Oropharyngeal Cancer

Oropharyngeal Cancer | Johns Hopkins Medicine

In a sample study, researchers at Johns Hopkins say they have found an association between the makeup of an individual's microbiome and head and neck cancer, a finding that potentially advances the quest for faster and more accurate cancer diagnosis and therapy.

In a report on the research published on May 30 in Oncotarget, the scientists say that populations of the human microbiome—the collection of normal bacteria inhabiting people's bodies—can help discriminate between patients with head and neck cancer and healthy individuals.

Doctors may be able to use sequencing tools to quickly and accurately screen and diagnose patients the bacteria present in their mouths.

“One of the goals of our research is to better understand how the microbiome may influence the immune response to cancer and how the immune response affects the microbiome in turn,” says Rafael Guerrero-Preston, assistant professor of otolaryngology–head and neck surgery at the Johns Hopkins University School of Medicine. “Our findings suggest that we may one day use the composition of the microbiome to test for disease.”

Trillions of microbes colonize the adult body. Changes in this community have already been tied to the risk and presence of arthritis, multiple sclerosis, irritable bowel syndrome, and cancer.

With more information on how these microbes are connected with cancer and cancer risk factors—such as genetic predispositions, smoking, and other environmental factors—researchers hope to create individualized screening and treatment plans for cancer patients and for those at an increased cancer risk.

For this study, Guerrero-Preston and his colleagues extracted bacterial DNA from the saliva of 42 patients. Seventeen samples were drawn from people with head and neck squamous cell carcinoma, seven of which were positive for HPV and 10 of which were HPV-negative. Twenty-five noncancerous samples were used as a control.

The bacterial DNA found in the saliva was sequenced and sorted into groups of highly related populations. Through further DNA analysis, researchers were then able to determine the category, or genus, of bacteria to which each group belonged.

The researchers found differences in the bacterial populations present in cancerous versus noncancerous samples.

Samples from patients with tumors, for example, showed increased populations of Streptococcus, Dialister, and Veillonella genera, as well as decreased populations of Neisseria, Aggregatibacter, Haemophilus, and Leptotrichia genera with respect to controls.

Tumor samples also showed an increased prevalence of the Lactobacillus genus, which was present in 9.1 percent of tumor samples and in only 0.1 percent of the healthy controls.

In addition, the researchers found correlations between the types of bacteria present and the patients' HPV statuses.

HPV-positive samples had increased abundances of Gemellaceae, Leuconostoc, and Veillonella genera when compared to HPV-negative samples.

Veillonella, for example, was present in 15 percent of HPV-positive tumor samples but was only present in 9.4 percent of HPV-negative tumor samples.

“We see some specific bacterial populations that are increased or lost in the presence of cancer when compared to healthy controls,” Guerrero-Preston says.

This may mean that either the tumor is affecting the environment in the mouth by killing bacteria that would fight cancer or that the patients may be predisposed to cancer because they originally lacked bacteria that prevent tumor development.

Guerrero-Preston cautions that these findings do not establish a direct cause-and-effect link between any of the bacteria and head and neck cancer, stressing their preliminary nature.

In particular, he says, future research needs to distinguish between the detection of bacterial DNA and the effects of the bacteria themselves.

In order to determine how bacteria affect the oral environment, Guerrero-Preston's team intends to look at which genes bacteria have turned on in saliva samples.

If the differences in the microbiome between cancerous and noncancerous patients are confirmed in further studies, doctors may be able to use the same sequencing tools as Guerrero-Preston to quickly and accurately screen and diagnose patients the bacteria present in their mouths.

Read more from Hopkins Medicine

Source: https://hub.jhu.edu/2016/06/29/bacterial-colonies-cancer-growth/

Treatment Options: Johns Hopkins Head & Neck Cancer Center

Oropharyngeal Cancer | Johns Hopkins Medicine

Patients at The Johns Hopkins Head and Neck Cancer Center benefit from access to top experts in all areas of cancer treatment. This includes specialists in head and neck surgery, medical oncology, radiation oncology, reconstructive surgery, pathology, rehabilitation, radiology, neurology and oral surgery.

