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Tobacco use linked to worse outcomes in HPV-positive
head and neck cancer, U-M study
finds
ANN ARBOR, Feb. 2010: Patients with
head and neck cancer linked to high risk
human papillomavirus, or
HPV, have worse outcomes if they
are current or former tobacco users, compared to those who have
never used tobacco, according to a new study from researchers at
the University of Michigan
Comprehensive Cancer Center.
High risk HPVs are the same viruses that are associated with
cancers of the uterine cervix. The researchers suggest that
current or former tobacco users may need a more aggressive
treatment regimen than patients who have never used tobacco.
HPV-positive head and neck cancers tend to be more responsive to
current treatments, and patients overall tend to have better
outcomes than patients with HPV-negative tumors. But the new
study found that current tobacco users with HPV-positive tumors
were five times more likely to see their cancer recur, and even
former smokers had an increased risk of recurrence.
“Because the effect of HPV is so strong in giving a very good
prognostic picture, we were surprised to find that smoking
remained a huge issue, and it actually affected the outcome in
the patients that smoked,” says senior study author Thomas
Carey, Ph.D., professor of
otolaryngology and pharmacology, and co-director of the
Head and Neck Oncology Program at the U-M Comprehensive Cancer
Center.
Results of the study appear in the Feb. 15 issue of Clinical
Cancer Research.
Current smokers 5 times more likely to see their cancer return
The study looked at 124 patients with advanced
oropharyngeal cancer, which is
cancer of the tonsils or the base of the tongue. Most of these
patients had HPV DNA in their tumors, which is consistent with
HPV being a major factor in
oropharyngeal cancer development. All 22 of the HPV-negative
patients were tobacco users, and about two-thirds of the 102 HPV-positive
patients were current or former tobacco users.
Of the HPV-positive patients who had never used tobacco, only 6
percent had a recurrence of their cancer. Meanwhile, 19 percent
of former tobacco users and 35 percent of current tobacco users
had a recurrence. Still, the outcomes were better than the HPV-negative
patients, among whom half recurred.
Tobacco users have traditionally been more likely than non-users
to develop head and neck cancers. But a recent rise in these
cancers linked to HPV has meant more non-smokers are being
diagnosed with the disease. HPV-positive head and neck cancers
tend to be more responsive to chemotherapy and radiation
treatments, which has researchers wondering if these highly
toxic treatments could be reduced in this group of patients.
“The side effects of these treatments affect critical functions
such as eating and swallowing. Since the HPV-positive tumors
respond so well to treatments, our research team has been
asking: Could we potentially spare patients some of these side
effects while maintaining good outcomes if we reduce the doses
given? If we decide to reduce intensity of treatment, our study
shows we will want to take tobacco use into account. Any smoking
or tobacco use increases the risk of recurrence or a second
primary cancer,” Carey says.
Researchers from U-M’s multidisciplinary head and neck oncology
program are planning a clinical trial to look at reducing
treatment intensity for low-risk patients – those whose tumors
express certain markers, including HPV, and who are not tobacco
users. The trial will likely begin this spring.
|
Uso de tabaco vinculado con peores resultados
en cáncer de cabeza y cuello de pacientes positivo VPM, según un
estudio de la UM
ANN ARBOR: Los pacientes con cáncer de cabeza y cuello vinculado a
un riesgo más alto de virus de papiloma humano (VPH) tiene peores
cursos de su enfermedad si fuman o han fumado, en comparación con
los que jamás han usado tabaco, según un nuevo estudio de
investigadores en el Centro Integral del Cáncer de la Universidad de
Michigan.
Los VPH de alto riesgo con los mismos virus que están vinculados con
el cáncer de cuello uterino.
Los investigadores indican que las personas que fuman o han fumado
podrían necesitar un régimen de tratamiento más agresivo que los
pacientes que jamás han usado tabaco.
Los cánceres de cabeza y cuello en pacientes positivo de VPH tienden
a responder mejor a los tratamientos actuales, y los pacientes en
general tienden a tener mejores resultados que los pacientes con
tumores negativos de VPH. Pero el nuevo estudio encontró que los
pacientes con tumores positivo de VPH y que siguen usando tabaco
tienen cinco veces más probabilidades de ver una reaparición del
cáncer, y que aún los ex fumadores tienen un riesgo mayor de
recurrencia.
“Dado que el efecto del VPH es tan fuerte para dar un muy buen
pronóstico, nos sorprendió encontrar que el tabaquismo seguía siendo
un problema importante, y que realmente afectaba el resultado en los
pacientes que fumaban”, dijo el autor principal del estudio
Thomas Carey, profesor de
otorrinolaringología y farmacología y co director del Programa de
Oncología de Cabeza y Cuello en el Centro Integral del Cáncer de la
UM,
Los resultados del estudio se publican en la edición del 15 de
febrero de la revista Clinical Cancer Research.
Fumadores tienen cinco veces más probabilidades de ver una
reaparición del cancer
El
estudio observó a 124 pacientes con cáncer orofaringeal avanzado,
esto es cáncer en las amígdalas o la base de la lengua. La mayoría
de estos pacientes tenía ADN de VPH en sus tumores, lo cual se
corresponde con que el VPH es un factor principal en el desarrollo
del cáncer orofaringeal. Los 22 pacientes negativos de VPH eran
fumadores, y casi dos tercios de los 102 pacientes positivos de VPH
fumaban o habían fumado.
De los pacientes positivos de VPH que nunca habían
usado tabaco solamente el 6 por ciento tuvo una recurrencia de su
cáncer. Mientras tanto el 19 por ciento de los usuarios de tabaco y
el 35 por ciento de los usuarios actuales de tabaco tuvieron una
recurrencia. Aún así los resultados fueron mejores que para los
pacientes negativos de VPH, entre los cuales la mitad tuvo una
recurrencia.
Los usuarios de tabaco han tenido, tradicionalmente, más
probabilidades de desarrollar cáncer de cabeza y cuello que los no
usuarios de tabaco. Pero un aumento reciente en estos cánceres
vinculados al VPH ha significado que a más no fumadores se les
diagnostica con la enfermedad. Los cánceres de cabeza y cuello
positivos de VPH tienden a responder más a la quimioterapia y los
tratamientos con radiación, por lo cual los investigadores se
preguntan si estos tratamientos altamente tóxicos podrían reducirse
para este grupo de pacientes.
“Los efectos secundarios de estos tratamientos afectan funciones
críticas tales como comer y tragar. Dado que los tumores positivos
de VPH responden tan bien a los tratamientos nuestro equipo
investigador se ha preguntado: ¿Podríamos evitar a algunos de los
pacientes estos efectos secundarios manteniendo al mismo tiempo los
buenos resultados si reducimos las dosis administradas? Si
decidimos reducir la intensidad del tratamiento nuestro estudio
muestra que tomaremos en cuenta a los usuarios de tabaco. Cualquier
forma de tabaquismo incrementa el riesgo de recurrencia o de un
segundo cáncer primario”, según Carey.
Los investigadores del programa multidisciplinario de oncología de
cabeza y cuello de la UM planifican una prueba clínica para observar
la reducción de la intensidad de los tratamientos para los pacientes
de bajo riesgo, esto es aquellos cuyos tumores expresan ciertos
marcadores, incluido el VPH, y que no sean usuarios de tabaco. Las
pruebas comenzarán esta primavera (hemisferio norte).
|
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