HPV linked to better survival in tonsil, tongue cancer, U-M study finds

Participants whose cancer did not respond to the chemotherapy and radiation went on to receive surgery. The researchers found that even with surgery, only 4 of 11 patients survived.

“For most patients, the chemoradiation was very effective. But a subset of patients still do not do well. Our next step was to look at the biomarkers to see if we could determine which patients were responding to treatment, based on the tumor biology,” says Carey, who is also associate chair and professor of otolaryngology and pharmacology at the U-M Medical School.

By looking biopsies taken before treatment, the researchers found 64 percent of the tumors were positive for high-risk strains of HPV. Almost all of the HPV-positive tumors responded to initial chemotherapy and 78 percent of those patients survived with their organs preserved. Of the HPV-negative study participants, only four of 15 survived. In addition, the researchers found that patients whose tumor expressed a marker called EGFR had worse outcomes.

“The combination of markers was an important indicator. Patients whose tumors expressed high levels of EGFR did poorly. But those who had high EGFR and were also HPV-positive had some protection. Patients with high EGFR and low HPV fared the worst. This is a step in the direction of affecting future treatment,” says Bhavna Kumar, a research laboratory specialist who was the lead author on both papers.

The researchers also found that tumors with low expression of a protein called p53, combined with high expression of another protein, BCLXL, also had poor outcomes. These markers provide additional targets for potential new therapies.

About 35,300 Americans will be diagnosed with head and neck cancer this year, according to the American Cancer Society. For information about head and neck cancer treatment, visit www.mcancer.org or call the U-M Cancer AnswerLine at 800-865-1125.

Additional study authors were Julia S. Lee, Gregory T. Wolf, Kitrina G. Cordell, Jeremy M.G. Taylor, Susan G. Urba, Avraham Eisbruch, Theodoros N. Teknos, Douglas B. Chepeha, Mark E. Prince, Christina I. Tsien, Nisha J. D’Silva, Carol R. Bradford, Huong H. Tran, Kun Yang, David M. Kurnit, Joshua A. Bauer, Nancy Wallace, Tamara Miller, and Heidi Mason.

Funding for the studies was from the National Institutes of Health, a U-M Specialized Program of Research Excellence (SPORE) grant in head and neck cancer, the U-M Comprehensive Cancer Center, and the State of Michigan.

References:

Chemoselection as a Strategy for Organ Preservation in Advanced Oropharynx Cancer: Response and Survival Positively Associated with HPV16 Copy Number, Worden et al, Journal of Clinical Oncology, online publication May 12, 2008

EGFR, p16, HPV Titer, BCLXL and p53, Gender and Smoking as Indicators of Response to Therapy and Survival in Oropharyngeal Cancer, Kumar et al, Journal of Clinical Oncology, online publication May 12, 2008

Editors: High-resolution images are available on request