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Tobacco Use Linked to Worse Outcomes in HPV-Positive Head and Neck Cancer ANN ARBOR, Mich -- February 15, 2010 -- Patients with head and neck cancer linked to high risk human papillomavirus (HPV) have worse outcomes if they are current or former tobacco users, according to a study published in the February 15 issue of Clinical Cancer Research. The research suggests that current or former tobacco users may need a more aggressive treatment regimen than patients who have never used tobacco. Past research has shown that HPV-positive head and neck cancers tend to be more responsive to current treatments and these patients overall tend to have better outcomes than patients with HPV-negative tumours. However, the new study found that current tobacco users with HPV-positive tumours were 5 times more likely to have their cancer recur. Even former smokers had an increased risk of recurrence. “Because the effect of HPV is so strong in giving a very good prognostic picture, we were surprised to find that smoking remained a huge issue, and it actually affected the outcome in patients who smoked,” said senior author Thomas Carey, PhD, Head and Neck Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan. The study looked at 124 patients with advanced oropharyngeal cancer. Most of these patients had HPV DNA in their tumours, which is consistent with HPV being a major factor in oropharyngeal cancer development. All 22 of the HPV-negative patients were tobacco users, and about two-thirds of the 102 HPV-positive patients were current or former tobacco users. Of the HPV-positive patients who had never used tobacco, 6% had a recurrence of their cancer. Meanwhile, 19% of former tobacco users and 35% of current tobacco users had a recurrence. Still, the outcomes were better than the HPV-negative patients, all of whom were smokers, and among whom half recurred. Tobacco users have traditionally been more likely than non-users to develop head and neck cancers. But a recent rise in these cancers linked to HPV has meant more non-smokers are being diagnosed with the disease. HPV-positive head and neck cancers tend to be more responsive to chemotherapy and radiation, which has made researchers wonder if these highly toxic treatments could be reduced in this group of patients. “The side effects of these treatments affect critical functions such as eating and swallowing,” said Dr. Carey. “Since the HPV-positive tumours respond so well to treatment, our research team has been asking: Could we potentially spare patients some of these side effects while maintaining good outcomes if we reduce the doses given? If we decide to reduce intensity of treatment, our study shows we will want to take tobacco use into account. Any smoking or tobacco use increases the risk of recurrence or a second primary cancer.” SOURCE: University of Michigan Health System E-mail this page to a friend or colleague! To print, use this version