Treatment Paradigms in HPV-Associated SCCHN

Abstract

The primary risk factor for development of HPV-related (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is oral HPV infection, most frequently by HPV type 16. The most clinically relevant features of HPV+ disease is the significantly increased incidence worldwide, improved response to chemotherapy and radiation and overall prognosis, as well as distinct patterns of failure in comparison to their HPVnegative brethren. As a result, the AJCC Cancer Staging Manual 8th edition has introduced significant changes from the seventh edition, recognizing the prognostic power of newly validated pathologic features of some primary tumors and of cervical lymph node metastases and differentiating high-risk human papilloma virus (HR-HPV)-associated oropharyngeal cancer from OPSCC with other causes. In addition, considerable thought has been directed toward reevaluating historic treatment paradigms. Recent efforts pursue treatment deintensification to reduce long-term toxicities in this relatively younger patient cohort. This also includes minimally invasive surgery techniques and the substitution or elimination of standard cytotoxic chemotherapy with biologic agents and immunotherapies. Overall, HPV-related cancers are now recognized as a distinct entity. This has resulted in a reexamination of the core principles of head and neck cancer treatment developed decades ago, with the goals of obtaining high cure rates simultaneously with meanigful reductions in long-term toxicity and improved quality of life.