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#148210 - 04/13/12 04:38 PM HPV vaccine to prevent oral cancer recurrence?
RogerC Offline
"OCF Canuck"
Contributing Member (25+ posts)

Registered: 12/28/11
Posts: 25
Loc: Hamilton, Ontario Canada
http://abcnews.go.com/Health/hpv-vaccine-prevent-cancer-recurrence/story?id=16013281#.T4hQOb_hc3J

"The human papillomavirus (HPV) vaccine has been touted as a way to prevent cervical cancer and genital warts, but a new study suggests the vaccine may also prevent women diagnosed with precancers from developing recurrences.

Researchers randomly assigned more than 1,350 women diagnosed with genital warts or certain precancerous conditions to receive either three injections of the HPV vaccine or a placebo. The women were followed for about four years.

Women who received the vaccine had 46.2 percent lower risk of developing another HPV-related disease after treatment for their genital warts or their precancerous condition."


First, the study subjects did not actually have cancer, they had precancerous conditions. Without treatment, 30-50% of dysplasia progress to cervical cancer. The study points to 46.2% decrease in recurrence... of further HPV precancerous growths, not cancer (right?). As HPV-related oral cancer survivors, progression to cancer has already been established in us. Second, say a new study focuses on cervical cancer survivors, HPV SCC cervical cancer does not necessarily behave the same as HPV SCC oral cancer.
That said, the current study does present scientific validation that something is happening to the virus in those women who receive the vaccine. And it seems from a few forums I visit, there are some H&N survivors who have decided to get it.

My doctor is willing to give it to me but it is not covered in any way where I live. Cost is $550. Fortunately, I can afford it. Clinical benefit unknown.

Thoughts? Would you consider it?




_________________________
FNAB Dx SCC left lymph Sept2/11 (age 43), left tonsillectomy Sept21/11 confirmed primary. T1N2bM0. 35 IMRT both sides Oct17-Dec12/11. Cisplatin week 1,4,7. Non-smoker, non-drinker, p16+.

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#148216 - 04/13/12 08:00 PM Re: HPV vaccine to prevent oral cancer recurrence? [Re: RogerC]
ChristineB Online   content
Administrator, Director of Patient Support Services
Patient Advocate (old timer, 2000 posts)

Registered: 06/23/07
Posts: 8201
Loc: PA
Did I miss something here? From what I read, this article is only talking about other cancers. I did not see OC mentioned at all, unless I missed something.

For those who are HPV+ oral cancer survivors, their risk of a recurrence is already much less than that of patients who are non HPV. The Guardisil shot has been effective in helping to prevent HPV+ 16 and 18 which are the 2 that cause most cancers. There are still many other strains out there that it does not protect you against.

If I were you I would ask the doctor who suggested this to you exactly how they thought it would help an HPV+ oral cancer survivor. Does getting the shot change you from being HPV+ to HPV-?

Hope to hear from Brian (our HPV expert) on this one.
_________________________
Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07, no caregiver
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo extended hospital stay, ICU & burn unit
PICC line w/ IV antibiotics 8 mo
10/4/10, 2/14/11 reconst surg
OC 3 times in 3 years
very happy to be alive smile

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#148244 - 04/14/12 04:29 AM Re: HPV vaccine to prevent oral cancer recurrence? [Re: ChristineB]
Brian Hill Offline
OCF Founder
Patient Advocate (old timer, 2000 posts)

Registered: 03/18/02
Posts: 4646
Loc: Laguna Niguel, CA
Your interpretation of this work is right on. I am going to the NIH/NCI on May 18th to argue alongside Dr. Gillison for a federally funded trial of the vaccines on head and neck cancers. Merck isn't interested in pursuing this - their experience so far (due to their bungled marketing of the cervical cancer use) is less than they would have hoped, and this is a 10 million dollar effort, which they do not wish to fund. GSK has shown interest in a combined private sector, federal, and non profit (OCF) funding group effort to get the answers that we need.

The science community for the most part is a big believer in the vaccines potential in oral. But since the cervix and the oropharynx are not apples and apples, there are a lot of unknowns. Given the low incidence of clinical issues from getting the vaccine, there is little down side except for the cost. Having said that, recurrences in the HPV+ group are very low compared to tobacco carcinogenesis in NEVER smokers ( not non smokers who smoked at some period of their life).

Please note that in the last two weeks we have put a number of stories about the vaccine on the OCF news feed. One about Merck's marketing failures, another about adverse events (almost none), this time being reported outside the FDA reporting system, which confirms what we knew from the FDA collection of data, that there are no more adverse events in this vaccinated group than in an unvaccinated part of the population.

