Information and Resources from the U-M Comprehensive Cancer Center

Research Roundup: HPV and Cancer; race and rectal cancer

Researchers at the University of Michigan Comprehensive Cancer Center have found a series of markers that indicate which patients are more likely to survive cancers of the base of the tongue and tonsils. The research is a promising step toward tailored, individualized treatment for a cancer that dramatically impacts swallowing and speaking.

Notably, researchers found that cancers linked to HPV, or human papillomavirus, are the most responsive to current chemotherapy and radiation treatments, while tumors that express high levels of a certain growth factor receptor are the least responsive and most deadly. HPV is the virus that can cause cervical cancer and is the target of a new vaccine. Results of the study appeared in the July 1 issue of the Journal of Clinical Oncology.

"The chemotherapy and radiation therapy we use to treat this type of cancer is very aggressive.

If we can identify those patients most likely to respond, we could reduce the intensity of the therapy for those likely to have the best outcomes. At the same time, we hope to identify new treatments that specifically target those tumors that we know are not responding to current therapies," said Thomas Carey, Ph.D., co-director of the U-M head and neck oncology program.

Cancers of the tonsils and the base of the tongue have increased in recent years, in what Carey calls an "epidemic" of HPV- induced head and neck cancer. At the same time, declines in smoking rates have led to a decrease in the incidence of other types of head and neck cancers.

In the study, researchers treated 66 patients with advanced cancer of the tonsils and the base of the tongue. Study participants were given an initial course of chemotherapy to gauge the tumor's response. Those whose tumor was reduced by more than half of its original size received a full course of chemotherapy and radiation simultaneously. Patients whose tumors did not respond were referred for surgery.

Fifty-four of the 66 participants responded to the initial chemotherapy. Of that group, 62 percent are alive today without evidence of cancer, and 73 percent fully preserved their organs. Participants whose cancer did not respond to the chemotherapy and radiation went on to receive surgery. The researchers found that even with surgery, only four of 11 patients survived.

The researchers found 64 percent of the tumors were positive for high-risk strains of HPV. Almost all of the HPV-positive tumors responded to initial chemotherapy and 78 percent of those patients survived with their organs preserved. Of the HPV- negative study participants, only four of 15 survived. In addition, the researchers found that patients whose tumor expressed a marker called EGFR had worse outcomes.

African-Americans less likely to receive chemotherapy for rectal cancer, U-M study finds

African-American patients and white patients are seeing rectal cancer specialists at similar rates, but African-Americans are still less likely to receive chemotherapy or radiation therapy, according to a University of Michigan Comprehensive Cancer Center study published in the Journal of the National Cancer Institute.

The study found African-Americans were 23 percent less likely to receive chemotherapy for rectal cancer and 12 percent less likely to receive radiation therapy than whites.

"This is very important. We knew that African-Americans were not receiving chemotherapy for rectal cancer at the same rates as white Americans and it was contributing to their increased mortality. Now we have a better idea of where the problem lies: somewhere between the visit with the oncologist and the actual initiation of chemotherapy," said Arden Morris, M.D., M.P.H., assistant professor of surgery at the U-M Medical School.

The study looked at 2,582 whites and 134 African-Americans aged 66 and older who had been diagnosed with rectal cancer. Data was pulled from a National Cancer Institute registry that collects information on cancer incidence, treatment and mortality.

Long-term survival after rectal cancer surgery is up to 20 percent worse for African-Americans than for whites. At the same time, the addition of chemotherapy and radiation is known to improve survival in all rectal cancer patients by as much as 20 percent. Researchers suspect the lack of treatment in African-Americans is largely driving the decreased survival.

"We now know that the initial visit with an oncologist is not the barrier to treatment. Our next step is to better understand the human factors that contribute to this discrepancy. We're interested in hearing what individual people have to say," Morris said.

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