Mattia Zaffaroni

HPV-driven cancer: from epidemiology to the HPV-driven tumor board proposal, everything you wanted to know but were afraid to ask

Human papilloma virus (HPV)-related cancers are well-known clinical entities in different body sites. Cervix, anus, and oropharynx are the most common tumors related to the virus infection. The aim of this work was to highlight similarities and differences among HPV-related cancers of different subsites. The narrative review was focused on the following topics: (1) epidemiology, (2) prognostic factors, (3) treatment approaches, (4) radiomic analysis, (5) radiosensitivity, (6) de-escalation strategies. Common aspects as well as differences have been highlighted for cervical, anal and oropharyngeal HPV-related tumors. Common prognosticators in terms of patients characteristics (anemia, smoking habits), tumor histology (lymph node extracapsular extension) biological features (high circuating HPV DNA), blood cell immunomodulating response (high level of tumor-infiltrating lymphocytes and high neutrophil-to-lymphocyte ratio) as good parameters of radiosensitivity (radiosensitivity index RSI, and genomic adjusted radiation dose GARD) have been found among the analyzed tumor subsites. On the contrary, other aspects like treatment approaches (different RT techniques and doses), radiomic analysis and de-intensification strategies were found to be different among tumors. HPV-related tumors have several common prognostic and predictive features that do not translate into common therapeutic approaches and de-intensification strategies. A better understanding of which factors are associated with a high risk of early recurrence or favourble clinical outcomes could help in guiding clinical assessment and screening activities and might improve efforts for precision medicine.