HPV-associated head and neck cancer: a virus-related cancer epidemic

Mutational Landscape of Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma and Association with Immune Checkpoint Inhibitor Outcomes

PURPOSE

Understanding the mutational landscape of recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) is important in identifying biomarkers to determine which patients may benefit from immune checkpoint inhibitors (ICI).

EXPERIMENTAL DESIGN

The HAWK (NCT02207530), CONDOR (NCT02319044), and EAGLE (NCT02369874) studies evaluated R/M HNSCC treatment with durvalumab or durvalumab-tremelimumab. Tumor tissue samples pooled from HAWK/CONDOR (n = 153) and plasma cell-free DNA samples from EAGLE (n = 285) were analyzed to identify somatic alterations and association with survival.

RESULTS

The mutational landscape was similar in tissue and plasma. Compared with the wild type, TP53 mutations were associated with significantly shorter overall survival (OS; HR; 95% confidence interval) with standard of care (SoC; EAGLE: 2.12; 1.20-3.78) and ICIs (HAWK/CONDOR: 1.49; 1.05-2.12 and EAGLE: 1.44; 0.99-2.10). In EAGLE, patients with TP53 mutations had significantly longer OS with durvalumab-tremelimumab versus SoC (P = 0.045). KMT2D mutations were associated with a trend toward longer OS (HR; 95% confidence interval) versus the wild type in HAWK/CONDOR (0.81; 0.56-1.19) and a trend toward longer OS with ICIs versus SoC in EAGLE. For both mutations, a European Cooperative Oncology Group performance status of 1 was associated with worsened OS, and PD-L1 positivity was associated with improved OS.

CONCLUSIONS

This is the first large-scale study to show the mutational landscape of R/M HNSCC and its association with clinical outcomes in patients treated with ICIs or SoC. The TP53 mutation was a negative prognostic marker; however, treatment with durvalumab-tremelimumab significantly improved survival over SoC. Further investigation of KMT2D as a predictive biomarker for immunotherapy in R/M HNSCC is warranted.

Association of esophageal squamous cell carcinoma with head and neck cancer

BACKGROUND AND OBJECTIVES

Esophageal squamous cell carcinomas (ESCC) are often accompanied by head and neck squamous cell carcinoma (HNSCC) and vice versa. Our study aimed to describe the prevalence of HNSCC in patients with ESCC, the chronology of appearance and the impact on survival.

METHODS

A retrospective review was carried out through a computerized database of patients diagnosed with ESCC at Hospital Clinic of Barcelona between January 1999 and June 2019. Demographic data, date of ESCC diagnosis, survival time, primary tumor location, diagnosis of HNSCC and chronological relationship were recorded.

RESULTS

A total of 231 patients with ESCC confirmed histologically were included in the study with a median age of 64 years (IQR, 56.0-72.0), and 178 (77%) were male. The majority of the patients had a history of smoking and alcohol consumption (69.7% and 60.6%, respectively). The predominant location of ESCC was the middle esophagus (n=124, 53.7%). Forty-one patients (17.7%) had HNSCC: 21 (51.2%) were previous, 14 (34.1%) synchronous and 6 (14.6%) metachronous. All the patients were followed and 196 (84.8%) died with a median survival time of 19 months (IQR, 7-66). There were not statistically significant differences among the living patients and the deceased.

CONCLUSIONS

In our setting, a 17.7% of patients with ESCC have an associated HNSCC with no significant differences in survival between patients with both ESCC and HNSCC compared to those with only ESCC. However, the implementation of a screening program could allow the detection of a second primary tumor at early stages.

