Tobacco Plays Important Role in Modulating HPV+OPSCC Clinical Outcomes

What is the biological and epidemiological interplay between tobacco and human papillomavirus (HPV) exposure in the context of oropharyngeal squamous cell carcinoma (OPSCC)?

Bottom Line: The interaction between tobacco exposure and HPV infection in the context of OPSCC has significant implications for both standard of care treatment regimens and development of novel therapeutic approaches, in particular those which incorporate immunomodulatory agents.

Background: Oropharyngeal squamous cell carcinoma (OPSCC) incidence is rapidly increasing in the United States and around the world, driven in large part by infection with the human papillomavirus (HPV). HPV-associated OPSCC (HPV+OPSCC) has been shown to have improved response to treatment relative to tobacco-associated OPSCC. However, improvement in patient survival has not been uniform. Subsets of OPSCC patients in the US and around the world continue to have poor oncologic outcomes. Although the drivers of this phenomenon remain unclear, there is increasing evidence that tobacco exposure plays an important role in modulating HPV+OPSCC clinical outcomes.

Study design: Literature review.

Synopsis: The authors discussed the potential biological and epidemiological interplay between tobacco and HPV exposure in the context of OPSCC. Multiple retrospective and prospective cohorts show that HPV+OPSCC patients with a history of tobacco exposure have response to treatment and clinical outcomes distinct from HPV+OPSCC non-smokers, which poses clinical and scientific challenges to be addressed over the next decade.

Citation: Sandulache VC, Wilde DC, Sturgis EM, Chiao EY, Sikora AG. A hidden epidemic of “intermediate risk” oropharynx cancer. Laryngoscope Investig Otolaryngol. Published October 17, 2019. doi: 10.1002/lio2.316.