HPV, HCV Should Guide Cancer Patient Prognosis, Treatment

Human papillomavirus and hepatitis C virus infection should be considered during clinical trials of head and neck squamous cell carcinoma and non-Hodgkin’s B-cell lymphoma, respectively

medwireNews: The role of viral infection in the prognosis of cancer patients has been highlighted in two separate studies of patients with Squamous cell carcinoma of the head and neck (SCCHN) and indolent non-Hodgkin’s B-cell lymphoma (NHL).

The first of the two reports, both published in Annals of Oncology, indicates that SCCHN patients whose tumours test positive for human papillomavirus (HPV) have significantly better outcomes than those without the infection.

Results from two clinical trials showed that patients testing positive for HPV using in situ Hybridisation (ISH) with a wide spectrum probe had a significantly better objective response rate than their HPV-negative counterparts (55 vs 19%), as did patients testing positive for p16 - a marker for active HPV infection – using Immunohistochemistry (50 vs 19%).

This translated into better overall survival for HPV-positive than negative patients (median 12.9 vs 6.7 months) and p16-positive versus negative patients (median 11.9 vs 6.7 months), giving hazard ratios for overall survival in favour of HPV and p16 infection of 2.69 and 2.17, respectively.

“Given the epidemic of HPV-positive SCCHN, it is likely that upcoming studies for recurrent/metastatic disease will have increasing numbers of HPV-positive patients, possibly from oropharynx and non-oropharynx primary sites”, observe Athanassios Argiris, from the University of Texas Health Science Center at San Antonio, USA, and co-workers.

They emphasise the importance of stratifying future trial participants by HPV status. “Head and neck cancers which arise because of HPV infection have distinct biology and natural history, possibly opening up the possibility of different therapeutic approaches in the future”, the team concludes.

The second study, by Luca Arcaini, from Fondazione IRCCS Policlinico San Matteo in Pavia, Italy, and co-authors, suggests that patients with NHL testing positive for hepatitis C virus (HCV) infection may benefit from antiviral therapy.

Of 100 indolent NHL patients with HCV infection given first-line antiviral therapy, consisting of interferon or PEG-interferon, 44% achieved a complete response and 33% a partial response, lasting for a median of 33 months. Tumour response was significantly predicted by complete HCV–RNA clearance.

Moreover, 5-year rates of both overall and progression-free survival were significantly higher for patients given first-line antiviral therapy than for 604 patients who were treated with chemotherapy, radiotherapy or other first-line options, at 92% versus 75% and 63% versus 45%, respectively.

Thirty-four patients received second-line antiviral therapy, 56% of whom achieved a complete response and 29% a partial response. The 5-year progression-free survival rate for these patients was 63%.

“[T]his strategy could be considered the first-line option for patients with indolent lymphomas who do not need for immediate conventional treatment”, the researchers comment.

“The observation that [antiviral therapy] used at any time during the patients' life is associated with improved [overall survival] enforces such a therapeutic opportunity and suggests a relevant advantage of [antiviral therapy] in this setting beyond the objective detection of lymphoma regression.”


Argiris A, Li S, Ghebremichael M, et al. Prognostic significance of human papillomavirus in recurrent or metastatic head and neck cancer: an analysis of Eastern Cooperative Oncology Group trials. Ann Oncol 2014;  Advance Access 5 May. doi: 10.1093/annonc/mdu167

Arcaini L, Vallisa D, Rattotti S, et al. Antiviral treatment in patients with indolent B-cell lymphomas associated with HCV infection: a study of the Fondazione Italiana Linfomi.  Ann Oncol 2014; Advanced Access 5 May. doi: 10.1093/annonc/mdu166 

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