I am pretty far out from my HPV+ diagnosis and treatment in December of 97. I have had many issues, but recurrence of an HPV+ squamous cell carcinoma has not been one of them.
_________________________
Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.

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#148245 - 04/14/12 04:51 AM Re: HPV vaccine to prevent oral cancer recurrence? [Re: ChristineB]
RogerC Offline
"OCF Canuck"
Contributing Member (25+ posts)

Registered: 12/28/11
Posts: 25
Loc: Hamilton, Ontario Canada
Hi Christine, you are correct. There is no reference in the study to oral cancer. The subject title here is my own question. And I'm wondering what people's thoughts are on it since there seems to be HPV+ oral cancer survivors out there going ahead and getting the vaccine.

I did not speak directly to my GP, I spoke with his clerk or nurse and she said he was okay with me receiving it. I take it as he is not giving me any resistance. I can't really speak for him, but I don't think he will offer any explanation of how the vaccine might help because I am the one asking for it, and there is no research to explain it as an oral treatment.

My guess is there are questions, observations and assumptions being made to extrapolate it to preventing HPV+ oral SCC recurrence. Why is there a reduction in future cervical dysplasia in those women who receive the vaccine? Is the vaccine acting as an immune booster to help clear it like what most people can do naturally? If it does have the ability to help eliminate viral load in those already positive, perhaps it can also prevent future oral dysplasia or precursors to oral SCC caused by HPV. The assumption being that HPV+ cervical changes are similar in behaviour to HPV+ oral changes.

I think it helps that HPV is not a robust virus and most people can get rid of it on their own. In contrast, people do not normally clear Hepatitis B, so giving them the Hep B vaccine is unlikely to boost their immune system into clearing it.

Unfortunately, this novel approach will not work on someone who is immunocompromised. The HPV vaccine is not technically doing the work, rather it's the person's immune response to it.


_________________________
FNAB Dx SCC left lymph Sept2/11 (age 43), left tonsillectomy Sept21/11 confirmed primary. T1N2bM0. 35 IMRT both sides Oct17-Dec12/11. Cisplatin week 1,4,7. Non-smoker, non-drinker, p16+.

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#148255 - 04/14/12 09:25 AM Re: HPV vaccine to prevent oral cancer recurrence? [Re: RogerC]
klo Offline
"OCF Down Under"
"Above & Beyond" Member (500+ posts)

Registered: 05/18/10
Posts: 638
Loc: Sydney Australia
RE: consideration of HPV vaccine.

I asked this question of our radiation oncologist this time last year, after the first all clear PET.

Remembering there are no data to suggest any benefits whatsoever once infected with HPV, I asked the RO what his thoughts were. His response was skeptical as to the value, but was ok for both Alex and I to take the course if we really wanted to.

He rightly pointed out that I had likely been exposed to HPV already and my body had reacted "normally" and was doing what it was supposed to by clearing the virus. The protective effect would likely be pointless as my body seemed capable of identifying and clearing the virus.

His attitude towards Alex having the shot was slightly different with his argument being that the vaccine was designed to be preventative and there was no evidence that it could assist in clearing the virus once infected. In Alex's case it was a bit like shutting the gate after the horse had bolted.

Having said all that, I have heard of anecdotal evidence that the vaccine is capable of assisting in erradication of the virus after a person has been infected. This is NOT proven, or even accepted in the scientific community.

I am lucky enough to be good friends with the person responsible for Gardasil in Australia. In Australia, the company responsible is not Merck and they have done a great job of educating and making the vaccine available. Uptake here has been extremely good, with none of the stigma and politics that appears to have limited access or use in the US. Alex and I have been offered the vaccine for free ($220 per shot otherwise). Whilst we seriously considered it, we have decided not to go ahead - mainly due to lack of data and possibly being too little, too late. That Alex could not face another round of any sort of treatment had its part to play as well.
_________________________
Karen
Love of Life to Alex T4N2M0 SCC Tonsil, BOT, R lymph nodes
Dx March 2010 51yrs. Unresectable. HPV+ve
Tx Chemo x 3+1 cycles(cisplatin,docetaxel,5FU)- complete May 31
Chemoradiation (IMRTx35 + weekly cisplatin)
Finish Aug 27
Return to work 2 years on
3 years out Aug 27 2013 NED smile
Still underweight

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#148261 - 04/14/12 12:27 PM Re: HPV vaccine to prevent oral cancer recurrence? [Re: klo]
davidcpa Offline

Administrator, Senior Patient Advocate
Patient Advocate (old timer, 2000 posts)

Registered: 09/28/06
Posts: 8255
Loc: Gulfport, Florida
I told this board 4 or 5 years ago that Dr Anna Giuliano, a HPV researcher from Moffitt, told me that even at my advanced age if I were single she would advise me of getting the vaccine. We traveled and spoke many times together re HPV including appearing before the CDC on behalf of the OCF on the male version of the Gardasil vaccination.
_________________________
David

Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 14, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.