Actinic keratosis with severe dysplasia and Bowen disease represent distinct pathways of intraepidermal squamous neoplasia: an immunohistochemical study

Intraepidermal squamous neoplasia is a precursor to invasive cutaneous squamous cell carcinoma. The most common type of intraepidermal squamous neoplasia is actinic keratosis (AK), although there is compelling clinicopathological evidence of a second distinct pattern of squamous dysplasia termed Bowen disease (BD). The distinction between these pathways of dysplasia has been inconsistently delineated in the literature. To further investigate the biological differences between AK and BD, a cohort of cases of intraepidermal squamous dysplasia including AK with mild/moderate dysplasia (n=26), AK with severe dysplasia (n=21) and BD (n=47) was prospectively collected. Immunohistochemistry was utilised to assess the protein expression of major tumour suppressor genes including p16, RB-1 and p53. Most cases of BD showed complete loss of RB-1 (∼80%), strong and diffuse positive staining for p16 (∼80%) ​and mutant pattern (diffusely positive or completely negative) of p53 (∼79%). However, lesions of AK showed loss of RB-1 in only 6%, strong and diffuse positive staining for p16 in 4% and mutant pattern of p53 in 85% of case (p<0.001). The statistically significant difference in RB-1 and p16 expressions between AK and BD confirms that the two morphologically distinct types of intraepidermal squamous neoplasia differ in protein expression of major tumour suppressor genes and provide evidence that they represent two distinct genomic pathways of squamous neoplasia. Recognition of clinical and genomic differences between different pathways of squamous neoplasia could potentially have an important role in predicting the biological behaviour and treatment of advanced tumours arising from these precursor lesions.

Metabolomics and network pharmacology approach to identify potential bioactive compounds from Trichoderma sp. against oral squamous cell carcinoma

This study aimed to profile metabolites from five Trichoderma strains and assess their cytotoxic and pharmacological activities, particularly targeting oral squamous cell carcinoma (OSCC). UHPLC-TOF-MS analysis revealed the presence of 25 compounds, including heptelidic acid, viridiol isomers, and sorbicillinol from the different Trichoderma extracts. Pharmacokinetic analysis showed moderate permeability and low interaction with P-glycoprotein, suggesting good drug absorption with minimal interference in cellular uptake. ADME-Tox analysis indicated limited inhibition of cytochrome P450 enzymes, low renal clearance, which are favorable for maintaining therapeutic levels. Toxicity predictions revealed some compounds with potential mutagenicity, but low hepatotoxicity and skin sensitization risks. Network pharmacology identified MAPK1 as a key target for oral cancer, and molecular docking and induced fit docking studies demonstrated strong binding affinities of Trichoderma metabolites, including stachyose and harzianol, to MAPK1. In addition, molecular dynamics (MD) simulations confirmed stable interactions. In vitro studies on NIH3T3 and YD-10B cells showed significant cytotoxicity, particularly with extracts CNU-05-001 (IC50:10.15 µg/mL) and CNU-02-009 (10.00 µg/mL) against YD-10B cells. These findings underscore the potential of Trichoderma metabolites in drug discovery, particularly for cancer therapies.

Improving outcome prediction in oropharyngeal carcinoma through the integration of diffusion-weighted magnetic resonance imaging radiomics

Background and purpose

Locoregional recurrence (LRR) is the primary pattern of failure in head and neck cancer (HNC) following radiation treatment (RT). Predicting an individual patient's LRR risk is crucial for pre-treatment risk stratification and treatment adaptation during RT. This study aimed to evaluate the feasibility of integrating pre-treatment and mid-treatment diffusion-weighted (DW)-MRI radiomic parameters into multivariable prognostic models for HNC.

Materials and methods

A total of 178 oropharyngeal cancer (OPC) patients undergoing (chemo)radiotherapy (CRT) were analyzed on DW-MRI scans. 105 radiomic features were extracted from ADC maps. Cox regression models incorporating clinical and radiomic parameters were developed for pre-treatment and mid-treatment phases. The models' discriminative ability was assessed with the Harrel C-index after 5-fold cross-validation.

Results

Gray Level Co-occurrence Matrix (GLCM)-correlation emerged as a significant pre-treatment radiomic predictor of locoregional control (LRC) with a C-index (95 % CI) of 0.66 (0.57-0.75). Significant clinical predictors included HPV status, stage, and alcohol use, yielding a C-index of 0.70 (0.62-0.78). Combining clinical and radiomic data resulted in a C-index of 0.72 (0.65-0.80), with GLCM-correlation, disease stage and alcohol use as significant predictors. The mid-treatment model, which included delta (Δ) mean ADC, stage, and additional chemotherapy, achieved a C-index of 0.74 (0.65-0.82). Internal cross-validation yielded C-indices of 0.60 (0.51-0.69), 0.56 (0.44-0.66), and 0.63 (0.54-0.73) for the clinical, combined, and mid-treatment models, respectively.

