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Determination of optimal treatment for elderly patients with HPV-caused oral cancer

Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States. There are approximately 200 different strains of HPV, the majority of which are harmless. However, nine are known to cause cancer and another six are also suspected. HPV is most commonly transmitted through skin-to-skin contact, most commonly through sexual intercourse (CDC). There are currently vaccines that can help prevent against specific strains of HPV that cause cancers, such as HPV16 and HPV18. For oral cancers, the primary concern is HPV16.


Approximately 26 million Americans have an oral HPV infection. Of those, only about 2,600 have HPV16. Most of those people will clear the virus naturally with their own immune system and never realize they were infected with the virus. HPV oral and oropharyngeal cancers are harder to discover than tobacco-related oral cancers because the symptoms are not always obvious to the individual, or to professionals that are diagnosing the disease. The symptoms can be negligible and even painless (Oral Cancer Foundation).

Many patients who suffer from cancer are treated with chemotherapy. However, with head and neck cancer, chemotherapy is controversial because it is associated with relatively high rates of acute and late toxicities. Therefore, patients with head and neck cancer tend to go through radiotherapy, a type of therapy using ionizing radiation, to control or kill cancerous cells. It has been proven, however, that radiotherapy combined with chemotherapy leads to an overall higher survival rate when it comes to the general population.

HPV can be found in anyone, but is most commonly found in patients between the ages of 20-24 and its effect on elderly patients is not as well-known. Researchers are working to learn more about this virus and the impact on the people it is infecting. Dr. Hanasoge and colleagues at Emory University conducted a retrospective study that looked at elderly patients who tested positive for squamous cell carcinoma (SCC) of the oropharynx and were treated with definitive chemo-radiation. The objective of this study was to try and identify the most effective treatment for these patients. HPV-positive status was confirmed either by positive p16 immunostaining or in situ hybridization (ISH) for HPV. Enzo’s PATHO-GENE® type 16/18 probe was used to perform ISH and detect the presence of HPV16 or HPV18.

The researchers focused on HPV-positive oropharyngeal SCC patients in stage N2c. Stage N2c refers to when the cancer has spread to one or more lymph nodes on both sides of the neck or on the side opposite the primary tumor (Oral Cancer Staging System). Given that HPV-positive disease is less common in older patients, the paradigm for their management is even less established. Clinical outcomes for elderly patients with confirmed HPV-positive oropharyngeal SCC was reported. These patients were found to have increased incidence of distant metastasis when treated with radiotherapy alone, compared with combined chemo-radiotherapy. The study concluded that the elderly patients who were treated with both chemotherapy and radiation tolerated the treatment similarly to those patients from the general population despite high rates of acute and late toxicity.

Enzo Life Sciences offers a comprehensive product portfolio for advancing your discoveries in HPV and in situ hybridization research with reagents and kits, including our PATHO-GENE® in situ typing assays (types 6/11, 16/18 and 31/33/51) (ENZ-32874, ENZ-32877, and ENZ-32895). In addition, Enzo offers an array of kits and probes for all of your in situ hybridization needs. A list of some of these products can be found below.

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Reference:

  1. S. Hanasoge, et al. Clinical outcomes in elderly patients with human papillomavirus–positive squamous cell carcinoma of the oropharynx treated with definitive chemoradiation therapy. Head Neck (2016) 38, 846.

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