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#148378 - 04/16/12 10:07 PM Re: HPV vaccine to prevent oral cancer recurrence? [Re: davidcpa]
Brian Hill Offline
OCF Founder
Patient Advocate (old timer, 2000 posts)

Registered: 03/18/02
Posts: 4646
Loc: Laguna Niguel, CA
_________________________
Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.

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#148391 - 04/17/12 02:41 AM Re: HPV vaccine to prevent oral cancer recurrence? [Re: Brian Hill]
RogerC Offline
"OCF Canuck"
Contributing Member (25+ posts)

Registered: 12/28/11
Posts: 25
Loc: Hamilton, Ontario Canada
Thanks for posting the specifics Brian.

If I am reading right, although it is premature to speculate, and there may be unknown variables involved, a few points to me show promise:

-women who already had 1 bout of HPV disease (assumes they are HPV+)
-some type of protective immune response is occurring against future HPV disease (if not validated for recurrent SCC at this point, at least precancerous disease)
-it induces a response beyond the 4 subtypes (the response is robust and generalized)
-the response is being exhibited beyond the cervix and in other parts of the female anatomy (perhaps effective in other areas of the body with squamous cells)

The $500+ question still begs statistical significance for those who had treatment for HPV-related cancer, reproductive SCC and oral SCC.
_________________________
FNAB Dx SCC left lymph Sept2/11 (age 43), left tonsillectomy Sept21/11 confirmed primary. T1N2bM0. 35 IMRT both sides Oct17-Dec12/11. Cisplatin week 1,4,7. Non-smoker, non-drinker, p16+.

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#148400 - 04/17/12 03:40 AM Re: HPV vaccine to prevent oral cancer recurrence? [Re: RogerC]
Brian Hill Offline
OCF Founder
Patient Advocate (old timer, 2000 posts)

Registered: 03/18/02
Posts: 4646
Loc: Laguna Niguel, CA
The benefits are clear in the study. WHY they exist is an unknown.

While I personally believe that even though the cervix and oropharynx are very different bits of anatomy, that this virus in each one has the same mechanism of invasion and cell domination/immortalization. Logic would dictate that the vaccines properties which interfere with the virus would be similar. But of course as always we lack a clinical model establishing proof.

The science to date, has convinced the OCF science board that fighting for boys vaccination was justified and worthwhile in oral cancers (not just genital warts), even though there was no hard clinical trial to justify it. As David has pointed out, this was accomplished by cooperating with a broad coalition of other stake holders like the HPV/Anal Cancer Foundation in arguments at the CDC. This was a big study, but conclusions about protection in head and neck recurrence is a more ambiguous issue that protection from the virus itself in a sexually/virus naive boy or girl.
_________________________
Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.

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#148433 - 04/17/12 09:46 PM Re: HPV vaccine to prevent oral cancer recurrence? [Re: Brian Hill]
RogerC Offline
"OCF Canuck"
Contributing Member (25+ posts)

Registered: 12/28/11
Posts: 25
Loc: Hamilton, Ontario Canada
I just re-read the specifics again and I'm confused now.

In the first part, it sounds like they focused on a subgroup who received the vaccine, developed HPV disease anyway, and subsequently had less recurrence than the placebo group. A generalization was made by the authors suggesting benefit of getting the vaccine after HPV disease although that is not what was in the study's methodology.

In the second part, "The studies did not include baseline HPV testing or clinical examination before randomization, so women with ongoing HPV disease were permitted." Therefore, it sounds like some of these women were indeed HPV+, yet not confirmed with any testing before receiving the vaccine.

So I'm confused. Did any of these women benefit from receiving the vaccine AFTER they were HPV+ or not?
Thanks





_________________________
FNAB Dx SCC left lymph Sept2/11 (age 43), left tonsillectomy Sept21/11 confirmed primary. T1N2bM0. 35 IMRT both sides Oct17-Dec12/11. Cisplatin week 1,4,7. Non-smoker, non-drinker, p16+.

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