Conclusion

The addition of Δ ADC improves the clinical model, highlighting the potential complementary value of radiomic features in prognostic modeling.

Analytical Validation of NavDx+Gyn, a cfDNA-Based Fragmentomic Profiling Assay for HPV-Driven Gynecologic Cancers

Background/Objectives: The NavDx+Gyn blood test detects and quantifies fourteen HPV types in various sample types to provide a reliable means of detecting and monitoring HPV-driven gynecologic cancers. NavDx+Gyn is an extension of the NavDx assay, which identifies five high-risk HPV types. NavDx has been clinically validated in multiple independent studies for the surveillance of HPV-driven oropharyngeal cancer and has been integrated into clinical practice by over 1300 healthcare providers at over 500 medical sites in the US. The NavDx+Gyn assay incorporates an analysis of nine additional high-risk HPV types. Here, we report a detailed analytical validation of the NavDx+Gyn assay for use in cervical, vaginal, and vulvar cancer patients to detect fourteen high-risk HPV types related to HPV-driven gynecologic cancers. Methods: Parameters include specificity as measured by limits of blank (LoBs) and sensitivity illustrated via limits of detection and quantitation (LoDs and LoQs). Results: The LoBs were between 0 and 0.0926 copies/μL, LoDs were 0.1009 to 0.3147 copies/μL, and LoQs were 0.1009 to 0.3147 copies/μL, demonstrating the high analytic sensitivity and specificity provided by NavDx+Gyn. In-depth evaluations, including accuracy and intra- and inter-assay precision studies, were shown to be within acceptable ranges. Regression analysis revealed a high degree of correlation between expected and effective concentrations, demonstrating excellent linearity (R2 > 0.99) across a broad range of analyte concentrations. Conclusions: These results demonstrate that NavDx+Gyn accurately and reproducibly detects fourteen types of high-risk HPV, which aids in the diagnosis and surveillance of the vast majority of HPV-driven gynecologic cancers.

Human Papillomavirus: A Narrative Review for Dental Providers in Prevention and Care

(1) Introduction: Human papillomavirus (HPV) is a significant public health concern associated with various cancers, including a rising incidence of oropharyngeal cancer (OPC). Despite the availability of effective vaccines targeting high-risk HPV types, vaccination rates remain suboptimal. Dental professionals are uniquely positioned to contribute to HPV prevention through education, vaccination advocacy, and early detection. (2) Methods: This narrative review synthesized the literature from 2006 to 2024 on HPV epidemiology, pathophysiology, vaccine efficacy, and the role of dental providers in HPV prevention. Sources included peer-reviewed articles listed in Pubmed and Google Scholar, including observational studies and review articles, guidelines, clinical trials, and governmental data. Key barriers to HPV-related care in dental practice and strategies for overcoming them were analyzed. (3) Results: The review underscores the critical role of dentists in HPV-related disease prevention, highlighting their ability to detect HPV-related lesions, promote vaccine uptake, and address patient concerns. Barriers such as limited knowledge, discomfort discussing HPV, and misinformation were identified. Strategies like incorporating HPV education into dental training, utilizing emerging diagnostic tools, and adopting effective communication approaches can enhance the role of dental professionals in reducing HPV-associated cancer risks. (4) Conclusion: By integrating HPV education, vaccination advocacy, and early detection into routine dental care, dental professionals can play a transformative role in public health. A dental provider's endorsement can increase HPV vaccine uptake and help prevent oral cancer. These efforts align with broader health promotion goals, offering a significant opportunity to reduce the burden of HPV-associated cancers and improve long-term patient outcomes.

OligoDOMTM: a T-cell response-enhancing platform applied to cancer immunotherapy

Background

Neoepitopes derived (0) from tumors are attractive cancer immunotherapy targets, especially when combined with immune checkpoint inhibitors (CPIs). Vaccines using lipid nanoparticle (LNP)-encapsulated mRNA to deliver neoepitopes have shown encouraging results in patients and animal models, due to T cell-dependent responses. However, a low mutational burden is often a predictor of poor CPI response: the immune response against the few available mutations can be insufficient. An enhanced response to these few mutations could increase CPI efficacy. Here, we investigate the potential of oligoDOM™, a self-assembling sequence, to improve neoepitope immunogenicity and antitumor efficacy in murine cancer models.