Different cancer treatments have varying effects on patients’ quality of life. At Johns Hopkins, our physicians are committed to preserving quality of life while maximizing efforts to defeat cancer.

Physicians routinely collect information regarding all facets of quality of life for head and neck cancer patients, including speech, swallowing and social functioning, and will invite you to participate in our studies to help our understanding of how cancer therapies affect daily living activities.

Radiation therapy is often a part of standard treatment for head or neck cancer patients.  It can cause problems such as infection to the gums, mouth sores and tooth decay.

For this reason, it is important for you to visit your dentist and to have any needed dental treatment completed PRIOR to starting radiation treatment at The Johns Hopkins Kimmel Cancer Center.

Dental treatment AFTER radiation treatment can be complicated by slow healing and the risk of infection.

Importance of Seeing a Dentist Prior to Radiation Treatment for Head and Neck Cancer

Radiation treatment used during your cancer care can harm normal cells including cells in your mouth.

If you go to the dentist before head and neck radiation treatment begins, you can help prevent serious mouth problems from developming after or during your radiation treatment.

Side effects of radiation treatment often happen to a patient because their mouth is not healthy before the radiation treatment begins.

Intensity-Modulated Radiation Therapy (IMRT)

IMRT is an advanced method of radiation therapy that ‘modulates’ (or is able to vary the intensity) of the dose of radiation to the tumor while minimizing the dose to the surrounding normal structures.

This is achieved through computer-controlled machines and multiple beams of radiation from different angles. The radiation beams shape can change during treatment, bending around healthy tissues to target just the cancerous tissue.

The result is a ‘cloud’ of radiation that is designed to conform to the three-dimensional shape of the tumor while reducing the radiation dose to the surrounding normal parts of the head and neck.

This helps to reduce the risk of side-effects which can show up during treatment and also helps to reduce the risk of developing injury to important functions such as saliva production and swallowing. 

The radiation planning process involves the correct identification of the anatomical location of the tumor and the normal structures in the patient.  Physicians use diagnostic imaging tools including computed tomography (CT), positron emission tomography (PET) and magnetic resonance imaging (MRI) in addition to physical findings.

  The radiation therapy is typically administered in a series of daily appointments (Monday through Friday) over five to seven weeks.  In order to increase treatment precision, the patient is immobilized with the help of a custom fitted mask.  The mask is made during the radiation “planning session” and is molded to fit the individual patient.

  The mask is made of a thermoplastic material which is soft when heated and becomes rigid when it cools.
 

View a video on radiation treatment

More information about radiation oncology

Neoadjuvant chemotherapy ( Chemotherapy ONLY, given prior to Radiation or Surgery )

Neoadjuvant (or induction ) chemotherapy is a drug treatment given to cancer patients before radiation or surgery. The aim is to reduce the size of the tumor and decrease distant metastasis, hoping to improve the success of additional treatments.

At Johns Hopkins, a combination of cisplatin, docetaxal and 5 FU (Fuorouracil ) is used primarily for patients with bulky, locally advanced squamous cell cancers of the head and neck.  These tumors are typically found in the mouth, tonsils, base of the tongue, hypopharynx, and larynx.

In certain patients with undifferentiated sinonasal cancers (rare cancers of the nasal cavity or sinuses) and esthesioneuroblastomas (a rare cancer of the upper nasal cavity), a combination of cisplatin and etoposide is used. 

Current clinical trials studying the use of induction chemotherapy includes a combination of afatinib, carboplatin and paclitaxel followed by concurrent chemotherapy and radiation.

