Human Papillomavirus-Associated Oropharyngeal Cancer: Defining Risk Groups and Clinical Trials.
Human Papillomavirus-Associated Oropharyngeal Cancer: Defining Risk Groups and Clinical Trials.
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DOI：
10.1200/jco.2015.61.2358
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发表时间：
2015-10-10
期刊：
影响因子：
--
通讯作者：
Burtness B
中科院分区：
文献类型：
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作者：
Bhatia A;Burtness B
人乳头瘤病毒相关口咽癌（HPVA-OPC）发病率迅速上升，具有独特的流行病学、分子和生物学特征。尽管被认为具有较好的预后，但目前的证据并不支持与hpv阴性的OPC相比进行更低强度的治疗。目前的联合治疗具有显著的发病率风险，并且HPVA-OPC患者的中位年龄较低。因此，这些患者在治疗的不良反应下寿命更长，这刺激了治疗去强化试验的发展，这些试验试图在不影响疗效的情况下降低治疗相关的发病率。许多放疗和化疗的降级试验正在进行中。微创手术技术也在评估之中。确定去强化治疗的理想患者组和确定预后风险组以避免对pvva - opc中较低风险亚群治疗不足是很重要的，并且需要经过验证的生物标志物来识别预后最佳的患者。显著的吸烟暴露降低了HPVA-OPC的良好预后。目前，低强度治疗仅在临床试验中是一种选择，只要有临床试验选择，应向丙型肝炎- opc患者提供临床试验选择。最后，识别新的治疗靶点和信号通路对于开发新的治疗策略至关重要，这对于低风险患者和复发和转移性疾病患者是迫切需要的。
Human papillomavirus–associated oropharynx cancer (HPVA-OPC) is rapidly increasing in incidence and has unique epidemiologic, molecular, and biologic characteristics. Despite being recognized as having superior prognosis, current evidence does not support less intense therapy compared with HPV-negative OPC. Current combined modality therapies confer a significant risk of morbidity, and patients with HPVA-OPC have a younger median age. These patients, therefore, live longer with the adverse effects of treatment, and this spurs the development of treatment deintensification trials that attempt to decrease treatment-related morbidity without compromising efficacy. Many radiation and chemotherapy de-escalation trials are underway. Minimally invasive surgical techniques are also being evaluated. It is important to identify the ideal patient group for treatment deintensification and to define prognostic risk groups to avoid undertreating the poorer-risk subset in HPVA-OPC, and validated biomarkers are needed to identify patients with the best prognosis. Significant smoking exposure mitigates the favorable prognosis of HPVA-OPC. Currently, less intense treatment is an option only in the setting of clinical trials, and patients with HPVA-OPC should be offered clinical trial options whenever they are available. Finally, recognition of novel therapeutic targets and signaling pathways is critical to the development of new treatment strategies that are desperately needed for patients with poor risk and those with recurrent and metastatic disease.