Methods

LNP-formulated mRNA constructs encoding short epitope strings fused with oligoDOM™ were tested. Immune responses in mice were compared between constructs with oligoDOM™ and their controls. Specific T-cell responses against four tumor models (MC38, CT26, TC-1, B16-OVA) were measured using ELISpot in naïve mice. Two models (TC-1 and B16-OVA) were further selected for tumor growth efficacy testing.

Results

LNP-formulated neoepitope-oligoDOM™ mRNA constructs induced a significantly superior immune response as compared with the control groups in four neoantigens tested. This increased specific immunogenicity is linked to antitumor growth effects in murine syngeneic cancer models such as the B16-OVA and TC-1. The induced T-cell immune response significantly correlated with tumor growth rate reduction.

Discussion

Combining oligoDOM™ and LNP-mRNA technologies offers a versatile platform that allows for efficient short neoepitope strings delivery. This approach represents a feasible, potentially effective strategy for personalized cancer immunotherapy.

Staging and Treatment Implications in Small Oral Squamous Cell Carcinoma with Bone Infiltration

Background/Objectives: Oral squamous cell carcinoma (OSCC) with bone infiltration is categorized as a T4 tumor regardless of its size. T4 tumors are an indication for postoperative radiotherapy, which could be overtreatment for small oral squamous cell carcinoma (SOSCC) with bone infiltration. Methods: A retrospective study of 189 patients with OSCC with the potential for mandibular infiltration was performed. The influence of the predictive variables on overall survival (OS) and disease-free survival (DFS) was assessed using the Kaplan-Meier method. A random forest approach was applied to determine the importance of each variable for survival in a multivariate context, and a partial correlation analysis was performed. Results: A statistical analysis of the effects of covariates suggested only a small influence of bone infiltration on OS. Patients with bone infiltration had a 5-year OS of 69%, and those without bone invasion had a 5-year OS of 71%. Age, lymph node metastasis, depth of invasion (DOI), and tumor size had the most decisive prognostic influence on survival. Conclusions: Bone infiltration appears to have less prognostic explanatory power than other known variables regarding OS. Therefore, adjuvant therapy should be carefully evaluated.

Mortality of Head and Neck Cancer in China From 1990 to 2019: A Secondary Data Analysis

BACKGROUND

The rising global incidence of head and neck cancer imposes a growing burden on health systems. However, comprehensive analysis of mortality trends, particularly age, period, and cohort effects, remains limited.

OBJECTIVE

This study aims to evaluate head and neck cancer mortality trends in China from 1990 to 2019, with a focus on age, period, and cohort effects.

METHODS

A secondary data analysis was conducted using data from the Global Burden of Disease Study, focusing on the Chinese population aged 20 years and older. The cancers examined included those of the lip-oral cavity, nasopharynx, other pharynx, larynx, and thyroid. Mortality data, including death numbers and age-standardized rates, were analyzed using joinpoint regression and age-period-cohort analysis to identify trends.

RESULTS

The study revealed that from 1990 to 2019, the age-standardized mortality rate for head and neck cancer in China decreased more significantly than the global average. Although the overall trend in China showed a decrease, there were sporadic increases, especially among males. In contrast, females exhibited a more consistent decline. The age-period-cohort analysis demonstrated increasing mortality with age, decreasing mortality over successive periods, and fluctuating cohort effects, with a marked decrease for cohorts born after 1930.

CONCLUSION

Overall, the mortality rate for head and neck cancer in China is declining, with age being a significant risk factor for mortality, and earlier-born cohorts facing higher risks. Continuous monitoring is essential to understand the impact of evolving clinical practice guidelines on the mortality of head and neck cancer.

