Short-Term Mortality Is Lower When Oropharynx Cancer Is HPV-Positive

By Will Boggs MD

January 14, 2020

NEW YORK (Reuters Health) - Short-term mortality among patients with oropharynx cancer (OPC) is lower when the cancer is positive for the human papillomavirus (HPV), a review of data finds.

Previous studies have shown an improved prognosis for patients with HPV-positive OPC, compared with those who have HPV-negative OPC, but most studies have not considered possible differences between these groups in the risks of competing mortality.

Dr. Danielle N. Margalit and colleagues from Harvard Medical School and Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, used a custom data set from the Surveillance, Epidemiology, and End Results (SEER) database to identify short-term causes of mortality among patients with OPC and to examine how these causes may differ according to HPV status.

HPV-positive patients had significantly lower two-year cumulative rates of all-cause mortality (10.4% versus 33.3% for HPV-negative patients), lower rates of head and neck cancer (HNC)-specific mortality (4.8% versus 16.3%, respectively), and lower rates of competing-cause mortality (5.6% versus 17.0%, respectively).

Second primary malignancies represented 63.5% of competing-cause mortality among HPV-negative patients but only 42.9% of competing-cause mortality among HPV-positive patients, according to the online report in Cancer.

In multivariable analyses, HPV-positive status was significantly associated with 55% lower risk of all-cause mortality, 59% lower risk of HNC-specific mortality, and 45% lower risk of competing-cause mortality.

Higher T classification, increasing age, single relationship status, and lack of treatment were associated with an increased risk of HNC-specific mortality.

Increasing age, black race, uninsured status, T4 disease, and an absence of cancer-directed treatment were associated with an increased risk of competing-mortality.

"Patients with HPV-positive and HPV-negative OPC have significantly different rates of both HNC mortality and competing mortality," the authors conclude. "HPV-negative patients are at substantial risk of competing mortality, even within 2 years of cancer diagnosis. These differences can inform power calculations for clinical trials and patient management in the acute and survivorship settings."

Dr. Robert L. Ferris from University of Pittsburgh School of Medicine and UPMC Hellman Cancer Center, who has researched various aspects of oropharyngeal cancer, told Reuters Health by email, "We have agreed as a field to separately enroll HPV-positive and HPV-negative patients on trials for >10 years, but just based on etiology, and now we have actual data for why they are two different diseases with different clinical courses and competing causes and time frames for mortality from disease, from treatment or from comorbidities."

"We should likely treat these two populations differently and individualize our surveillance and monitoring for recurrence and comorbidities after treatment," he said.

"We are just beginning to see trials emerge of HPV-positive specific populations and determining whether they need the same full course of surgery or radiation and/or chemotherapy (and now immunotherapy)," Dr. Ferris said. "These will guide how to treat the two diseases and also the impact on competing morbidity and mortality as this paper now quantifies."

Dr. Margalit did not respond to a request for comments.

SOURCE: Cancer, online January 13, 2020.