Approximately 25% of head and neck squamous cell cancer, especially oropharangeal cancers are associated with high risk HPV-16, 18, 31, 33, and 35. Patient with HPV-16 related tumors tend to be younger, have smaller primary lesions and experience improved survival compared with patient with HPV-16 negative tumor. Studies have shown a 60 to 80% reduction in the risk of cancer death in HPV positive tumors. Similarly, both high EGFR expression and low HPV titer are associated with poor outcome. This study was carried out to correlate the response of neoadjuvant chemotherapy with presence of HPV and EGFR expression in oral cancer.
Patients and Method
HPV status by PCR and the EGFR expression by IHC was studied in 20 patients of locally advanced squamous cell oral cancer receiving neoadjuvant chemotherapy with docetaxel and carboplatin. Response was evaluated with RECIST criteria. Mean, median and standard deviation were calculated for continuous variables. Responses were correlated with positivity of HPV asserted by PCR and EGFR status.
Majority of the cases had primary tumor of buccal mucosa (25%), lower alveolus (25%) and tongue (25%). HPV 16 was positive in 5 patients (25%), while none of the patient had HPV 18. Level of EGFR expression was 1+ in 6 (30%) 2+ in 5 (25%) and 3+ in 9 patients (45%). 14 patients (70%) were given 3 cycles, 2 patients (10%) 4 cycles, 3 patients (15%) 5 cycles of chemotherapy. complete response was seen in 5%, partial response in 45%, 30% had stable disease and 20% progressive disease. There was significant relation of response with bleeding at the time of presentation (x2 = 8.235, p = 0.041) and site of tumor (x2 = 27.037, p = 0.008) with patients with buccal mucosa, lip and alveolus having a better response than retromolar trigone and tongue lesions. No significant relation was seen with growth type, pretreatment T stage, grade, HPV status and EGFR status.
Human papilloma virus and EGFR expression does not predict response to neoadjuvant chemotherapy in oral cancer.