COSM14: HPV Status and Prognosis for Oropharyngeal Cancers

The main vaccine target group in the U.S. is 11- to 12-year-old girls who have not yet become sexually active. The Advisory Committee on Immunization Practices for the Centers for Disease Control, as of October 2011, also recommends routine vaccination of boys between nine and 21 years old.

Quadrivalent HPV vaccines are highly effective at preventing infections, but more effort needs to be put into encouraging parents to get their children vaccinated to further prevent recurrent respiratory papillomatosis (RRP), said Craig Derkay, MD, director of pediatric otolaryngology at Eastern Virginia Medical School in Norfolk.

At up to five years of follow-up, the vaccines were 100% effective at preventing the HPV 6- and 11-types, which are responsible for causing RRP. Data suggest that the vaccine provides long-term protection, with VLP [virus-like particle] antibody titer levels that plateau at about 18 months following the vaccination course, suggesting no need for future booster doses, Dr. Derkay added.

Two recent papers suggest that the vaccine could have some therapeutic value for treating RRP. In one of the studies, in which 11 adults with RRP were given the vaccine, six of them were disease-free at one year, three of them had fewer recurrences, and two had no change (International Papillomavirus Conference 2011. OP-236). Moreover, the vaccine will protect against the most common HPV subtypes responsible for causing oropharyngeal cancer.

Despite the evidence that vaccines work, Dr. Derkay noted that vaccine uptake rates have not changed since 2011, requiring an increased effort by otolaryngologists to promote vaccination among the families they treat. “There is an anti-vaccine movement in the United States,” in part because some think the vaccines will lead to earlier sexual behavior, he said. “I think that’s a fallacy in the same way that encouraging seat belt use encourages you to drive drunk.”

Treatment Courses

James Rocco, MD, PhD, director of head and neck cancer research at Massachusetts General Hospital (MGH) and the Daniel Miller Associate Professor of Otology and Laryngology at Harvard Medical School in Boston, delved into new ways of assessing how well different patients with HPV-positive oropharyngeal cancer will respond to different treatments. “There are lots of different treatment options, and we really have no way to know which are best in terms of survival and function,” he said, even though it’s known that some patients are being overtreated and are thus at unnecessary risk of serious side effects.