HIV and Oral Health: New Strategies for Treatment of HPV-Positive Oropharyngeal Cancer
By: Mark Schweizer, DDS MPH
Director of Development and Special Projects
Dental Director Southeastern AIDS Training and Education Center
Nova Southeastern University College of Dental Medicine
[email protected]
The human papillomaviruses (HPVs) have been linked with a growing number of epithelial-derived tumors, including head and neck squamous cell carcinomas. HPV demonstrates a particular predilection for causing tumors of the oropharynx, with the majority of cases involving infection with high-oncogenic risk HPV-16. People living with HIV are at increased risk of infection with HPV- and HPV-related oral complications even with adequate control of their HIV infection with antiretroviral therapy.
A dual strategy of deintensified treatment for human papillomavirus (HPV)-positive oropharyngeal cancer led to 2-year locoregional control and overall survival (OS) of 95%, results of a prospective study showed.
Progression-free survival (PFS) at 2 years was 86%, and 91% of the 114 patients remained free of distant metastases. No grade ≥3 late adverse events occurred, and global quality of life improved from pretreatment to 2 years.
Incorporating a lower dose of cisplatin and lower total radiation dose, the protocol achieved encouraging results without neoadjuvant chemotherapy or routine surgery, according to coauthors at the University of North Carolina (UNC) at Chapel Hill in the Journal of Clinical Oncology.
“The data reported herein support the approach of deintensified CRT (chemo radiotherapy) without the need of neoadjuvant chemotherapy,” the authors stated. “Future studies of the neoadjuvant chemotherapy and transoral surgery approach should attempt more radical reduction in RT dose to further reduce toxicity and improve QoL (quality of life).”
The study added valuable information to ongoing discussion and clinical evaluation of strategies to use less aggressive treatment for HPV-positive oropharyngeal cancer, which has a more favorable prognosis, as compared with HPV-negative disease.
