De-escalation studies in HPV-positive oropharyngeal cancer: How should we proceed?

Pawel Golusinski; June Corry; Vincent Vander Poorten; Ricard Simo; Elisabeth Sjögren; Antti Mäkitie; Luis Paulo Kowalski; Johannes Langendijk; Boudewijn J M Braakhuis; Robert P Takes; Andrés Coca-Pelaz; Juan P Rodrigo; Stefan M Willems; Arlene A Forastiere; Remco De Bree; Nabil F Saba; Yong Teng; Alvaro Sanabria; Pasquale Di Maio; Mateusz Szewczyk; Alfio Ferlito

doi:10.1016/j.oraloncology.2021.105620

De-escalation studies in HPV-positive oropharyngeal cancer: How should we proceed?

Oral Oncol. 2021 Dec:123:105620. doi: 10.1016/j.oraloncology.2021.105620. Epub 2021 Nov 17.

Authors

Pawel Golusinski¹, June Corry², Vincent Vander Poorten³, Ricard Simo⁴, Elisabeth Sjögren⁵, Antti Mäkitie⁶, Luis Paulo Kowalski⁷, Johannes Langendijk⁸, Boudewijn J M Braakhuis⁹, Robert P Takes¹⁰, Andrés Coca-Pelaz¹¹, Juan P Rodrigo¹², Stefan M Willems¹³, Arlene A Forastiere¹⁴, Remco De Bree¹⁵, Nabil F Saba¹⁶, Yong Teng¹⁷, Alvaro Sanabria¹⁸, Pasquale Di Maio¹⁹, Mateusz Szewczyk²⁰, Alfio Ferlito²¹

Affiliations

¹ Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora; Department of Maxillofacial Surgery Poznan University of Medical Sciences, Poland. Electronic address: [email protected].
² Department Radiation Oncology, GenesisCare St Vincent's Hospital, Melbourne, Australia.
³ Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
⁴ Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK.
⁵ Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands.
⁶ Department of Otorhinolaryngology - Head and Neck Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Finland; Division of Ear, Nose, Finland.
⁷ Head and Neck Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil.
⁸ Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁹ International Head and Neck Scientific Group, Italy.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
¹¹ Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
¹² Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.
¹³ Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁴ Department of Oncology, Johns Hopkins University, Baltimore, MD, USA.
¹⁵ Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁶ Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
¹⁷ Department of Hematology and Medical Oncology Emory University School of Medicine; Winship Cancer Institute of Emory University, Georgia.
¹⁸ Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, San Remo, Italy.
²⁰ Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland.
²¹ Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

PMID: 34798575
DOI: 10.1016/j.oraloncology.2021.105620

Abstract

Human papilloma virus (HPV) is a well-established causative factor in a subset of squamous cell carcinomas of the head and neck (HNSCC). Although HPV can be detected in various anatomical subsites, HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) is the most common HPV-related malignancy of the head and neck, and its worldwide incidence is constantly rising. Patients with OPSCC are generally younger, have less co-morbidities and generally have better prognosis due to different biological mechanisms of carcinogenesis. These facts have generated hypotheses on potential treatment modifications, aiming to minimize treatment-related toxicities without compromising therapy efficacy. Numerous randomized clinical trials have been designed to verify this strategy and increasingly real-world evidence data from retrospective, observational studies is becoming available. Until now, the data do not support any modification in contemporary treatment protocols. In this narrative review, we outline recent data provided by both randomized controlled trials and real-world evidence of HPV-positive OPSCC in terms of clinical value. We critically analyze the potential value and drawbacks of the available data and highlight future research directions. This article was written by members and invitees of the International Head and Neck Scientific Group.(www.IHNSG.com).

Publication types

Review

MeSH terms

Carcinoma, Squamous Cell* / diagnosis
Carcinoma, Squamous Cell* / virology
Head and Neck Neoplasms
Humans
Oropharyngeal Neoplasms* / diagnosis
Oropharyngeal Neoplasms* / virology
Papillomaviridae
Papillomavirus Infections* / complications
Papillomavirus Infections* / diagnosis
Retrospective Studies