definitive radiotherapy (typically with concurrent chemotherapy) and transoral robotic surgery (with adjuvant therapies based on pathologic risk factors) are both acceptable treatment options for patients. The decision on which treatment is optimal depends on individual patient factors and should be made in a multi-disciplinary setting with input from a radiation oncologist, head and neck surgeon, and medical oncologist. Where appropriate, patients in this setting should be considered for enrollment on clinical studies evaluating de-escalation of treatment intensity given the very favorable outcomes and high toxicity profile associated with conventional therapies. However, caution is needed given negative data for de-escalation in the definitive chemotherapy and radiation setting. It remains unclear what the prognostic significance of HPV status is in patients with squamous cell carcinomas of the head and neck outside of the oropharynx.