Dr. Burtness on the 2 Types of Head and Neck Cancer скачать в хорошем качестве

Dr. Burtness on the 2 Types of Head and Neck Cancer

Barbara Burtness, MD, Chief, head and neck medical oncology, co-leader, developmental therapeutics, Fox Chase Cancer Center, discusses the differences between the traditional and the human papillomavirus (HPV) derived variations of head and neck cancer. Traditional head and neck cancer is formed after exposure to tobacco and alcohol. The biology for this type of cancer is well understood and generally contains a mutation in p53, heterozygosity in p16, and a high mutation burden. This type of cancer is very treatment resistance. The second type of head and neck cancer primarily develops in the oropharynx as a result of HPV. There are many different strains of HPV with several high-risk types existing; HPV-16 is the most common form in the US. HPV related cancer does not generally develop a p53 mutation, which makes this type less resistant to chemotherapy. The expression of viral oncoproteins lead to the degradation of both the p53 and Rb proteins and a compensatory upregulation of p16. The overall low mutational burden in HPV-positive head and neck cancers results in a higher response to treatment than HPV-negative. Two large studies evaluated intensifying therapy in advanced head and neck cancer. The first was the TROG 02.02 that looked at the impact of radiotherapy quality on outcome and the second was the RTOG 0129 that examined radiation and cisplatin intensity. These trials demonstrated that therapy intensity and quality did not significantly improve cure rates, however subset analyses within these trials did find that HPV status effected outcomes significantly. Patients that were HPV-positive experienced 80-85% better outcomes, compared to those that were HPV-negative.