CAP Formulating New Treatment Guidelines for HPV-Related Head and Neck Cancers

The College of American Pathologists (CAP) is moving toward firm treatment guidelines regarding the diagnosis of the human papilloma virus (HPV) in head and neck cancers.

Commonly known as HPV, the virus has caused a doubling of HPV-positive forms of squamous cell carcinomas in recent years. Even as the actual overall number of head and neck cancers have dropped since 1980, incidents of HPV-positive oropharyngeal cancer—generally the middle throat area including the tongue, the tonsils, the soft palate—have risen. At least 25 percent of all head and neck cancers are now associated with a positive HPV result. About 70 percent of oropharyngeal carcinomas are associated with HPV.

There are more than 15,000 diagnoses of such cancers in the U.S. every year, according to data from the Centers for Disease Control and Prevention, with men about four times more likely to be diagnosed than women.

Tobacco usage is the primary risk factor for non-HPV head and neck cancers, but clinicians say the factors for oropharyngeal carcinoma are different. That has potentially led to some doctors skipping diagnostic tests and missing potential diagnoses. Moreover, HPV-related head and neck cancers are in many instances not as aggressive as non-HPV forms of the disease—five-year survival rates are typically between 80 and 90 percent—requiring treatment pathways different from other head and neck cancers.

"These patients may be candidates for less aggressive or tailored therapies, so accurate HPV assessment in head and neck cancers is becoming critical," said William C. Faquin, M.D., a pathologist at Massachusetts General Hospital in Boston and co-chairman of the committee CAP convened to promulgate the guidelines. "It is also important to know when testing is not indicated."

The committee is comprised of surgeons, radiation oncologists, medical oncologists and pathologists. Draft guidelines were initially released over the summer for public comments, although CAP spokesperson Kerry Lydon said they are no longer available.

"At this point, the expert panel reviews all comments; they refresh the literature search; and from there they begin to draft final guidelines, which (will) then go through additional review/ revision," Lydon said. The final guidelines are expected to be released by the third quarter of 2017, she added.

Takeaway: The College of American Pathologists is developing new guidelines for diagnosing HPVassociated head and neck cancers.