Concurrent chemoradiation (Chemotherapy and Radiation together)

Concurrent chemoradiation is the administration of a drug during radiation therapy. At Johns Hopkins, this treatment is considered the standard of care in the following circumstances:

  • For localized squamous cell carcinomas (those that have not spread beyond the sinuses, mouth, throat, and the neck) that cannot be completely removed with surgery. This is termed unresectable cancer.
  • For patients who have had their cancer completely removed by surgery but are at high risk for recurrence of the cancer – in this situation, surgery is followed by chemoradiation.
  • For patients with locally advanced larynx cancer (cancer of the voicebox that has spread to nearby tissue or lymph nodes) that would necessitate removal of the larynx – in this situation, chemoradiation may be appropriate to try to preserve the patient’s natural voice; surgery is then reserved for recurrence of the cancer in the larynx or if the cancer is not completely eradicated by chemoradiation.
  • For certain patients with cancers of the oropharynx (ex. tonsil, tongue) – chemoradiation instead of surgery may be appropriate to preserve speech/swallowing abilities.

In addition, Johns Hopkins offers several clinical trials to improve upon current chemoradiation therapy for patients with head and neck squamous cell carcinoma. You will be invited to participate in these trials if you are eligible.

  • The addition of tadalafil to improve the immune function during chemoradiation.
  • The addition of the HPV (human papilloma virus) vaccine after completion of chemoradiation.
  • Radiation de-intensification to decrease treatment related toxicities for patients with HPV related cancers.
  • Treatment intensification by adding dasatinib and cetuximab to the chemoradiation.  

View a video on chemotherapy treatment 

Surgery

Whenever possible, oncology surgeons at Johns Hopkins aim to use minimally invasive surgical techniques to best preserve patients’ function and appearance.

Small tumors sometimes can be removed during outpatient surgeries under local or general anesthesia. If the cancer is larger, a patient most ly would need to stay in the hospital following surgery.

Your physicians will discuss the best type of operation for you, depending on the size and location of your cancer, and whether it has spread.

Listed below are some procedures Johns Hopkins surgeons are using to remove tumors. Because of the high volume of complex cancers being treated at our medical center, our surgeons have extensive experience in performing these procedures.

Transoral Endoscopic Surgery

Many patients with smaller tumors in the mouth, throat and voice box may be candidates for tumor removal through the mouth (transoral).  This is a minimally invasive technique that avoids incisions through the neck or face. These procedures result in less swelling, less scarring and a lower risk of infection.

It also helps preserve function and appearance. Patients may be able to eat right after surgery, and even if their voice is affected it may be still be functional.

 Our team has much experience in transoral surgery using both the laser and the surgical robot (transoral robotic surgery or TORS).

  Johns Hopkins was the first center in Maryland to begin TORS and remains a leader in this area.

Neck Dissection with Nerve Preservation

Neck dissection operations take out lymph nodes, that may have cancer, on one or both sides of the neck through an incision in the neck.

Traditionally, surgeons have removed tissue from five areas or levels in the neck, sometimes resulting in significant impairment to shoulder function and producing accompanying pain and numbness.

With advances in the field, there are now several types of neck dissections, varying what structures are affected by cancer and need to be removed.

Johns Hopkins surgeons, when possible, now perform modified or selective neck dissection procedures.

Whenever possible the involved lymph nodes are removed, sparing the sternocleidomastoid muscle (a long muscle in the neck that rotates the neck and flexes the head), the spinal accessory nerve (a nerve that carries messages from the central nervous system to two major neck muscles) and the internal jugular vein (a major blood vessel that drains blood from the head, brain, face and neck and sends it toward the heart).

In the selective procedures, surgeons operate on fewer areas, preserving function in the shoulder, and can sometimes leave the sensory nerves, preventing numbness, especially in the earlobe.

Most procedures must be done on an inpatient basis, with patients staying in the hospital for one night. In some cases, patients may go home the same day.

Transoral Robotic Surgery (TORS)

Surgery is one option for treating oropharynx tumors – cancers occurring in the throat, base of the tongue, and tonsils.

Conventionally, removing tumors through surgery required a very large neck incision and cutting of the bottom jaw. This left patients with difficulty in swallowing and speaking.

Today, advances in surgical equipment have made it possible to reach orophayrngeal tumors through incisions in the mouth by using robotic technology.

Who Benefits?

Patients that may benefit most from robotic procedures include those with early stage tumors with little or no lymph node involvement in the neck.

