What is the best treatment for patients with human papillomavirus–positive and –negative oropharyngeal cancer?

Authors

  • Damien Urban MBBS, BMedSc,

    1. Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
    2. Head and Neck Service, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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  • June Corry MBBS, FRACR,

    1. Head and Neck Service, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
    2. Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
    3. Department of Radiation Oncology, University of Melbourne, Melbourne, Victoria, Australia
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  • Danny Rischin MBBS, MD, FRACP

    Corresponding author
    1. Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
    2. Head and Neck Service, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
    3. Department of Radiation Oncology, University of Melbourne, Melbourne, Victoria, Australia
    • Corresponding author: Danny Rischin, MBBS, MD, FRACP, Head and Neck Service, Department of Medical Oncology, Peter MacCallum Cancer Centre, St. Andrew's Pl, East Melbourne, Victoria 3002 Australia; Fax: (011) + 61 3 9656 1408; danny.rischin@petermac.org

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Abstract

The discovery that the human papilloma virus (HPV) is associated with a high and increasing percentage of oropharyngeal squamous cell carcinomas (SCCs) is among the most significant advances in the field of head and neck oncology. HPV-positive oropharyngeal cancer (HPVOPC) has clinical, etiologic, pathologic, and molecular features that distinguish it from HPV-negative disease. Increasingly, HPVOPC is being diagnosed in clinical practice because of the easy availability of p16 immunohistochemistry, a surrogate marker of HPV. The superior prognosis of HPVOPC has led to a reexamination of treatment approaches, and clinical trials are currently investigating strategies to deintensify treatment to reduce acute and late toxicity while preserving efficacy. This is of particular interest in low-risk patients. Unfortunately, patients with HPV-negative tumors still have high rates of locoregional failure and more efficacious treatments are required. This review of oropharyngeal SCC focuses on current and investigational treatment strategies in patients with both HPV-positive and HPV-negative oropharyngeal SCC. Cancer 2014;120:1462–1470. © 2014 American Cancer Society.

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