RTP On Demand — Head & Neck/Thyroid | Research To PracticeCase: A 48-year-old man with HPV-positive tonsil cancer
2:56 minutes.
TRANSCRIPTION:
DR COHEN: He was a 48-year-old gentleman who presented to us with a neck mass and really typical presentation for a subset of head and neck cancer patients that we see today, nonsmoker, nondrinker, relatively young gentleman. Neck mass that he had noticed for a few months that was growing. And indeed, he ended up having an oropharynx primary. It was a tonsillar primary and he was HPV-positive. DR LOVE: And what were you thinking at that point? DR COHEN: Then we staged him. He had a small primary tumor. It was a T2 tumor. He had several lymph nodes on that side of the neck, so N2B disease, which for head and neck cancer means that he was Stage IVB. And for Stage IVB patients, we treat them with concurrent chemotherapy/radiation, and that’s exactly what he received. DR LOVE: And how did he do? DR COHEN: He did very well. He had the typical side effects, mucositis and dermatitis from the treatment, but he didn’t require a feeding tube. He was able to continue oral intake the whole way through. He recovered in the appropriate period of time. And now he’s more than 2 years from therapy and still disease free. DR LOVE: And I take it at this point you treated him exactly the same as if he had been HPV-negative? DR COHEN: We do. There’s no indication right now based on HPV status to change management. Those clinical trials are being done and there’s a big push in the clinical trial community to try and deintensify therapy for HPV-positive patients with the thought that we may be able to cure just as many — and the cure rates are quite high for HPV-positives — but reduce both the acute and, especially, the long-term toxicity for these patients. And so in a clinical trial setting, I think it’s appropriate to try deintensification. But outside of that, we have to be very careful. DR LOVE: So you said that by being HPV-positive, the prognosis is better. What kinds of numbers do you give to a patient like this, and what kind of numbers would you give to a patient like this who’s HPV-negative? DR COHEN: Right. So here’s a patient with Stage IVB disease, T2N2B, nonsmoker, though, with HPV-positive. I would tell them that they have a 70% chance of being cured, and in reality they probably have a little bit higher chance of being cured. It’s probably around 80% and may be a little bit higher than that. But using somewhat conservative numbers, I’d say 70% Identical patient, let’s say T2N2B, HPV-negative disease, this patient is likely to be a smoker, almost certainly to be a smoker. Their cure rate almost drops by half to somewhere around 45% to 50%, unfortunately. |