Approximately 10 to 20 percent of patients with oropharygeal tumors may be considered ideal candidates for the procedure.

Patients who smoke tobacco or have HPV negative tumors are especially encouraged to receive a primary surgical treatment for their cancer as these cancers often do not respond as well to radiation and chemotherapy.

What are the Benefits?

Studies have shown that the outcomes of such procedures – called transoral robotic surgery – result in swallowing and speech function that is as good or better than other surgical methods, but without disfiguring scars.

While up to 20 percent of patients who receive combination chemotherapy and radiation may have feeding tubes inserted for an average of five years, zero to 5 percent of patients undergoing transoral procedure need the tubes during the same time.

For physicians performing TORS, a guided endoscope helps create a high resolution, 3D image of the back of the mouth and throat, typically a difficult area to reach with conventional tools. With two robotically-guided instruments that act as a surgeon’s arms, tumors are able to be dissected free from surrounding tissue safely.

Pairing Surgery with Radiation

Most patients undergoing TORS for oropharyngeal cancer still need to receive radiation therapy. But since the tumor has been surgically removed, radiation doses are generally lower than for patients who receive combined chemotherapy and radiation regimens.

Ongoing Surgical Research at Johns Hopkins

Johns Hopkins surgeons are monitoring patients who receive TORS for oropharyngeal cancer with pre- and post-operative tests on swallowing, speech and quality of life. The results may help surgeons compare the outcomes of robotic procedures with more conventional ones.

Surgeons at Johns Hopkins are working with computer and bioengineering experts at the Johns Hopkins University to develop a robotic tool to improve surgeons’ access to the larynx (voice box). Head and neck cancer physicians generally use a flexible scope called a laryngoscope to access the voice box and other areas of the throat.

Johns Hopkins experts are developing a robotic laryngoscope that can be used by thumbing a joystick with one hand. By threading a laser fiber optic line through the device, surgeons can remove tumors without using a scalpel in otherwise unreachable areas.

They believe that such a device can also provide improved high resolution images of the throat, dexterity around corners, and required stability to use in operating room settings.

Scarless Surgery for Thyroid Tumors

To avoid a disfiguring scar across the neck from thyroid surgery, patients are turning to Johns Hopkins surgeons who are testing new techniques to remove the endocrine gland without a neck scar.

Young, healthy patients with select benign or suspicious lesions in the thyroid could be considered candidates for the procedures. Approximately half of all thyroid surgeries are done for benign or suspicious lesions. Patients with known cancers must undergo surgery via the neck because surgeons need to remove both sides of the thyroid gland and dissect lymph node tissue surrounding it.

In one procedure that was first developed in South Korea, surgeons enter through the axilla (or armpit) and use robotic arms extended under the chest to access the thyroid. Doctors say there a similar risk profile with this procedure, and patients retain good speech and swallowing ability.

Johns Hopkins surgeons will be monitoring outcomes of patients treated with the procedure. They are also studying the feasibility of removing the thyroid gland through the bottom of the mouth with robotic devices.

Source: https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/head_neck/cancers/treatment.html

Oral Candidiasis

Oropharyngeal Cancer | Johns Hopkins Medicine

— The first section of this topic is shown below —

  • Candida albicans
    • This is the dominant organism in oral candidiasis (~80% of colonizing isolates).
      • C. albicans may cause infection alone or in combination with non-C. albicans species.
    • Typically susceptible to azole antifungals, but resistance can develop.
  • Non-albicans Candida spp
    • Most common non-C. albicans organisms: C. glabrata,C. tropicalis, C. dubliniensis and C. krusei.
    • C. glabrata may occur as part of a mixed infection (along with C. albicans) and can cause fluconazole refractory infections, some of which can prove resistant to other azoles as well.

