What are the risks of HPV-associated head and neck squamous cell carcinoma?

HPV-associated head and neck squamous cell carcinoma (HNSCC) is a type of cancer linked to infection with high-risk human papillomavirus, most often HPV type 16. The risks for developing this cancer include having a persistent HPV infection, which can lead to changes in cell metabolism and DNA methylation patterns. However, compared to HPV-negative HNSCC, HPV-associated tumors generally have a better prognosis and may respond differently to treatments like radiotherapy and immunotherapy.

What the research says

Persistent infection with high-risk HPV, especially HPV16, is a primary risk factor for HPV-associated HNSCC ⁹¹⁰. The virus's oncoproteins, E6 and E7, alter cell metabolism and interact with tumor suppressor proteins p53 and pRb, driving cancer development ⁹. These metabolic changes are distinct from those in HPV-negative HNSCC ⁹. Epigenetic dysregulation, such as abnormal DNA methylation, is also common in HPV-associated HNSCC and may contribute to carcinogenesis ¹¹. Interestingly, HPV-associated HNSCC often has a better prognosis than HPV-negative disease, though about 20% of patients still have poor outcomes ¹¹. Treatment approaches may differ; for example, de-escalation of radiotherapy in HPV-related oropharyngeal cancer has been studied to reduce side effects, but unselected de-escalation can be inferior, while risk-stratified approaches are promising ⁶. Therapeutic vaccines targeting HPV proteins E6 and E7 are being developed to prevent or treat these cancers ¹⁰.

What to ask your doctor

• What is my HPV status, and how does it affect my treatment options and prognosis?
• Are there any clinical trials for HPV vaccines or targeted therapies for my type of cancer?
• Could radiotherapy de-escalation be appropriate for my case to reduce side effects?
• How often should I be monitored for recurrence, and what tests are recommended?
• What lifestyle changes can help reduce my risk of HPV-related cancers?