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| |  Presence of HPV in Tumour is the Best Predictor of Oropharyngeal Cancer Survival COLUMBUS, Ohio -- June 11, 2010 -- The presence of human papilloma virus (HPV) in tumours is the most important predictor of survival for people diagnosed with oropharyngeal cancer, according to a study published online in the New England Journal of Medicine. This is the first study large enough to show that the presence of HPV tumours accounts for better response to therapy, rather than other favourable factors that may be present, such as young age and small tumours. The second leading predictor of survival is lifetime smoking history, followed by cancer stage. The findings suggest that the HPV status of a patient's tumour and their smoking history may be used in the future, in addition to cancer stage, to determine the aggressiveness of a patient's therapy. "Previous studies indicated a relationship exited between the presence or absence of HPV in oropharyngeal tumours and patient survival, but they couldn't determine if other favourable factors present in these patients were responsible for their better outcome," said lead author Maura Gillison, MD, Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James), Columbus, Ohio. "These findings close the door on these questions and will allow the field to move forward with clinical trials designed to determine how we should use molecular and behavioural factors to personalise therapy for patients." Dr. Gillison emphasised that there is insufficient data at this time to indicate how a specific patient's cancer therapy should be tailored based on these factors. For the study, Dr. Gillison and colleagues analysed the tumours and outcomes of 323 patients with stage III or IV oropharyngeal cancer who were part of a Radiation Therapy Oncology Group clinical trial. Of these patients, 206 had HPV-positive tumours and 117 had HPV-negative tumours. At 3 years after treatment, 82% of patients with HPV-positive tumours were still alive, compared with 57% of patients with HPV-negative tumours. Rates of cancer relapse at 3 years for the groups were 43% and 74%, respectively. The investigators determined that HPV presence in tumours accounted for most of the difference in therapy response and survival between patients with HPV-positive and HPV-negative tumours, while factors such as younger age, white race, better energy level, absence of anaemia and smaller tumours were responsible for only about 10% of the difference. Smoking history emerged as the second most important independent predictor of survival and cancer relapse for patients with oropharyngeal cancer. The risk of cancer relapse or death increased by 1% for each additional pack year of tobacco smoking. The investigators found that at 3 years, about 93% of patients with HPV-positive tumours who were never- or light-smokers were alive, as compared with about 70% of patients with HPV-positive tumours who were smokers and about 46% of patients with HPV-negative tumours who were smokers. "The 2 risk factors that place an individual at risk for oropharyngeal cancer are also the most important factors determining patient survival," said Dr. Gillison. "This is probably because these factors determine the genetic profile of these cancers and how they respond to treatment." SOURCE: Ohio State University Medical Center
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