From the Guidelines
The treatment approach for HPV-related oropharyngeal cancers typically involves a combination of surgery, radiation therapy, and chemotherapy, with treatment de-intensification strategies increasingly being considered, as recommended by the most recent guidelines from the Journal of Clinical Oncology 1. For early-stage disease (stages I-II), either transoral robotic surgery (TORS) or radiation therapy alone may be sufficient. For locally advanced disease (stages III-IV), the standard approach includes definitive chemoradiation with cisplatin (100 mg/m² every 3 weeks for 3 cycles) concurrent with intensity-modulated radiation therapy (IMRT) delivering 70 Gy to the primary tumor and involved nodes over 6-7 weeks. Alternatively, surgery followed by adjuvant radiation (60 Gy) with or without chemotherapy may be used based on pathological risk factors. Due to the better prognosis of HPV-positive cancers compared to HPV-negative ones, treatment de-intensification strategies are being explored to reduce long-term toxicities while maintaining efficacy. These include reduced radiation doses (from 70 Gy to 60 Gy), substitution of cisplatin with less toxic agents like cetuximab, or immunotherapy with pembrolizumab or nivolumab, as supported by recent studies 1. Post-treatment surveillance typically includes clinical examinations every 1-3 months for the first year, every 2-4 months for the second year, every 4-6 months for years 3-5, and annually thereafter, along with imaging studies as clinically indicated, in line with recommendations from the National Comprehensive Cancer Network 1. The favorable response of HPV-related oropharyngeal cancers to treatment is attributed to enhanced radiation sensitivity and stronger immune response against viral antigens expressed by tumor cells, as noted in recent guidelines from the European Society for Medical Oncology 1. Key considerations in the management of HPV-related oropharyngeal cancers also include the role of TORS, the importance of multidisciplinary team management, and the need for individualized treatment planning based on patient and tumor characteristics, as emphasized in recent studies 1.
Some key points to consider in the treatment of HPV-related oropharyngeal cancers include:
- The use of TORS as a surgical option for early-stage disease
- The role of adjuvant therapy in patients with close or positive surgical margins
- The importance of pathological risk factors in determining the need for adjuvant therapy
- The potential benefits of treatment de-intensification strategies in reducing long-term toxicities
- The need for ongoing surveillance and follow-up after treatment to monitor for recurrence and late effects, as recommended by recent guidelines 1.
Overall, the management of HPV-related oropharyngeal cancers requires a multidisciplinary approach, taking into account the latest evidence and guidelines, as well as individual patient and tumor characteristics, to optimize outcomes and minimize toxicity, as supported by recent studies 1.
From the Research
HPV Related Oropharyngeal Cancers
HPV related oropharyngeal cancers are a type of cancer that occurs in the oropharynx, which is the middle part of the throat, and is caused by the human papillomavirus (HPV).
Treatment Approaches
The treatment approach for HPV related oropharyngeal cancers typically involves a combination of surgery, radiation therapy, and chemotherapy.
- Surgery may be used to remove the tumor and affected lymph nodes.
- Radiation therapy may be used to kill cancer cells that remain after surgery.
- Chemotherapy may be used in conjunction with radiation therapy to enhance its effectiveness.
Adjuvant Radiotherapy
Adjuvant radiotherapy is a type of radiation therapy that is given after surgery to remove any remaining cancer cells.
- A study published in 2022 found that adjuvant radiotherapy is associated with improved survival in patients with HPV-positive oropharyngeal carcinoma who have adverse pathological features 2.
- The study found that patients who received adjuvant radiotherapy had a median 3-year overall survival rate of 92.0%, compared to 84.2% for those who did not receive adjuvant radiotherapy.
De-intensified Chemoradiotherapy
De-intensified chemoradiotherapy is a type of treatment that uses lower doses of chemotherapy and radiation therapy to reduce side effects.
- A study published in 2019 found that de-intensified chemoradiotherapy is effective in treating HPV-associated oropharyngeal cancer, with most patients experiencing early recovery of quality of life and continued improvement of symptoms beyond 1 year after treatment 3.
- Another study published in 2017 found that transoral robotic surgery (TORS) as a single modality treatment is a good option for cure in HPV-negative early resectable oropharyngeal malignancies, and can be used to de-intensify the treatment of early stage oropharyngeal carcinoma 4.
Systemic Therapies
Systemic therapies, such as chemotherapy, may be used concurrently with radiation therapy to treat HPV-related oropharyngeal cancers.
- A study published in 2016 found that platin-treated patients had greater hematologic toxicity, and required more intravenous hydration, while cetuximab-treated patients had a higher incidence of confluent mucositis 5.
- A study published in 2019 found that radiotherapy plus cisplatin is the standard of care for eligible patients with HPV-positive oropharyngeal carcinoma, and that radiotherapy plus cetuximab showed inferior overall survival and progression-free survival compared to radiotherapy plus cisplatin 6.