Radiotherapy plus ERBITUX® Inferior to Radiotherapy plus Cisplatin in HPV-Positive Oropharyngeal Squamous Cell Carcinoma

January 21st, 2019

The RTOG 1016 randomized, phase III trial has demonstrated that among  HPV-positive Oropharyngeal cancer patients, Radiotherapy plus ERBITUX® showed inferior Overall Survival and Progression Free Survival compared with Radiotherapy plus Cisplatin. Because of the substantial morbidity and lifelong toxicities such as dry mouth, difficulty swallowing, and loss of taste associated with Cisplatin chemotherapy and Radiotherapy, ERBITUX® (Cetuximab), an Epidermal Growth Factor Receptor (EGFR) targeted monoclonal antibody  is often considered an alternative to Cisplatin . Based on this first randomized clinical trial specifically designed for patients with HPV-positive Oropharyngeal cancer, Radiotherapy plus Cisplatin should be the standard of care for eligible patients with HPV-positive Oropharyngeal carcinoma.

Guideline for Human Papilloma Virus Testing in Head and Neck Carcinomas

February 9th, 2018

The Centers for Disease Control and Prevention estimates that in the US, there are more than 16,000 cases of Human PapillomaVirus (HPV)-positive OroPharyngeal Squamous Cell Carcinoma (OPSCC) per year and there has been a significant increase in incidence during the past several decades. Expression of tumor suppressor protein, known as p16, is highly correlated with infection with HPV in HNSCC. Accurate HPV assessment in head and neck cancers is becoming important as it significantly impacts clinical management. The College of American Pathologists convened a panel of experts and following review of evidence from over 400 peer reviewed articles, came up with the Guideline. This can be reviewed at  This guideline is recommended for all new Oropharyngeal Squamous cell carcinoma patients, but not routinely recommended for other head and neck carcinomas.

Oncoprescribe Blog: Personalized Therapy based on HPV status in patients with Head and Neck Cancer

November 16th, 2010

Even though long term use of alcohol and tobacco has been implicated as major risk factors for the development of head and neck cancers, it appears that oral HPV (Human Papilloma Virus) 16 accounts for 60% of oropharygeal cancers in the USA. The biology of HPV positive head and neck cancers is different in that it is often seen in younger individuals who do not smoke or drink and tends to originate in the orpharynx and frequently is poorly differentiated with a basaloid nonkeratinizing histopathology. These patients do better that those who are HPV negative.

In an RTOG study, HPV associated oropharynx head and neck cancers responded best to chemoradiation and several retrospective studies have demonstrated a 60% reduction in the risk of death from HPV positive head and neck cancers compared to patients with HPV negative head and neck cancers. Therefore analyzing the tumor for HPV 16 by FISH may be of value in predicting who will benefit best from chemoradiation. In fact ECOG has a study underway evaluating the optimal treatment intervention for HPV positive head and neck cancer patients with the goal of reducing treatment related morbidity but without compromising efficacy.

Armed with this information, we should be able to soon pursue a kinder and gentler approach when treating HPV positive patients with head and neck cancers.