COSM14: HPV Status and Prognosis for Oropharyngeal Cancers

Published work has stratified the risk of death of oropharyngeal cancers by HPV status and the amount of smoking by patients, with HPV-negative patients who have 10 or more pack years having the worst risk. HPV-positive patients can be stratified into low- and high-risk groups through the combined use of both pack years and nodal status (N Engl J Med. 2010:363:24-35).

Dr. Rocco then discussed biomarkers that can go beyond nodal status and smoking history as poor prognostic markers in HPV-positive oropharyngeal cancer. Based on his prior work demonstrating that high expression of the anti-apoptotic BCL-2 protein is related to worse outcome, he presented the clinical application of these findings as part of an ongoing prospective study at the Massachusetts Eye and Ear Infirmary (MEEI) and the MGH Cancer Center to assess how “full” the BCL-2 tank is (Clin Cancer Res. 2010;16:2138-2146).

The technique, known as BH3 profiling, involves single-cell suspensions and adding peptides that mimic all the anti-cell death and pro-cell death molecules in the cell to predict the patient’s response at the time of primary tumor biopsy. The result is an assessment of a patient’s tumor cells’ propensity toward apoptosis in response to cytotoxic therapy like chemoradiation. It also lays the groundwork for future clinical trials of BCL-2 inhibitors. Prospective trials are now underway to see how well this knowledge can be used to ascertain the best treatment course in patients.

Dr. Rocco also described how multiple subpopulations of cancer cells within a tumor also can lead to resistance to treatment: The fewer the number of subpopulations of alleles, the lower probability of resistance to treatment; the more subpopulations, the higher the likelihood of resistance. Researchers in Dr. Rocco’s lab developed a way, called mutant-allele tumor heterogeneity (MATH), to measure this intratumor heterogeneity, and showed that high tumor heterogeneity predicts a worse outcome in head and neck cancer (Cancer. 2013;119:3034-3042). Prospective studies are now underway at MEEI and the MGH Cancer Center to see how well this knowledge can be used to ascertain the best treatment course in patients.

Treatment for Adults

Michael M. Johns III, MD, associate professor of otolaryngology-head and neck surgery at Emory University School of Medicine and director of the Emory Voice Center in Atlanta, highlighted the differences between adult and pediatric RRP. In adults, it usually presents as a voice problem and typically has a much slower growth rate than in children.

Treatment has shifted toward awake procedures, prompted largely by growing use of the fiber-based KTP laser. The treatment goals should be to preserve the voice, prolong the time between treatments, and avoid using general anesthesia, he said.