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Outcomes Better for HPV-Positive Cancer Patients

Patients with head and neck cancers who test positive for human papillomavirus (HPV) have better survival rates than those who test negative for HPV, according to study results that will be presented Wednesday during Scientific Oral Presentations-General Head and Neck Surgery.

The presentation of the study will take place from 8:36 am-8:41 am Wednesday in Room C141 of the convention center.

“We showed that if we just looked at HPV-positive patients versus HPV-negative patients, without adjusting for any other factors, the patients with HPV-positive disease had better survival at three years,” said Aaron J. Feinstein, MD, MHS. Dr. Feinstein is the lead author of “Treatment Modality and Outcome in HPV+ Head and Neck Cancer in Veterans.”

The traditional patient with head and neck cancer has risk factors such as smoking, alcohol use, and older age. However, more patients with head and neck cancers do not have the same factors, but do tend to have HPV-related cancers, mostly oropharyngeal tumors, said Dr. Feinstein, a resident at the University of California, Los Angeles, Department of Head and Neck Surgery.

“We are trying to understand what the interplay is between these traditional and newer risk factors,” he said, adding that the study looked at 209 patients treated at a Los Angeles Veterans Affairs hospital from 2010 to 2014. “We wanted to find out if the way we are treating them is appropriate or if we could do different things to improve treatment.

“We looked at whether their pathology had been tested for HPV or p16, which is a surrogate marker for the HPV infection. Then, we made some comparisons. We looked at all patients and patients who were HPV-positive versus HPV-negative, and we also compared different treatment modalities, which we categorized as surgery, radiation alone, or chemotherapy plus radiation therapy.”

While there were differences between the two groups, there also were several similarities. The HPV-positive group had more Caucasian patients while the HPV-negative group had more African-Americans and non-Caucasians. Smoking, alcohol use, and age were similar in both groups.

Chemoradiation was the most common treatment, but in the end, the treatment did not affect outcomes, Dr. Feinstein said.

“When we accounted for different stages of disease, the key classifications—how big the tumor is, whether they had disease of the neck, whether they had metastatic disease, their age, and whether they are HPV-positive—all of those factors played a role in how likely the patients were to survive. But the kind of treatment they received had no effect. All of the numbers we looked at for chemoradiation versus radiation versus surgery were not statistically different.”

Outcomes were also affected by whether a patient was HPV-positive versus HPV-negative, Dr. Feinstein said.

“Over half of them were HPV-positive, and they did better at three years than HPV-negative patients, but the treatment modality did not seem to be related to how well they were doing,” he said.