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  • Candida albicans
    • This is the dominant organism in oral candidiasis (~80% of colonizing isolates).
      • C. albicans may cause infection alone or in combination with non-C. albicans species.
    • Typically susceptible to azole antifungals, but resistance can develop.
  • Non-albicans Candida spp
    • Most common non-C. albicans organisms: C. glabrata,C. tropicalis, C. dubliniensis and C. krusei.
    • C. glabrata may occur as part of a mixed infection (along with C. albicans) and can cause fluconazole refractory infections, some of which can prove resistant to other azoles as well.

There's more to see — the rest of this entry is available only to subscribers.

Shoham, Shmuel. “Oral Candidiasis.” Johns Hopkins ABX Guide, The Johns Hopkins University, 2020. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540400/all/Oral_Candidiasis. Shoham S. Oral Candidiasis. Johns Hopkins ABX Guide. The Johns Hopkins University; 2020. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540400/all/Oral_Candidiasis. Accessed May 18, 2020.Shoham, S. (2020). Oral Candidiasis. In Johns Hopkins ABX Guide. The Johns Hopkins University. Retrieved May 18, 2020, from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540400/all/Oral_CandidiasisShoham S. Oral Candidiasis [Internet]. In: Johns Hopkins ABX Guide. The Johns Hopkins University; 2020. [cited 2020 May 18]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540400/all/Oral_Candidiasis.* Article titles in AMA citation format should be in sentence-caseMLAAMAAPAVANCOUVERTY – ELECT1 – Oral CandidiasisID – 540400A1 – Shoham,Shmuel,M.D.Y1 – 2020/02/08/BT – Johns Hopkins ABX GuideUR – https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540400/all/Oral_CandidiasisPB – The Johns Hopkins UniversityDB – Johns Hopkins GuideDP – Unbound MedicineER –

Source: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540400/all/Oral_Candidiasis

Oropharyngeal Cancer

Oropharyngeal Cancer | Johns Hopkins Medicine

Linkedin Pinterest What is Head and Neck Cancer Cancer

The oropharynx consists of the structures in the back of the throat, including the base of tongue, palatine tonsils, posterior pharyngeal wall and soft palate.

There are many different types of cancers of the oropharynx, however the vast majority are squamous cell carcinomas. Squamous cell carcinomas can be divided into two types, HPV-positive and HPV-negative.

There are about 15,000 new cases of oropharyngeal cancer each year, with the vast majority being HPV-positive.

More information about HPV-positive squamous cell carcinoma

What are the symptoms of oropharyngeal cancer?

Symptoms of oropharyngeal cancer include:

  • Neck mass
  • Difficulty swallowing
  • Muffled voice quality
  • Ear pain
  • Throat pain or sore throat
  • Lump or mass in the back of the throat

How is oropharyngeal cancer diagnosed?

Many patients with oropharyngeal cancer initially present with a neck mass. Any adult with a neck mass for more than two weeks should see an otolaryngologist for an evaluation.

An evaluation consists of a complete head and neck examination, including looking into the throat and voice box with a small scope that is passed through the nose to allow the physician to see if there are any suspicious masses.

A fine-needle aspiration biopsy, a procedure that places a small needle into the neck mass to extract cells, is performed under local anesthesia.

This allows a pathologist to evaluate the cells under a microscope to determine the cause of the neck mass.

Oftentimes the pathologist is able to determine whether the mass is cancerous or benign, and if cancerous, the type of cell the cancer comes from. A complete workup involves imaging, which may include a MRI, CT scan or PET scan.

Oropharyngeal cancer treatment

Treatment for oropharyngeal cancer depends on a number of factors, including but not limited to: type of cancer, size of the tumor and location of cancer, speech and swallow function and overall medical condition of the patient.

Treatments include surgery, radiation and chemotherapy.

Our team specializes in both open and minimally invasive robotic surgery, the most advanced techniques in head and neck radiation and the newest chemotherapy options.

Usually one treatment modality is used for early stage cancers (either radiation or surgery) and combined treatment modalities are recommended for advanced stage cancers (surgery and radiation).

Scientists are currently investigating immunotherapy for head and neck cancers.

This treatment approach, which has been effective in other types of cancer, uses drugs and vaccines to harness the immune system’s natural ability to fight cancer.

