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Prognostic Factors for HNSCC

Panelists: Ezra Cohen, MD, UC San Diego Moores Cancer Center; Viktor Grünwald, MD, Medical School Hannover; Kevin Harrington, MD, PhD, The Royal Marsden NHS Foundation; Tanguy Y. Seiwert, MD, The University of Chicago Medical Center
Published: Sunday, Nov 20, 2016


Transcript:

Ezra Cohen, MD:
You mentioned, Tanguy, about the potential prognostic implications of some of the things that you’re talking about. Viktor, let me turn to you and ask, what are some of the prognostic factors that you think about, and do they influence your management?

Viktor Grünwald, MD: Well, I think we talk about the virus and how it’s associated with the cancer development. And something we really should keep in mind is that you could have a virus that causes cancer, but you could also smoke. That’s certainly something that is different in the United States than it is in Europe. Because in Europe, we still have a higher fraction of people smoking, and so you have more combinations. Something that I think we also have to put into the equation is the exposure to toxins such as tobacco, because that eats up your benefit that you will derive from a virus-associated cancer. We group into HPV-positive and negative, but to be frank, we have to be more precise in terms of other toxic events that may lead to cancer. And, so, tobacco is one of those, actually.

Tanguy Y. Seiwert, MD: In fact, I would like to second Viktor’s comment that tobacco changes the risk profile of these HPV-positive tumors. I always say that HPV doesn’t help you avoid the toxic effects from smoking. But, essentially, even in the US, particularly in Chicago, at least 50% of the HPV-positive tumors still occur in smokers. So, some people think this may be a cofactor.

Ezra Cohen, MD: Let me dwell on that point for a minute because we have a nice distribution of European oncologists and North American oncologists. Tell me about what you’re seeing with respect to HPV-positive instance of head and neck cancer, Viktor and Kevin. Maybe Viktor you can start. Are you beginning to see these patients?

Viktor Grünwald, MD: Yes, we do, and there’s an increase over time. There actually has been a recent publication of that topic coming from Berlin. But, still, it’s not at the same magnitude as we see it to be in the United States. I think it’s up to 80% from oropharyngeal cancer. And it’s far less in Europe. So, we have similar effects, but in magnitude, it is not the same actually.

Ezra Cohen, MD: And Kevin, what are you seeing in your clinics?

Kevin Harrington, MD, PhD: Well, I think the same way as in other parts of life, including the recent Brexit, you can see that the UK’s not necessarily completely in step with the rest of Europe. And what we have seen actually, and has been published only last month in Cancer Research by Terry Jones and colleagues, is we conducted a nationwide survey representing all the four constituent countries of the United Kingdom. And we demonstrated, in fact, that the rate of HPV infection in oropharyngeal cancer is now about 50%. But, what we showed, and which surprised us significantly, was no change over a 10-year period when we looked at a decade-wide change. And moreover, what we showed is a doubling of HPV-negative oropharyngeal carcinoma in the United Kingdom, as well. So, I suspect that we may see similar patterns in other countries. But, for now, the UK is not necessarily identical to the data being shown in the rest of Europe.

Ezra Cohen, MD: Very interesting. And, Tanguy, I know you’ve done a lot of work around HPV. Give us a snapshot of what’s going on in the United States.

Tanguy Y. Seiwert, MD: I think in the United States, we are seeing this very marked increase in the incidence of HPV-positive tumors in the oropharynx. Some HPV-positive tumors also occur outside the oropharynx, although they’re much less common. I think the rate of projected increase will continue for at least another 15, 20 years. I think, at least in the United States, that rate is increasing. But, maybe mirroring what Kevin said, and I’m not sure that there are very good data, but there are geographic differences where it seems like in certain areas, especially on the coast, there is more incidence of HPV-positive tumors. They are somewhat less in the middle of the country. But, I think, everywhere, you’re starting to see this increase. So, for us, for an oropharyngeal tumor, probably 70%, maybe up to 80%, of patients are not HPV-positive.

Transcript Edited for Clarity
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Transcript:

Ezra Cohen, MD:
You mentioned, Tanguy, about the potential prognostic implications of some of the things that you’re talking about. Viktor, let me turn to you and ask, what are some of the prognostic factors that you think about, and do they influence your management?

Viktor Grünwald, MD: Well, I think we talk about the virus and how it’s associated with the cancer development. And something we really should keep in mind is that you could have a virus that causes cancer, but you could also smoke. That’s certainly something that is different in the United States than it is in Europe. Because in Europe, we still have a higher fraction of people smoking, and so you have more combinations. Something that I think we also have to put into the equation is the exposure to toxins such as tobacco, because that eats up your benefit that you will derive from a virus-associated cancer. We group into HPV-positive and negative, but to be frank, we have to be more precise in terms of other toxic events that may lead to cancer. And, so, tobacco is one of those, actually.

Tanguy Y. Seiwert, MD: In fact, I would like to second Viktor’s comment that tobacco changes the risk profile of these HPV-positive tumors. I always say that HPV doesn’t help you avoid the toxic effects from smoking. But, essentially, even in the US, particularly in Chicago, at least 50% of the HPV-positive tumors still occur in smokers. So, some people think this may be a cofactor.

Ezra Cohen, MD: Let me dwell on that point for a minute because we have a nice distribution of European oncologists and North American oncologists. Tell me about what you’re seeing with respect to HPV-positive instance of head and neck cancer, Viktor and Kevin. Maybe Viktor you can start. Are you beginning to see these patients?

Viktor Grünwald, MD: Yes, we do, and there’s an increase over time. There actually has been a recent publication of that topic coming from Berlin. But, still, it’s not at the same magnitude as we see it to be in the United States. I think it’s up to 80% from oropharyngeal cancer. And it’s far less in Europe. So, we have similar effects, but in magnitude, it is not the same actually.

Ezra Cohen, MD: And Kevin, what are you seeing in your clinics?

Kevin Harrington, MD, PhD: Well, I think the same way as in other parts of life, including the recent Brexit, you can see that the UK’s not necessarily completely in step with the rest of Europe. And what we have seen actually, and has been published only last month in Cancer Research by Terry Jones and colleagues, is we conducted a nationwide survey representing all the four constituent countries of the United Kingdom. And we demonstrated, in fact, that the rate of HPV infection in oropharyngeal cancer is now about 50%. But, what we showed, and which surprised us significantly, was no change over a 10-year period when we looked at a decade-wide change. And moreover, what we showed is a doubling of HPV-negative oropharyngeal carcinoma in the United Kingdom, as well. So, I suspect that we may see similar patterns in other countries. But, for now, the UK is not necessarily identical to the data being shown in the rest of Europe.

Ezra Cohen, MD: Very interesting. And, Tanguy, I know you’ve done a lot of work around HPV. Give us a snapshot of what’s going on in the United States.

Tanguy Y. Seiwert, MD: I think in the United States, we are seeing this very marked increase in the incidence of HPV-positive tumors in the oropharynx. Some HPV-positive tumors also occur outside the oropharynx, although they’re much less common. I think the rate of projected increase will continue for at least another 15, 20 years. I think, at least in the United States, that rate is increasing. But, maybe mirroring what Kevin said, and I’m not sure that there are very good data, but there are geographic differences where it seems like in certain areas, especially on the coast, there is more incidence of HPV-positive tumors. They are somewhat less in the middle of the country. But, I think, everywhere, you’re starting to see this increase. So, for us, for an oropharyngeal tumor, probably 70%, maybe up to 80%, of patients are not HPV-positive.

Transcript Edited for Clarity
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