HPV Antibodies Signal Better Prognosis for Head and Neck Cancer Patients

The presence of HPV antibodies in head and neck cancer patients is a good prognostic marker that can be used to determine survival rate.

Highlights

This is one of the first studies to show that HPV antibodies are a good prognostic marker for increased patient survival with head and neck cancer.
The presence of the HPV antibody in the blood can be used as a signal of prognosis and it is not dependent on the quantity of antibody present.
Identification of both E6 and E7 antibodies is a better prognostic marker

An evidence of human papilloma virus (HPV) in patients with head and neck cancer is an indication of better prognosis, according to a new study published in the Journal JAMA Oncology. The researchers have found that, instead of a biopsy, a blood serum test that identifies one of the two antibodies against HPV virus is a good and reliable signal for prognosis. This test could be an effective marker of prognosis for all types of head and neck cancer.

Brown University’s professor of epidemiology and of pathology and laboratory medicine, Dr. Karl Kelsey, who is the senior author of the study said “What this adds is that it helps us know how best to measure clinically the HPV contribution to this disease."

Head and Neck Cancers - Types, Risk Factors, Symptoms, Diagnosis, Treatments
Head and neck cancers usually occur in the squamous cells lining the moist, mucosal surfaces inside the head and neck.

‘Smoking increases risk for head and neck cancer with poor prognosis.’

Head and Neck Cancer

Head and neck cancers include cancers that begin in the squamous cells that line the mucosal membrane. The different types of head and neck cancers include cancer of the oral cavity, salivary glands, larynx, pharynx and the paranasal sinuses and the nasal cavity.

Head and neck cancer is caused mostly due to tobacco smoking and alcohol consumption, while a small percentage of head and neck cancers may also be caused due to Human Papilloma Virus (HPV) infection.

Identifying the Prognosis Marker

Blood samples of 1000 people with head and neck cancer who were diagnosed between the years 1999 and 2011 were studied.

Patients who tested positive for oncogene HPV proteins E6 or E7 had a better prognosis
They were less likely to die when assessed after a 5 year period.
25% less likely to die when they showed an immune response compared to people with no immune response

Cancer Prognosis Testing

It is very important to carry out a prognosis test for cancer to determine the survival risk and to identify the best method of treatment. Every individual responds differently to cancer and a prognosis test will provide a better understanding of the response.

Quiz on Head and Neck Cancer
Head and neck cancers begin in squamous cells that line the moist, mucosal surfaces inside the head and neck. These kinds of cancers related to squamous cells are referred to as squamous cell carcinomas.

Cancers of head and neck are further differentiated by the area of head and neck in which they begin. This form of cancer starts in lip, oral cavity (mouth), nasal cavity, paranasal sinuses, pharynx and larynx.

Head and Neck Cancers Could be Treated by Targeting T Cell Channel
Regulating the expression of at the cellular level and using the body's own immune response to fight the tumor cells would give more effective outcomes.

Cancers in brain, eye, esophagus, thyroid gland, scalp, muscles and bones of head and neck are not categorized under head and neck cancers. In some cases, squamous cells can be found in lymph nodes of upper neck when there is no evidence of cancer in other parts of head and neck. If this happens, cancer is called metastatic squamous neck cancer with unknown (occult) primary.

It can be used to decide upon the course of treatment, as in some forms of cancer, rigorous chemotherapy may not be required. Some of the prognosis tests are also used to determine recurrence risk of the specific cancer.

HPV virus was earlier associated only with cancers in the oropharynx, however, now it is associated with all cancers in the head and neck region. In the current study, it was found that the HPV immune response identified among cancers that were located in the oropharynx and the larynx showed a better but similar survival risk. The risk of survival was lower among cancers in the oral cavity.

Immunotherapy Doubles Head and Neck Cancer Survival
Nivolumab - an immunotherapy drug greatly improves survival for patients with relapsed head and neck cancer - a disease which is notoriously difficult to treat.

The prognosis test based on the HPV antibodies were dependent on the following conditions

The detection of the antibodies in the patients with head and neck cancer was an indicator of better prognosis, it was not dependent on the quantity of antibodies present.
Testing for both E6 and E7 antibodies was a better detector of prognosis than detecting only one type of antibody.
There was a lowered risk of dying for people who showed the presence of antibody, even among those who consumed alcohol and tobacco.
The least survival rate was witness among smokers without any antibody for HPV.

Reason for Better Survival Rates:

There are two major factors which could influence prognosis of head and neck cancer patients due to infection by the HPV virus:

Tumor Suppressor Genes: The HPV virus delineates the tumor suppressor genes among head and neck cancer patients, these genes are known to drive tumor growth.
Immune Response: The presence of additional antibodies due to the HPV virus may have an effect on the growth and maturation of the cancer cells, leading to better prognosis. Cancers are known to evade the immune response of the host, failing to mount a suitable response, which encourages their proliferation. However, in patients with HPV infection, the immune response against the virus might lead to the destruction of cancer cells. The importance of eliciting an immune response to cancer is utilized in immunotherapy, where the immune cells of the host are used to control the growth of cancer.

This study is of great significance in the treatment and management of head and neck cancers. Many studies now focus on the genetic risk factors that are associated with the various cancers, to help determine the nature of cancer and the recurrence risk. However, the current study that focuses on the presence of antibodies provides a better understanding about the survival rate.

Prognostic Markers in Cancer

There are some well-established factors that are considered to be good prognostic markers for cancer.

The age of the patient is an important factor in cancer prognosis. When the age is over 60 years, the prognosis is lower.
The hemoglobin level in the body should be above 12mg/l
The stage of cancer should be I or II
Fewer than 4 lymph nodes should be affected

The ease of detection of the E6 and the E7 proteins that determine the antibodies of HPV, according to the current study, might soon make this test widely available. The benefits of understanding the prognosis make effective testing mandatory.

References:

Prognostic factors versus predictive factors: Examples from a clinical trial of erlotinib - (http://www.moloncol.org/article/S1574-7891(07)00102-0/abstract)
Molecular Pathology Testing To Estimate Prognosis for Common Cancers - (https://www.cms.gov/Regulations-and-Guidance/Guidance/FACA/downloads/id69b.pdf)
Survival rates and factors that affect prognosis (outlook) for non-Hodgkin lymphoma - (http://www.cancer.org/cancer/non-hodgkinlymphoma/detailedguide/non-hodgkin-lymphoma-factors-prognosis)
Head and Neck Cancers - (https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet)

Source-Medindia