A few immunotherapy drugs have been approved for second-line therapy in some advanced head and neck cancers, and investigators are looking into whether a combination of immunotherapy and radiation could improve outcomes.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/oropharyngeal-cancer

Robert L. Ferris, MD, PhD, FACS

Oropharyngeal Cancer | Johns Hopkins Medicine

  • Director, UPMC Hillman Cancer Center
  • Hillman Professor of Oncology
  • Associate Vice Chancellor for Cancer Research
  • Co-Director, Tumor Microenvironment Center
  • Professor, Department of Otolaryngology, of Immunology, and of Radiation Oncology
  • 1986-1990 B.A. Chemistry, University of North Carolina at Chapel Hill (with honors and distinction)
  • Graduate:1990-1995 Johns Hopkins Medical School M.D. Baltimore, MD
  • Graduate: 1993-1998 Johns Hopkins Medical School Ph.D. Immunology Baltimore, MD
  • 1995-1996 Department of General Surgery John L. Cameron, MD Johns Hopkins Hospital Surgery Baltimore, MD
  • 1996-2000 Residency in Otolaryngology Charles W. Cummings, MD Head and Neck Surgery, Johns Hopkins Hospital

Choby GW, Kim J, Ling DC, Abberbock S, Mandal R, Kim S, Ferris RL, Duvvuri U.

Transoral robotic surgery alone for oropharyngeal cancer: quality-of-life outcomes. JAMA Otolaryngol Head Neck Surg. 2015 Jun;141(6):499-504.

Griffith CC, Pai RK, Schneider F, Duvvuri U, Ferris RL, Johnson JT, Seethala RR. Salivary gland tumor fine-needle aspiration cytology: a proposal for a risk stratification classification. Am J Clin Pathol. 2015 Jun;143(6):839-53

Maxwell JH, Thompson LD, Brandwein-Gensler MS, Weiss BG, Canis M, Purgina B, Prabhu AV, Lai C, Shuai Y, Carroll WR, Morlandt A, Duvvuri U, Kim S, Johnson JT, Ferris RL, Seethala R, Chiosea SI.  Early Oral Tongue Squamous Cell Carcinoma: Sampling of Margins From Tumor Bed and Worse Local Control. JAMA Otolaryngol Head Neck Surg. 2015 Jul 30:1-8.

Ferris RL, Baloch Z, Bernet V, Chen A, Fahey TJ 3rd, Ganly I, Hodak SP, Kebebew E, Patel KN, Shaha A, Steward DL, Tufano RP, Wiseman SM, Carty SE; American Thyroid Association Surgical Affairs Committee. American Thyroid Association Statement on Surgical Application of Molecular Profiling for Thyroid Nodules: Current Impact on Perioperative Decision Making. Thyroid. 2015 Jul;25(7):760-8.

Holsinger FC, Ferris RL.Transoral Endoscopic Head and Neck Surgery and Its Role within the Multidisciplinary Treatment Paradigm of Oropharynx Cancer: Robotics, Lasers, and Clinical Trials. J Clin Oncol. 2015 Sep 8. pii: JCO.2015.62.3157.

Chapman, BV, Wald Al, Akhtar P, Munko AC, Xu J, Gibson SP, Grandis JR, Ferris RL, Khan SA. MicroRNA-363 targets myosin 1B to reduce cellular migration in head and neck cancer. BMC Cancer 2015 Nov 6;15:861.

Li J, Srivastava RM, Ettyreddy A, Ferris RL.  Cetuximab ameliorates suppressive phenotypes of myeloid antigen presenting cells in head and neck cancer patients. J Immunother Cancer. 2015 Nov 17;3:54. 2015.

