Introduction: The prognostic value and biologic implications of HPV status in locally advanced settings are now well established. However, there is considerably less data regarding the role of HPV in recurrent and/or metastatic (R/M) HNSCC. The relatively low rate of recurrences of patients with locally advanced HPV-positive disease has led to a small number of HPV-positive patients entering clinical trials for R/M settings; in these studies, patients were not stratified based on HPV status, and consequently HPV-positive patients can only be analyzed retrospectively. A lack of standardization in HPV testing and reliance on only p16 in retrospective analysis has also led to a significant overestimation of sample sizes, as well as poor quality data which were already too small to be practice-changing or to provide any firm conclusions. In order to contribute to the currently scarce data for this disease, we present our experience with patients diagnosed with HPV-positive R/M HNSCC between 2010 and 2014 that were evaluated by rigorous HPV testing and treated at our institution.
Methods: Retrospective chart review using our electronic medical record (EPIC) for all patients diagnosed with HPV-positive R/M HNSCC between 2010 and 2014. Patients with at least six months of follow-up and p16 and HPV positivity, determined by immunohistochemistry (IHC), with a 75% cut-off for positive staining, followed by reflex polymerase chain reaction (PCR), respectively, were included.
Results: We assessed eleven patients who underwent a variety of treatments. The longest length of follow-up was 56 months from diagnosis of R/M disease. The pattern of initial failure was mainly distant and reflects the highly responsive nature of HPV-positive HNSCC and excellent locoregional control. PFS and OS were 7 and 34+ months, respectively. Four patients (36%) are alive and disease-free (median OS of 39+ months). Three disease-free patients were treated with TPF (taxane, platinum, 5-fluorouracil) as aggressive curative systemic therapy. Another patient treated with TPF was disease-free for 25 months and died of disease at 42 months.
Conclusion: Our study demonstrates a favorable prognosis for patients with HPV-positive R/M HNSCC and that aggressive systemic treatment can lead to a prolonged disease-free period or possibly cure, even after metastasis.