Low HPV infection rate led to decreased survival in blacks with SCCHN

Median OS was more than threefold higher in whites vs. blacks with the disease.

Compared with white patients with squamous cell carcinoma of the head and neck, black patients with the disease experienced worse OS. According to researchers, the discrepancy was caused by oropharyngeal cancer outcomes and low prevalence of HPV infection — which improved survival in squamous cell carcinoma — among blacks.

According to Scott Lippman, MD, professor in the department of clinical cancer prevention, The University of Texas M.D. Anderson Cancer Center, these data have serious public health implications. He said that these data and the information on HPV in general is the most important development in the field of head and neck cancer that he has seen in the last 30 years.

“This is the tip of the iceberg. This [study] will lead the way in other diseases related to infections,” he said during a press conference held by the American Association for Cancer Research.

In prior research, the researchers demonstrated a discrepancy in disease-free survival between white and black patients with squamous cell carcinoma of the head and neck who underwent chemoradiation; the greatest difference occurred in patients with oropharyngeal cancer. In addition, compared with HPV-negative patients, HPV-positive patients with oropharyngeal cancer have superior outcomes.

In this study, Kevin J. Cullen, MD, director, University of Maryland Cancer Center, and colleagues analyzed OS using a retrospective cohort and examined OS and HPV status using data from the phase-3, multicenter TAX 324 trial. TAX 324 studied induction chemotherapy followed by concurrent chemoradiation in patients with SCCHN.

In the retrospective cohort, median OS was 52.1 months for white patients (n=106) and 23.7 months for black patients (n=95; P=.009). The survival difference was due to OS in the subgroup of patients with oropharyngeal cancer (69.4 months for whites vs. 25.2 months for blacks; P=.0006). There was no significant difference in survival among races in patients with no oropharyngeal cancer (P=.58).

One hundred and ninety-six white patients and 28 black patients from the TAX 324 were available for HPV status assessment. Median OS was threefold higher among white patients than blacks (70.6 months vs. 20.9 months). In addition, there was a significant difference in OS among HPV-positive vs. HPV-negative patients with oropharyngeal cancer (P<.0001).

Overall, 34% of white patients and 4% of black patients were HPV-positive (P=.0004). There was no difference in survival among white and black patients who were HPV-negative (P=.56).

“The implication is that we need to analyze HPV in these patients upfront, and we need to incorporate that result in the treatment,” Cullen said during a press conference. “For patients who are HPV-positive, we know that they will do well with chemotherapy and radiation; patients who are HPV-negative are going to do significantly less well, and we need to think about newer treatments and whether surgery is feasible and appropriate for these patients. That will improve our outcome survival for black patients and for HPV-negative white patients.”

Settle K. Cancer Prev Res. 2009;doi:10.1158/1940-6207.CAPR-09-0149.

This kind of work — the way they attacked this problem, the elegant way they moved through the problem — actually helped define the scientific question in head and neck cancer in a much better way. [In addition, it] actually improves our ability to treat head and neck cancer, not just for blacks but also for whites and all human beings. We believe that the HPV differences are based on sociocultural differences 30, 40 or 50 years before people get head and neck cancer, but that’s not the major story. The major story is how they elegantly went through and defined each of these questions, and by doing that they changed how we’re going to be approaching people with head and neck cancer. We’re going to be assessing for HPV status as well as we’re going to be looking at HPV status in all the clinical trials going forward.

– Otis Brawley, MD

Chief Medical Officer, American Cancer Society