Concha-Benavente, F, Srivastava, RM, Trivedi, S, Y Lei, U Chandran, RR. Seethala5, GJ. Freeman, and RL Ferris. Identification of the cell-intrinsic and extrinsic pathways downstream of EGFR and IFNγ that induce PD-L1 expression in head and neck cancer. Cancer Research,in press

Garcia-Bates Tatiana, Kim Eun, Concha-Benavente, Trivedi Sumita, Mailliard Robbie B, Gambotto Andrea, Ferris RL. Enhanced cytotoxic CD8 T cell priming using DC expressing HPV-16 E6/E7- p16INK4 fusion protein with sequenced anti-PD1. Journal of Immunology, 2016 March 15 196/6/2429 featured by the “In this Issue” section (Top 10% of articles published in the journal)

Lei Y, Kansy B, Li J, Cong L, Liy Y, Trivedi S, Wen H, Timg JPY, Ouyang H, and Ferris RL. EGFR- targeted mAb therapy modulates autophagy in head and neck squamous cell carcinoma through NLRX1-TUFM protein complex. Oncogene, in press

View Dr. Ferris's most current publications.

Dr. Ferris is a head and neck surgical oncologist with an NIH R01 funded basic/translational immunology laboratory.  He investigates mechanisms of anti-tumor immunity in the microenvironment, as well as immune escape mechanisms developed by tumor cells to evade NK and T cells elimination. Dr.

Ferris’s lab also studies immune checkpoint receptors and cellular immune mechanisms of anti-tumor responses and immunotherapy in phase I and phase II clinical trials, as well as correlative studies of immune markers in the serum and tumor microenvironment.  Dr. Ferris is the Associate Vice Chancellor for Cancer Research and the Co-Director of the Tumor Microenvironment Center.

  In these capacities, his goals are to facilitate and enhance development of new targets and therapeutic agents through collaborative, trans-disciplinary preclinical research and clinical application.

These include immunosuppressive effects which inhibit clinical activity of cetuximab, including suppressive immunologic effects and immune escape mechanisms by tumor cells in cetuximab treated patients.  Dr. Ferris is pleased to serve as contact PI of the NCI P50 Head and Neck SPORE, to further facilitate preclinical and clinical investigations, and to stimulate new collaborations.

  He was elected surgical oncology Co-Chair of the NCI Head and Neck Steering committee, which provides additional opportunities to leverage translational and clinical oncology research.  As co-chair of the ECOG H&N committee, Dr. Ferris is leading two prospective randomized trials.

ECOG 3311 (accrual 268/515) investigates the potential for surgical deintensification through reduced radiation dose in HPV+ oropharyngeal cancer patients treated with transoral robotic or laser surgery. More recently ECOG-ACRIN 3132 compares adjuvant radiation alone vs. cisplation-radiation in patients with disruptive or nondisruptive p53 alteration, using a molecular biomarker of “high risk” status.

NCI NCTN-Network Lead Academic Site, 03/01/16-02/28/17, Co-investigator PI: Brufsky, NIH U10 CA180844

Source: http://www.otolaryngology.pitt.edu/people/robert-l-ferris-md-phd-facs

Oropharyngeal Cancer | Johns Hopkins Medicine

Home > News > News Releases > 2017 > Risk for Developing HPV-Related Throat Cancer Low

October 20, 2017

Screening for oral HPV unwarranted, study suggests

The prevalence of throat (oropharyngeal) cancers caused by the human papilloma virus (HPV) has increased in recent decades, and some groups are much more ly than others to have the oral HPV infections that can cause these cancers. However, a new study by Johns Hopkins Bloomberg School of Public Health researchers shows that the risk of developing HPV-related throat cancer remains generally low.

There has been interest in the possibility of testing for oral HPV infection to identify people who are at high risk for HPV-related throat cancer. The findings, which was published in the Annals of Oncology on Oct. 20, suggest that such testing is not justified at this time.

“Currently available tests for the presence of oral HPV infections are not very predictive of oropharyngeal cancer risk—most people who have an oral HPV infection will eventually clear it on their own,” says study co-author Gypsyamber D’Souza, PhD, an associate professor in the Bloomberg School’s departments of Epidemiology and International Health.

“Despite recent increases in its incidence, HPV-associated oropharyngeal cancer remains a rare cancer in the U.S.,” says co-author Carole Fakhry, MD, MPH, an associate professor in the Johns Hopkins School of Medicine and Bloomberg School’s Department of Epidemiology.

