Top Takeaways from ASCO: HCV, head and neck cancers

Patients with hepatitis C virus seropositivity may be at increased risk for cancers outside the liver. This includes head and neck cancers, with the strongest association observed between patients with oropharyngeal cancers that tested positive for human papillomavirus.

Although the strength of this association appeared as strong as that with non-Hodgkin’s lymphomas, further investigation is needed to examine these findings, as well as a possible interaction between HPV and HCV infections.

“There is increasing epidemiological and clinical evidence that HCV infection does not stay limited to the liver, but also leads to several extrahepatic manifestations and non-liver cancers such as B-cell non-Hodgkin’s lymphomas,” Parag Mahale, MBBS, MPH, of the department of infectious diseases, infection control and employee health at The University of Texas MD Anderson Cancer Center, told Healio.com. “Few studies with small sample sizes had found association of HCV with cancers of oral cavity.”

Parag Mahale

Methods of study

Mahale, along with Harrys A. Torres, MD, FACP, FIDSA, associate professor, founder and director of the Hepatitis C Clinic at MD Anderson, and colleagues explored this association further in medical records of 34,545 patients tested for HCV antibodies from June 2004 to May 2014.

At the clinic, established in 2009 as a facility dedicated to treating patients with cancer who were also infected with HCV, a high rate of patients with head and neck cancers had been observed.

The researchers looked at cases of first primary oropharyngeal cancers and non-oropharyngeal cancers in the oral cavity, nasopharynx, hypopharynx and larynx; those with lymphomas of the oropharyngeal or non-oropharyngeal regions were not considered. Patients with smoking-related lung, esophagus and urinary bladder cancers served as controls.

The investigators analyzed biopsy reports of patients with oropharyngeal cancers tested for HPV through in-situ hybridization and constructed multivariable logistic regression models to test the association.

Overall, 164 patients (40%) with oropharyngeal cancers, 245 patients (60%) with non-oropharyngeal cancers and 694 controls — including 378 patients (55%) with lung cancer; 168 patients (24%) with esophagus cancer and 148 patients (21%) with urinary bladder cancer were analyzed.

Compared with controls, patients with oropharyngeal cancers were more often men (82% vs. 68%, P = .001), received their cancer diagnoses at a younger age (median, 59 years vs. 63 years; P < .0001), were better educated (≥ bachelor’s degree, 57% vs. 38%; P < .0001), smoked fewer cigarettes (median pack-years, 24 vs. 36; P = .0001) and consumed more alcohol (drinks/week > 28, 23% vs. 13%; P = .002).

Patients with non-oropharyngeal cancers were also more often men (77% vs. 68%, P = .01), received their cancer diagnoses at a younger age (median, 59 years vs. 63 years; P < .0001), smoked fewer cigarettes (median pack-years, 30 vs. 36; P = .2), consumed more alcohol (more than 28 drinks/week, 29% vs. 13%; P = .002) and were more frequently co-infected with HIV (4% vs. 1%, P = .05) than controls.

Associations identified

Multivariable logistic regression models demonstrated an association between HCV seropositivity and oropharyngeal cancers (OR = 2.1; 95% CI, 1.1-4.2) and non-oropharyngeal cancers (OR = 2.8; 95% CI, 1.4-5.7). However, among oropharyngeal cancers, HCV seropositivity was significantly associated with only those cancers that were positive for HPV (OR = 4.4; 95% CI, 1.9-10.5).

“[We] found moderate associations of the infection with non-oropharyngeal and HPV-positive oropharyngeal cancers after controlling for confounders such as smoking and alcohol intake,” Mahale said. “This is an indicator that HCV may be associated with other non-liver cancers, which needs to be explored.” – by Allegra Tiver

For more information: Mahale P, et al. Abstract 6041. Presented at: ASCO Annual Meeting. May 29-June 2, 2015; Chicago.

Disclosures: Mahale reports no relevant financial disclosures. Torres reports multiple financial relationships in consulting and research with Genentech, Gilead Sciences, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., and Vertex Pharmaceuticals.