Management of human papillomavirus-positive and human papillomavirus-negative head and neck cancer.

A subset of squamous cell carcinomas of the head and neck is now known to be caused by oncogenic human papillomavirus (HPV) infection. Viral-associated malignancies arise predominantly from the oropharynx and are generally more responsive to treatment compared with non-HPV squamous cell head and neck carcinomas. Although many patients with HPV-positive disease lack the traditional risk factors of tobacco and alcohol use, retrospective recursive partitioning analysis indicates that patients with a >10 pack-year smoking history and HPV-positive disease may be at intermediate risk for survival. This warrants further study in a prospective clinical trial. Thus, current clinical trials that are being designed to study curative treatment regimens, such as transoral surgery or combinations of radiation with systemic therapy, are being developed separately for HPV-positive and HPV-negative disease with attention to tobacco history. This review will discuss some of the ongoing research efforts for HPV-positive and HPV-negative head and neck carcinomas.