HPV is transmitted to the mouth and throat mostly by performing oral sex and appears to cause about 70 percent of oropharyngeal cancers. These cancers appear at the back of the throat, base of the tongue, or tonsils.

Each year in the United States, there are about 12,000 cases of these HPV-associated cancers, more than 80 percent of them in men, according to the Centers for Disease Control and Prevention.

The incidence of HPV-associated oropharyngeal cancer has been rising since the 1980s, and in the past two decades has doubled among men. HPV is also considered the chief cause of most cervical, vaginal, penile and anal cancers.

The Bloomberg School researchers made use of behavioral and medical data from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014 on 13,089 adults—data that included oral HPV tests.

Oral infections with the dozen HPV types known to cause oropharyngeal cancer (especially HPV 16, the type that causes most throat cancers) were present at low prevalence in every defined group in the study, the researchers found.

Women ages 20 to 69, for example, had a frequency of infection of just over 1 percent, compared to 6 percent for men ages 20 to 69. Men ages 50 to 59 were most ly to have an infection (8.1 percent) of any age group.

Oral sex was clearly associated with a higher prevalence of infection, the researchers found, although the highest infection prevalence was seen only among men. Women with 10 or more lifetime oral sex partners had a relatively low 3.

0 percent prevalence of infection, whereas for men with 10 or more lifetime oral sex partners the figure was 14.4 percent. Prevalence of infection for those reporting zero or one lifetime oral sex partner was consistently low (between 0 and 2.

4 percent).

Smoking also was associated with higher oral HPV prevalence. Prevalence was 14.9 percent among men who smoked and reported five or more lifetime oral sex partners, compared to less than half that (7.3 percent) for men who reported five or more lifetime oral sexual partners but did not smoke.

Infection with any potentially cancer-causing HPV type is not as predictive of cancer risk as it may seem, the researchers note. In part, that is because some HPV types are much more cancer-causing than others.

In fact, one type—type 16—is thought to cause more than 90 percent of all HPV-driven oropharyngeal cancers. The NHANES data showed that oral HPV 16 prevalence was very low on average in all groups, ranging from 0.

1 percent in women ages 60 to 69 to 2.4 percent in men ages 60 to 69.

Consistent with this low prevalence was the data on actual oropharyngeal cancer cases from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) registry. According to the SEER data, men have a lifetime risk of these cancers of only 0.7 percent, while for women the lifetime risk is just 0.2 percent.

“For most people these data should be very reassuring, as they show that their risk of oropharyngeal cancer is very low,” D’Souza says.

Mass screening for oral HPV infection is not advisable, she adds, because existing tests, for example, of oral HPV 16 DNA, currently have more harms (from false positives) than benefits. A positive result on such a test would tend to cause anxiety for the person involved, without conferring a strong benefit by accurately predicting the chance of getting cancer.

D’Souza, Fakhry and their colleagues in this field are working to develop tests that are much more predictive of HPV-oropharyngeal cancer. “We have ongoing studies of strategies for using biomarkers to determine and stratify people’s oropharyngeal cancer risk,” says Fakhry.

A preventive vaccine (Gardasil) against HPV types 6, 11, 16, and 18 has been in widespread use for a decade, and a version that also protects against five other HPV types was FDA-approved in 2014. These vaccines won’t clear existing HPV infections. However, the researchers say, the vaccines should eventually bring all HPV-associated cancer rates down by preventing new infections.

“Understanding personal risk of oropharyngeal cancer: risk-groups for oncogenic oral HPV infection and oropharyngeal cancer,” was written by G. D’Souza, T.S. McNeel, and C. Fakhry.

The research was supported by the National Institute of Dental and Craniofacial Research at the National Institutes of Health (R35 DE026631).

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or bbenham1@jhu.edu and Robin Scullin at 410-955-7619 or rsculli@jhu.edu.

Source: https://www.jhsph.edu/news/news-releases/2017/risk-for-developing-hpv-related-throat-cancer-low.html