Why diagnostics for head and neck cancer needs to change 

Why diagnostics for head and neck cancer needs to change
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Researchers say patients who have head and neck cancer caused by the human papillomavirus (HPV) should be tested twice to ensure the best treatment outcomes. 

A large-scale, international study, titled ‘Prognostic implications of p16 and HPV discordance in oropharyngeal cancer,’ from 13 head and neck cancer centres across nine countries has been published in The Lancet Oncology. The trial of 7,895 patients found a significant number of people with ‘discordant’ results, in which the two tests for HPV showed different results.  

The findings revealed that one in ten patients who had discordant HPV results had significantly worse outcomes compared to those who tested negative in both tests. 

Current diagnostic methods for head and neck cancer

Two forms of testing are required to determine if cancer was caused by HPV. The first of these is HPV testing, which can detect the actual HPV virus in the tumour. The second test can detect a protein called P16, which is a common biomarker of HPV. P16 testing is easier than HPV testing, and is therefore generally preferred by medical professionals.  

“Through international collaboration, we have been able to answer a question that has perplexed the head and neck cancer community for over two decades. In that time, there has been an emergence of a new type of head and neck cancer this cancer called HPV-related to head and neck cancer, caused by the same virus that is often responsible for cervical cancer,” said Hisham Mehanna, Professor of Head and Neck Surgery at the University of Birmingham and lead author of the paper.

Patients with HPV-related cancer had better outcomes

The researchers were intrigued to find that patients with HPV head and neck cancer responded significantly better to current therapies than patients whose cancer was not HPV-related. In light of these findings, the researchers have begun searching for fewer toxic treatments for these patients, in order to reduce the burden of toxicity. In addition to this, more clinical trials, exploring ways to increase the intensity of treatment for HPV-negative treatments, have taken place.  

“Therefore, testing for HPV in head and neck cancer patients has become a real priority and this new research has solved the conundrum puzzling the international community about why some patients respond much better to treatment than others,” explained Professor Mehanna.  

Patients with discordant tests who smoke were at a higher risk of worse outcomes. The researchers found that cancers in smokers tended to act like HPV-negative cancers. However, patients with discordant tests who did not smoke had good outcomes for HPV-positive cancers.  

“This has significant implications on how we test head and neck cancer patients moving forward, especially in regions where smoking is still prevalent and HPV disease is not prevalent, such as those in southern Europe and countries in the east. It also has significant implications for how we choose which studies to enrol these patients in, and in future, what treatment they get,” concluded Professor Mehanna.


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