Response to therapy and outcomes in oropharyngeal cancer are associated with biomarkers including human papillomavirus, epidermal growth factor receptor, gender, and smoking

Abstract

Induction chemotherapy and concurrent chemoradiation for responders or immediate surgery for non-responders is an effective treatment strategy head and neck squamous cell carcinoma (HNSCC) of the larynx and oropharynx. Biomarkers that predict outcome would be valuable in selecting patients for therapy. In this study, the presence and titer of high risk human papilloma virus (HPV) and expression of epidermal growth factor receptor (EGFR) in pre-treatment biopsies, as well as smoking and gender were examined in oropharynx cancer patients enrolled in an organ sparing trial. HPV16 copy number was positively associated with response to therapy and with overall and disease specific survival, whereas EGFR expression, current or former smoking behavior, and female gender (in this cohort) were associated with poor response and poor survival in multivariate analysis. Smoking cessation and strategies to target EGFR may be useful adjuncts for therapy to improve outcome in the cases with the poorest biomarker profile.

Figure 1

HPV copy number and response to induction chemotherapy. The solid circle represents the mean HPV value (solid line = the median; open circle = an outlier). HPV content is significantly associated with response (p=0.0237).

Figure 2

EGFR intensity, smoking history and survival. Patient groups: red line, never smoker EGFR low (n=8); yellow line, never smoker EGFR high (n=2); blue line, past smoker EGFR low (n=11); green line, past smoker EGFR high (n=9); purple line, current smoker EGFR low (n=4); magenta line, current smoker EGFR high (n=10).