Oropharyngeal cancer – is it time to change management according to human papilloma virus status?

Abstract

There is currently strong evidence supporting human papilloma virus (HPV) causation in a distinct disease entity of oropharyngeal cancer (OPC), with an increasing incidence worldwide.This review aims to critically analyse whether a change in our management approaches to HPV-positive OPC is now required for this increasingly significant public health concern. HPV-positive OPC appears to have increased worldwide. HPV status has a strong prognostic effect, and, in combination with smoking status, primary, and nodal stage, is useful in the risk stratification of OPC. HPV-positive OPC responds better to chemoradiotherapy, surgery, and postoperative chemoradiotherapy than HPV-negative tumours, with improved survival outcomes. There remain concerns regarding the efficacy of HPV detection assays in clinical practice. HPV-negative head and neck cancer still accounts for the largest subset of patients that we treat and carries poor survival outcomes. It is currently not advisable to change management for either HPV-positive or HPV-negative OPC as there is a lack of high-quality evidence to support this. High-quality randomized controlled trials are required to assess the efficacy of the different treatment modalities currently available for both HPV-positive and HPV-negative OPC.