A review of the carcinogenic potential of human papillomavirus (HPV) in urological cancers

Direct skin-to-skin contact during intimate sexual contact with a human papillomavirus (HPV)-positive individual is often the cause of HPV infection. In addition, many studies have been written up to date that look at the role of HPV in the growth of other types of tumors. Not all urological cancers are associated with HPV. However, penile cancer (PC) is often caused by HPV, especially high-risk types. HPV-16 has been the most frequent (68.3%), followed by HPV-6 (8.1%) and HPV-18 (6.9%). An increased risk of getting certain types of urinary cancers like prostate, bladder, testicular, and kidney has also been linked to these infections. Additionally, HPV may play a part in continuous inflammation and cancer progression in different organs and tissues. So, making HPV vaccine programs available to more people of the male sex around the world could significantly lower the number of urinary cancers caused by HPV. The critical effects of HPV on different types of urologic cancers (UCs), such as testicular, prostate, penile, and kidney cancer, and the importance of HPV vaccination have been seen in this study.

Understanding and treating HPV-associated oropharyngeal carcinoma: insights from a MedNewsWeek Keynote lecture by Dr Theodoros N. Teknos and literature review

Oropharyngeal carcinoma, a type of head and neck cancer (HNC), is an emerging malignancy associated with low survival rates. It typically affects older males and correlates with smoking, drinking, and lower socioeconomic conditions. Traditional treatments such as surgery have often yielded limited outcomes. However, recent insights, particularly those emphasized by Dr Teknos in his Keynote Conference at MedNews Week, have sparked a deeper exploration into alternative and more promising treatment methods. A comprehensive literature review was conducted to explore this subject further. One such approach, demonstrated by the UMCC 9921 trial, involves a comprehensive protocol starting with induction chemotherapy. This initial phase aims to reduce tumor burden and assess response to treatment. Based on the individual outcomes, patients then undergo concurrent chemoradiation or salvage surgery. This strategy has significantly improved survival rates, especially in human papillomavirus (HPV)-positive patients, showcasing the potential of tailored treatments. While these advancements are promising, long-term complications such as dysphagia and osteoradionecrosis remain a cause of concern. The rise of HPV-related head and neck squamous cell carcinoma has further changed how risk factors and treatment outcomes are viewed. HPV-positive cancers have unique characteristics and respond well to modern therapies. Researchers are investigating biomarkers such as circulating HPV DNA and immunoglobulin J polypeptide expression, which could provide valuable insights into disease progression and pave the way for more targeted and effective treatment strategies. In addition, the use of existing medications, such as fenofibrate, to combat HPV infections illustrates the resourcefulness in repurposing specific treatments. Challenges persist, especially in the need for reliable biomarkers for early disease progression detection and monitoring. Deeper insights into viral-host interactions shape promising immunotherapy strategies that could revolutionize treatment approaches. Collaborative efforts between researchers, healthcare providers, and policymakers play a vital role in translating these advancements into substantial clinical benefits, improving outcomes and quality of life for individuals affected by HPV-related diseases. While HPV-associated HNCs present significant challenges, continuous research and innovative treatments offer hope for a brighter future in combating this growing epidemic and improving patient care.

USP14 targets FABP5-mediated ferroptosis to promote proliferation and cisplatin resistance of HNSCC

BACKGROUND

Head and neck squamous cell carcinoma (HNSCC) ranks among the most lethal solid tumors in humans, with a five-year survival rate hovering around 50%. The limited understanding of its biological foundation has hindered the development of efficacious targeted therapeutics.

METHODS

TCGA database and immunohistochemistry were deployed to confirm the expression levels of ubiquitin specific protease 14 (USP14). CCK8 method was used to evaluate the influence of USP14 on cisplatin resistance. Further investigations into the role of USP14 were conducted through assessments of cell proliferation, colony formation, and Transwell assays. The impact of USP14 expression on ferroptosis was evaluated by measuring GSH/GSSG ratios, Fe2+ concentrations, and lipid peroxide levels. Co-IP was employed to verify the interaction between USP14 and FABP5.

RESULTS

Our analysis revealed that USP14 ranked among the most prominently upregulated deubiquitinases (DUBs) in tissue samples of HNSCC. Notably, aberrant USP14 expression was linked to tumorigenesis and the malignant evolution of HNSCC and further suggested a poor prognosis. In vitro experiment revealed that USP14 depletion markedly inhibited cell growth, cisplatin resistance, invasion and migration capabilities of HNSCC cells. Mechanically, USP14 inhibits FABP5 ubiquitination and degradation, thus positively modulating FABP5 expression. Subsequent analyses demonstrated that the loss of USP14 promoted ferroptosis in HNSCC cells. Finally, in vivo xenograft experiments confirmed that the USP14 small molecular antagonist IU1 could effectively attenuate cisplatin resistance in HNSCC.

