Cancer Fighters Thrive is a quarterly print and online magazine bringing readers practical, innovative and inspirational information about cancer treatment and survivorship.
Issue link: http://cancerfightersthrive.epubxp.com/i/259111
40 cancer fighters thrive | spring 2014 cf thrive. com infected with HPV when exposed, and not all patients who are infected with HPV get cancer. P16-positive cancers are caused by HPV, so we routinely test for HPV in oropharyngeal tumor speci- mens, and, if positive, we know there is direct causal relationship," she says. In fact, HPV16 has become a major fac- tor in head and neck cancer—specifcally in oropharyngeal cancers of the tonsils and the base of the tongue. According to the results of a study published in the Journal of Clinical Oncology, HPV was associated with about 16 percent of oro- pharyngeal cancers diagnosed during the 1980s and more than 70 percent of those diagnosed during the 2000s. 3 "This is something that is of major public health importance," explains Dr. Chong. "It is shooting head and neck cancer concerns way into the strato- sphere, and we are predicting an epidemic within the next 10 to 15 years." Characteristics of HPV-Related Head and Neck Cancer There are some key differences between HPV-related head and neck cancer and tobacco/alcohol–related head and neck cancer. For one, not all types of head and neck cancers are associated with HPV. In fact, HPV-related cancer is typically as- sociated with one type of head and neck cancer: oropharyngeal cancers of the tonsils and the base of the tongue. What's more, HPV-related head and neck cancer is typically diagnosed at a younger age—usually when patients are in their ffties, compared with heavy smokers or drinkers, who are more often diagnosed in their sixties. It is also more common in men than in women. But there is another key difference : better prognosis. "Patients who have HPV-related oropharyngeal cancer have an improved survival compared with those who have alcohol or smoking– related cancer," Dr. Yoo Bowne says. "If someone has HPV-related cancer and has never smoked, the cure rate is 80 to 90 percent; but if you look at the pa- tients who are heavy smokers or drinkers and don't have HPV, the cure rates are 30 to 40 percent," Dr. Chong explains. Individuals who are smokers and have HPV-associated cancer have an interme- diate prognosis with a 50 to 60 percent cure rate. Treatment The treatment for oropharyngeal cancer is the same, regardless of HPV status. Typically, these patients are treated with combined chemotherapy and intensi- ty-modulated radiation therapy. More- limited surgery, including robotic tech- niques, is in use at select medical centers. "HPV-associated tumors tend to re- spond signifcantly better to chemother- apy and radiation," Dr. Chong says. INNOVATION HPV VACCINATION There is no treatment for HPV, but there are two vaccines on the market approved by the U.S. Food and Drug Adminis- tration: Cervarix® (HPV2) prevents HPV16 and HPV18, and Gardasil® (HPV4) prevents HPV6, HPV11, HPV16 and HPV18. Both vaccines are administered as a three-dose series. Cervarix is licensed for use only in females, whereas Gardasil is licensed for use in both males and females. The HPV vaccine is considered a strong weapon in cancer prevention. It was originally developed as a way to prevent cervical cancer, but some researchers have speculated that the vaccine may also be efective at reducing the incidence of HPV-related head and neck cancer. Because head and neck cancer takes so long to develop, it will be difcult to determine the efects of the vaccine on it; however, if the suc- cess of the vaccine at preventing HPV and cervical cancer is any indication, it could be a powerful strategy in the fght against HPV-related head and neck cancer. Though the HPV vaccine was initially aimed at girls, it is now strongly recommended for 11- and 12-year-old girls and boys. In fact, in 2011 the Advisory Committee on Immunization Practices recommended routine use of the vaccine in young boys. 4 This could have important implications in head and neck cancer. "Of course, if we vaccinate only women, we won't see a huge efect in head and neck cancer incidence in men," Dr. Yoo Bowne says. Thus far compliance with the vaccine recommendations has been slow to take hold, but Dr. Chong hopes that education will change that. "This is a strong public health preventive recommendation by all those in the know in the legitimate medical community," he says. cftSp#23vky.indd 40 2/3/14 11:16 PM