A new study found that patients with high-grade dysplasia or esophageal adenocarcinoma Barrett, who have the human papilloma virus (HPV) have a better prognosis than patients with HPV-negative effect.
"If the results are favorable prognosis of HPV-positive dysplasia Barrett or adenocarcinoma confirmed in larger cohorts with more advanced disease, it makes it possible to reduce the toxicity of the treatment," - said Shan Rajendra, MD, Director, Gastro-intestinal viral Oncology Group, Ingamsky Institute applied medical research, Sydney, Australia, told Medscape medical News.
"These data may also be used for diagnosis, disease stratification, monitoring and treatment, including vaccination," - Rajendra said.
The study was published online Aug. 3 in JAMA Network Open.
For patients with HPV-positive carcinoma of the head and neck (HNSCC) survival rates are higher, and the risk of relapse is reduced in comparison with patients with HPV negative HNSCC. The current study is the first demonstrated similar relationships in different diseases, says Rajendra and his colleagues.
The group conducted a retrospective case-control study 142 patients with adenocarcinoma or Barrett. Thirty-seven patients were HPV positive and 105 were negative for HPV. The mean observation time was 33.4 months for the group and 43.8 months for the survivors.
HPV positivity was associated with significantly improved survival free survival (DFS). This was most pronounced in patients with HPV-positive cancer patients (hazard ratio [HR], 0,33, 95% confidence interval [CI], 0,16-0,67, P = 0,002), and in patients with transcriptionally active HPV positive Oncology (HR, 0,44, 95% CI, 0,22-0,88, P = 0,02).
HPV positivity was also associated with a decrease in the frequency of relapses and progression, and distant metastases and death from adenocarcinoma.
The average duration of overall survival was significantly improved in the group a positive effect on HPV, but HPV connection status with overall survival did not reach significance using the log-rank test. Although 26 of the 37 patients with HPV-positive (70.3%) were alive at the end of observation, compared with 58 of 105 patients with HPV-negative (55.2%), the difference was not statistically significant, possibly because of small sample size and the associated comorbid conditions, the researchers note.
HPV-positive tumors had a lower T stage and differentiation, and many patients with HPV-positive tumors underwent complete resection. The authors also note that TP53 mutations in patients with HPV-positive tumors may contribute to a more favorable outcome.
This study "is important to emphasize the potential role of HPV status in the EAC forecast. However, the use of HPV as a prognostic marker for treatment remains unproven, "- said Suhbinder Desi-Tindi, MD, Oncology Department, McMaster University, Hamilton, Ontario, Canada, points out in a related commentary.
It remains unclear, for example, whether the HPV infection leads to a more indolent cancer or the presence of HPV in tissue samples is more favorable pathology, she said.
Important questions to be explored in future clinical trials, include: how best to select patients for less intensive treatment, the best way to check the status of HPV, and which method (eg, chemotherapy , radiotherapy or surgery) it is best to opt for a de-escalation .
Another question concerns whether the patients to participate in clinical trials, given the mortality rate of these cancers.
We need larger studies of the role of HPV in the pathogenesis of cancer, especially before performing studies less intensive therapy. "Although the results of this small cohort study are impressive, they are preliminary and requires confirmation in larger, prospective," - she concludes.