Above: Johns Hopkins will soon launch a treatment deescalation trial in which eligible patients are offered immunotherapy followed by surgery and nearly half the doses of chemotherapy and radiation. Image shows 3D rendering of HPV.
More than a decade ago, physician-researchers at Johns Hopkins began noticing and documenting a wave of head and neck cancers that differed from traditional presentations. Patients with these tumors were often missing the usual risk factors that doctors had been taught to expect, such as smoking and alcohol use, and they tended to be significantly younger than those usually diagnosed with these cancers — in their forties and fifties, rather than their sixties and beyond. The malignant cells even looked different under the microscope. Doctors here were among the first in the world to link these tumors with human papilloma virus (HPV), the virus that also causes genital warts and the overwhelming majority of cervical cancers.
Since then, Johns Hopkins has continued to be a pioneer in learning the unique features of HPV-associated head and neck cancers and finding new ways to treat them. Recently, physicians here decided to pool their expertise to launch the Center for HPV-Related Head and Neck Cancer, part of the Sidney Kimmel Comprehensive Cancer Center, bringing multidisciplinary experts together to provide care specifically focused on this disease.
“HPV-related cancers used to make up only a fraction of the head and neck tumors we’d diagnose. Now it’s the predominant head and neck cancer that we see,” says Carole Fakhry, a Johns Hopkins otolaryngologist–head and neck surgeon who specializes in this condition. “Recognition of this shift led to many questions regarding diagnosis, treatment and support of this unique patient population.”
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Fakhry says that unlike traditional head and neck cancers, HPV-related tumors respond more readily to treatment, including surgery, radiation and chemotherapy. As a result of this, the question of whether or not patients can achieve similar outcomes with greatly reduced treatment intensity has emerged as a question of great interest. Johns Hopkins will soon launch a treatment deescalation trial in which eligible patients are offered immunotherapy followed by surgery and nearly half the doses of chemotherapy and radiation delivered to those with traditional disease. With careful monitoring, she says, these patients may be able to avoid lifelong side effects caused by collateral damage from these treatments.
Other clinical trials run through the center focus on the trigger for the disease itself, adds Tanguy Seiwert, a Johns Hopkins head and neck medical oncologist who specializes in immunotherapy and HPV-related head and neck cancer. The center’s team will soon be monitoring patients who have finished their treatment protocols for residual traces of HPV in their saliva and blood. Those who test positive will receive immunotherapy aimed at fighting the virus to potentially prevent cancer recurrence. Similarly, another clinical trial will use immunotherapy as a first-line treatment — a milder therapy that could help patients avoid high doses of harsher treatments.
Patients cared for through the center will have access to a host of experts in this condition, including medical, surgical, and radiation oncologists, physical therapists, and social workers. A patient navigator will help assemble each patient’s care team based on their unique needs, maximizing efficiency so patients can be seen and treated quickly.
“We are at an unprecedented point where we can really change outcomes for HPV-associated cancer patients,” says Seiwert. “For these cancers, Johns Hopkins will continue to lead the way.”