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Pathological and Virological Studies of p16-Positive Oropharyngeal Carcinoma with a Good Response to Neoadjuvant Chemotherapy

Human papillomavirus (HPV)-related, p16-positive oropharyngeal carcinoma is considered to be sensitive to anticancer drugs, and the standard treatment is therefore chemoradiotherapy, rather than surgery, especially for aggressive disease. However, with this higher sensitivity, chemotherapy alone may...

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Autores principales: Inukai, Daisuke, Kan, Taichi, Yamanaka, Shunpei, Okamoto, Hiroki, Fujimoto, Yasushi, Ito, Takanori, Taniguchi, Natsuki, Yamamoto, Yuuki, Tsuzuki, Toyonori, Takami, Akiyoshi, Ogawa, Tetsuya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600755/
https://www.ncbi.nlm.nih.gov/pubmed/33003369
http://dx.doi.org/10.3390/microorganisms8101497
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author Inukai, Daisuke
Kan, Taichi
Yamanaka, Shunpei
Okamoto, Hiroki
Fujimoto, Yasushi
Ito, Takanori
Taniguchi, Natsuki
Yamamoto, Yuuki
Tsuzuki, Toyonori
Takami, Akiyoshi
Ogawa, Tetsuya
author_facet Inukai, Daisuke
Kan, Taichi
Yamanaka, Shunpei
Okamoto, Hiroki
Fujimoto, Yasushi
Ito, Takanori
Taniguchi, Natsuki
Yamamoto, Yuuki
Tsuzuki, Toyonori
Takami, Akiyoshi
Ogawa, Tetsuya
author_sort Inukai, Daisuke
collection PubMed
description Human papillomavirus (HPV)-related, p16-positive oropharyngeal carcinoma is considered to be sensitive to anticancer drugs, and the standard treatment is therefore chemoradiotherapy, rather than surgery, especially for aggressive disease. However, with this higher sensitivity, chemotherapy alone may achieve a pathological complete response (CR), making radiation therapy unnecessary. A 46-year-old man with p16-positive squamous cell carcinoma (SCC) of the lateral oropharynx (palatine tonsil) underwent neoadjuvant chemotherapy. This achieved clinically significant tumor shrinkage and therefore surgery was performed for subsequent definitive treatment. Clinical and CT findings indicated a good effect of neoadjuvant chemotherapy on the tumor. A biopsy prior to chemotherapy revealed SCC, which demonstrated p16 immunoreactivity and positive signals for high-risk HPV by RNA in situ hybridization. The post-chemotherapy surgical specimen showed pathological CR and no p16 positive cells nor positive signals for high-risk HPV those were detected in the pre-chemotherapy specimen. There are some reports of chemotherapy alone achieving pathological CR in cases of p16-positive oropharyngeal carcinoma, but none have included high-risk HPV RNA findings. This is the first report of the disappearance of cancer cells as well as p16 staining and a positive signal for high-risk HPV. Achieving pathological CR confirmed by immunohistochemistry and high-risk HPV RNA in situ hybridization in a solid tumor with chemotherapy alone suggests that chemotherapy may have both an antitumor effect and an antiviral effect. Forgoing subsequent radiotherapy and undergoing surgery might be unnecessary and follow-up instead might be sufficient in such cases. Into the future, in an optimal tailored treatment approach, the option of neoadjuvant chemotherapy should be considered for management of p16-positive oropharyngeal carcinoma. Other options such as tumor immunotherapy are also expected to be effective.
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spelling pubmed-76007552020-11-01 Pathological and Virological Studies of p16-Positive Oropharyngeal Carcinoma with a Good Response to Neoadjuvant Chemotherapy Inukai, Daisuke Kan, Taichi Yamanaka, Shunpei Okamoto, Hiroki Fujimoto, Yasushi Ito, Takanori Taniguchi, Natsuki Yamamoto, Yuuki Tsuzuki, Toyonori Takami, Akiyoshi Ogawa, Tetsuya Microorganisms Case Report Human papillomavirus (HPV)-related, p16-positive oropharyngeal carcinoma is considered to be sensitive to anticancer drugs, and the standard treatment is therefore chemoradiotherapy, rather than surgery, especially for aggressive disease. However, with this higher sensitivity, chemotherapy alone may achieve a pathological complete response (CR), making radiation therapy unnecessary. A 46-year-old man with p16-positive squamous cell carcinoma (SCC) of the lateral oropharynx (palatine tonsil) underwent neoadjuvant chemotherapy. This achieved clinically significant tumor shrinkage and therefore surgery was performed for subsequent definitive treatment. Clinical and CT findings indicated a good effect of neoadjuvant chemotherapy on the tumor. A biopsy prior to chemotherapy revealed SCC, which demonstrated p16 immunoreactivity and positive signals for high-risk HPV by RNA in situ hybridization. The post-chemotherapy surgical specimen showed pathological CR and no p16 positive cells nor positive signals for high-risk HPV those were detected in the pre-chemotherapy specimen. There are some reports of chemotherapy alone achieving pathological CR in cases of p16-positive oropharyngeal carcinoma, but none have included high-risk HPV RNA findings. This is the first report of the disappearance of cancer cells as well as p16 staining and a positive signal for high-risk HPV. Achieving pathological CR confirmed by immunohistochemistry and high-risk HPV RNA in situ hybridization in a solid tumor with chemotherapy alone suggests that chemotherapy may have both an antitumor effect and an antiviral effect. Forgoing subsequent radiotherapy and undergoing surgery might be unnecessary and follow-up instead might be sufficient in such cases. Into the future, in an optimal tailored treatment approach, the option of neoadjuvant chemotherapy should be considered for management of p16-positive oropharyngeal carcinoma. Other options such as tumor immunotherapy are also expected to be effective. MDPI 2020-09-29 /pmc/articles/PMC7600755/ /pubmed/33003369 http://dx.doi.org/10.3390/microorganisms8101497 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Inukai, Daisuke
Kan, Taichi
Yamanaka, Shunpei
Okamoto, Hiroki
Fujimoto, Yasushi
Ito, Takanori
Taniguchi, Natsuki
Yamamoto, Yuuki
Tsuzuki, Toyonori
Takami, Akiyoshi
Ogawa, Tetsuya
Pathological and Virological Studies of p16-Positive Oropharyngeal Carcinoma with a Good Response to Neoadjuvant Chemotherapy
title Pathological and Virological Studies of p16-Positive Oropharyngeal Carcinoma with a Good Response to Neoadjuvant Chemotherapy
title_full Pathological and Virological Studies of p16-Positive Oropharyngeal Carcinoma with a Good Response to Neoadjuvant Chemotherapy
title_fullStr Pathological and Virological Studies of p16-Positive Oropharyngeal Carcinoma with a Good Response to Neoadjuvant Chemotherapy
title_full_unstemmed Pathological and Virological Studies of p16-Positive Oropharyngeal Carcinoma with a Good Response to Neoadjuvant Chemotherapy
title_short Pathological and Virological Studies of p16-Positive Oropharyngeal Carcinoma with a Good Response to Neoadjuvant Chemotherapy
title_sort pathological and virological studies of p16-positive oropharyngeal carcinoma with a good response to neoadjuvant chemotherapy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600755/
https://www.ncbi.nlm.nih.gov/pubmed/33003369
http://dx.doi.org/10.3390/microorganisms8101497
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