The Role of HPV in Head and Neck Cancer

Human papillomavirus (HPV) infection is sexually transmitted, and it is widely spread in the head and neck region, but its role in tumor development and prognosis has been demonstrated currently only for oropharyngeal cancers (HPV-OPSCC). To date, the role of HPV infection in the genesis and prognosis of non- oropharyngeal HNSCCs is unknown. HPV-OPSCC currently represents an increasingly prevalent and growing entity, and it mainly affects younger men, who are neither smokers nor drinkers, and have a significantly better prognosis. The American Joint Committee on Cancer’s eighth edition of the tumor-node- metastasis (TNM), indeed, distinguishes them from HPV-negative OPSCC. Considering the improved response to treatment and the high overall survival rate, numerous studies have focused on investigating deintensification protocols to minimize post-chemoradiotherapy sequelae. These deintensification strategies include transoral robotic surgery (TORS) and immunotherapy. Cetuximab was the most studied immunotherapy available at the time, and from 2020, in the United States, the HPV vaccine has also been approved for the prevention of HPV-HNSCC. Although these assumptions are promising, we are still far from achieving herd immunity and thus from being able to assess the real effectiveness of vaccines in the prevention of HPV-OPSCC, to date. In conclusion, much has been discovered about the role of HPV in HNSCCs, but much more remains to be revealed; a multidisciplinary approach is crucial for achieving the best possible treatment to patients.