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William C. Spanos, MD; Paul Nowicki, MD; Dong Wook Lee, MD; Andrew Hoover, BS; Bruce Hostager, PhD; Anjali Gupta, MD; Mary E. Anderson, MS; John H. Lee, MD

Arch Otolaryngol Head Neck Surg. 2009;135(11):1137-1146.

Background  Human papillomavirus (HPV) is the most identifiable cause of head and neck squamous cell cancer (HNSCC). Compared with HPV-negative HNSCC, HPV-positive HNSCC presents at an advanced stage but with significantly better survival. We created a syngeneic mouse model of HPV-positive and HPV-negative HNSCC by transforming mouse primary tonsil epithelial cells with either HPV oncogenes or a nonantigenic RNA interference strategy that affects similar oncogenic pathways.

Objectives  To examine the effect of radiation therapy on HPV-positive and HPV-negative tumors in immune-competent and immune-incompetent mice and to examine responses in human cancer cell lines.

Design  Prospective in vivo murine model.

Main Outcome Measures  Survival and tumor growth.

Results  For human and murine transformed cell lines, HPV-positive cells were more resistant to radiation and cisplatin therapy compared with HPV-negative cells. In vivo, HPV-positive tumors were more sensitive to radiation, with complete clearance at 20 Gy, compared with their HPV-negative counterparts, which showed persistent growth. Cisplatin in vivo cleared HPV-positive tumors but not HPV-negative tumors. However, neither radiation or cisplatin therapy cured immune-incompetent mice. Adoptive transfer of wild-type immune cells into immune-incompetent mice restored HPV-positive tumor clearance with cisplatin therapy.

Conclusions  The HPV-positive tumors are not more curable based on increased epithelial sensitivity to cisplatin or radiation therapy. Instead, radiation and cisplatin induce an immune response to this antigenic cancer. The implications of these results may lead to novel therapies that enhance tumor eradication for HPV-positive cancers.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Spanos, D. W. Lee, and J. H. Lee, Mr Hoover, and Ms Anderson), Gynecologic Oncology (Dr Nowicki), Pediatrics (Dr Hostager), and Radiation Oncology (Dr Gupta), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City. Drs Spanos and J. H. Lee are now with the Sanford Ear, Nose, and Throat Clinic, Sanford Health and Sanford Research/University of South Dakota, Sioux Falls.

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