ORAL CANCER IN MEN ASSOCIATED WITH HPV. The sexually transmitted virus called HPV, or human papillomavirus, is well known to lead to cervical cancer in women.
Now researchers are finding that many oral cancers in men are also associated with the virus.
A clinical trial testing therapies for advanced tongue and tonsil cancers has found that more than 40 percent of the tumors in men were infected with HPV.
If there is good news in the finding, it is that these HPV-associated tumors were among the most responsive to treatment.
Of an estimated 28,900 cases of oral cancer a year, 18,550 are in men.
HPV can enter the mouth during oral sex.
A study published in February by researchers at Johns Hopkins estimated that 38 percent of oral squamous-cell cancers are HPV related, and suggested that their increasing number might be a result of changing sexual behaviors.
The new study, published in two papers in The Journal of Clinical Oncology, included 51 men and 15 women with cancers of the tonsils or the base of tongue. The researchers were able to examine biopsies of 42 of the subjects before treatment. After tests for HPV, the researchers found that 27 tumors, nearly two-thirds, were positive for the virus. Of the 51 men, researchers found 22 with HPV.
Other experts found the results interesting, but said it was unclear what they would mean for treatment.
Finding the answer to that question is the next step, said to Dr. Maura L. Gillison, an associate professor of oncology at Johns Hopkins who was not involved in the study.
Dr. Gillison added, “All of our clinical trials now will be designed for either HPV-positive or HPV-negative patients. Right now, these patients are treated the same way.”
All the patients in the study were initially treated with induction chemotherapy, that is, an initial course to shrink the tumor.
Those whose tumors did not shrink by at least 50 percent, 12 patients, were then treated with surgery. Most of those did not survive their illness.
Of the remaining group, 49 of 54 responded to the next step, combined chemotherapy and radiation. In that group, 78 percent needed no surgery, and 70 percent survived more than four years. Of the 49, almost half, 24, were positive for HPV, and all but 3of those were men.
People with tumors with high HPV levels were significantly more likely to respond to treatment. They were also more likely to survive their cancer and to survive over all.
The researchers also tested these tumors for the presence of four genetic markers: EGFR, a cell receptor associated with various cancers; BCLXL, a repressor of cell death; and the tumor-suppressor proteins p53 and p16. The scientists found that these were also accurate predictors of the success or failure of the treatment. Women and smokers were less likely to be treated successfully.
“Patients who have HPV infections are at higher risk for these cancers,” Dr. Worden said. “But the good news is that if that’s the cause of their cancer, they’re more likely to survive treatment. We still don’t know what the ideal treatment regimens are. For example, these patients may benefit from less intense chemotherapy and radiation.”
Although the researchers acknowledge that the number of patients in their study was small, they conclude that especially in patients with HPV-positive tumors, chemotherapy followed by combined chemotherapy and radiation appears to be an effective treatment.
An author of the papers has an interest in a company that is developing an HPV detection method.[13May08, N.Bakalar, http://www.nytimes.com/2008/05/13/health/13canc.html?_r=1&oref=slogin&ref=science&pagewanted=print
HPV CAUSING HEAD AND NECK CANCERS IN MEN
Head and neck cancers, once found mainly in older male smokers and drinkers, are now increasing in men in their 30’s and 40’s. At the present rate of infection, HPV-related cancers may become more common than cervical cancer, experts say.
[“HPV-related Oral Cancers Rise Among Younger Men,” Baltimore Sun, 04-14-08, http://www.baltimoresun.com/news/health/bal-te.hpv14apr14,0,1493482.story)