Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 10, 2016; 7(1): 15-26
Published online Feb 10, 2016. doi: 10.5306/wjco.v7.i1.15
Advanced oropharyngeal squamous cell carcinoma: Pathogenesis, treatment, and novel therapeutic approaches
Paul L Swiecicki, Kelly M Malloy, Francis P Worden
Paul L Swiecicki, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109, United States
Kelly M Malloy, Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI 48109, United States
Francis P Worden, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109, United States
Author contributions: Swiecicki PL, Malloy KM and Worden FP contributed equally drafting of the article, making critical revisions, and final approval of the final article.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paul L Swiecicki, MD, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, 1500 E. Medical Center Drive, SPC 5848, Ann Arbor, MI 48109, United States. pswiecic@med.umich.edu
Telephone: +1-734-6478921 Fax: +1-734-2329365
Received: July 24, 2015
Peer-review started: July 27, 2015
First decision: September 30, 2015
Revised: October 7, 2015
Accepted: November 24, 2015
Article in press: November 25, 2015
Published online: February 10, 2016
Abstract

Oropharyngeal cancer accounts for approximately 2.8% of newly cancer cases. Although classically a tobacco related disease, most cases today are related to infection with human papilloma virus (HPV) and present with locally advanced tumors. HPV related tumors have been recognized as a molecularly distinct entity with higher response rates to therapy, lower rates of relapse, and improved overall survival. Treatment of oropharyngeal cancer entails a multi-disciplinary approach with concomitant chemoradiation. The role of induction chemotherapy in locally advanced tumors continues to be controversial however large studies have demonstrated no difference in survival or time to treatment failure. Surgical approaches may be employed with low volume oropharyngeal cancers and with development new endoscopic tools, more tumors are able to be resected via an endoscopic approach. Given advances in the understanding of HPV related oropharyngeal cancer, ongoing research is looking at ways to minimize toxicities via de-intensification of therapy. Unfortunately, some patients develop recurrent or metastatic disease. Novel therapeutics are currently being investigated for this patient population including immunotherapeutics. This review discusses the current understanding of the pathogenesis of oropharyngeal cancer and treatment. We also discuss emerging areas of research as it pertains to de-intensification as well novel therapeutics for the management of metastatic disease.

Keywords: Oropharyngeal cancer, Human papilloma virus, Transoral robotic surgery, Immunotherapy, Metastatic head and neck squamous cell carcinoma

Core tip: Treatment of oropharyngeal cancer entails a multi-disciplinary approach with concomitant chemoradiation. Given advances in the understanding of human papilloma virus related oropharyngeal cancer, ongoing research is looking at ways to minimize toxicities via de-intensification of therapy. Unfortunately, some patients develop recurrent or metastatic disease. This review discusses the current understanding of the pathogenesis of oropharyngeal cancer and treatment. We also discuss emerging areas of research as it pertains to de-intensification as well novel therapeutics for the management of metastatic disease.