HPV-related oropharyngeal cancer treatment review with special reference to less aggressive therapy

Abstract

Recognition of the characteristic and the prognostic value of HPV (human papillomavirus) infection in oropharyngeal cancer is one of the greatest successes of head and neck oncology during recent years. Histoclinical and molecular appearance of HPV-related tumours are different as compared to typical squamous cell head and neck cancers. HPV-related oropharyngeal cancer often occurs in younger groups of patients with relatively high socioeconomic status. Performance status is usually excellent or good. HPV-related cancers are more sensitive for radiotherapy and chemotherapy. Finally, outcome in HPV-related oropharyngeal cancer is significantly better in comparison to typical head and neck cancers. This has been confirmed in many clinical analyses. HPV-positive status was connected with 2.5–4 times reduced risk of death. This fact supports investigations of the less aggressive treatment options which would be less toxic and similarly effective as compared to standard radiotherapy or concomitant chemoradiotherapy. Review of the concepts and the most important clinical trials dedicated to treatment de-escalation in HPV-related oropharyngeal cancer was made. All are in progress and currently there is not sufficient data to recommend any less toxic regimen for routine clinical practice. It’s very important to remember that better prognosis does not necessarily mean satisfactory outcome of less aggressive regimens. Results of well planned, prospective, randomised trials, like RTOG 1016, are needed to establish the optimal treatment for HPV-related oropharyngeal cancer.