CONCLUSION

The results indicate that the USP14-FABP5 axis exerts oncogenic effects on HNSCC, providing a potential target for diagnosing and treating this type of malignancy.

HPV Infection and Oral Microbiota: Interactions and Future Implications

Human papillomavirus (HPV) is a leading cause of mucosal cancers, including the increasing incidence of HPV-related head and neck cancers. The oral microbiota-a diverse community of bacteria, fungi, and viruses-play a critical role in oral and systemic health. Oral microbiota dysbiosis is increasingly linked to inflammation, immune suppression, and cancer progression. Recent studies have highlighted a complex interaction between HPV and oral microbiota, suggesting this interplay influences viral persistence, immune response and the tumor microenvironment. These interactions hold significant implications for disease progression, clinical outcomes, and therapeutic approaches. Furthermore, the oral microbiota has emerged as a promising biomarker for HPV detection and disease progress assessment. In addition, probiotic-based treatments are gaining attention as an innovative approach for preventing or treating HPV-related cancers by modulating the microbial environment. In this review, current research on the interaction between HPV and oral microbiota is provided, their clinical implications are explored, and the future potential for utilizing microbiota for diagnostic and therapeutic innovations in HPV-associated cancers is discussed.

Robust HPV-16 Detection Workflow for Formalin-Fixed Cancer Tissue and Its Application for Oral Squamous Cell Carcinoma

BACKGROUND

Virus-related cancers are malignancies caused by specific viruses, such as human papillomavirus (HPV), hepatitis B virus, and human T-cell leukemia virus, contributing significantly to the global cancer burden through persistent infection and oncogenic transformation. The current study aimed to develop a robust HPV-16 detection method for formalin-fixed cancer specimens.

MATERIALS AND METHODS

To prevent false negatives resulting from DNA fragmentation, a DNA quality check step was added. Additionally, this study used multiplex polymerase chain reaction (PCR) covering the entire HPV-16 genome to mitigate effects caused by viral sequence variation. To prove this concept, we analyzed genomic DNA extracted from oropharyngeal cancer tissues known as HPV-16-positive. Subsequently, the protocol was tested on oral squamous cell carcinoma (OSCC) samples in our cohort. Given the wide variation in HPV-16 positivity in previous studies, it remains elusive how frequently HPV-16 is positive in OSCC.

RESULTS

The results showed faint bands or smears in the multiplex PCR of 7 out of 112 cases. Droplet digital PCR confirmed variable positivity levels of HPV-16, suggesting two scenarios of HPV-16 positivity in cancer tissue: cancer cells derived from infected cells or only a portion being HPV-16-positive. Finally, we comprehensively analyzed the case and identified the integration of a deleted HPV-16 genome into the intronic region of the host gene TMEM94 on chromosome 17. To the best of our knowledge, this is the first evidence showing the integration of HPV-16 in OSCC cells and providing its complete viral sequence.

CONCLUSIONS

The established protocol should be applicable to various cancer tissues for analyzing the association with HPV-16 infection.

Connexin 43 Expression as Biomarker of Oral Squamous Cell Carcinoma and Its Association with Human Papillomavirus 16 and 18

Oral squamous cell carcinoma (OSCC) is the main form of head and neck cancer. Gap junctions (GJs) are communication channels involved in cell proliferation control; they consist of hemichannels formed by connexin (Cx) proteins. The abnormal expression/function of Cx43 has been associated with tumor progression. Also, some human papillomaviruses (HPVs) have been linked to squamous cell cancer. Therefore, this study aimed at assessing Cx43 as a potential OSCC biomarker and exploring its association with histopathological differentiation and HPV infection. OSCC samples were inspected using hematoxylin and eosin staining, and Cx43 expression and HPV 16/18 were tested by immunofluorescence. Pearson correlation tests, ANOVA, and Kaplan-Meier curves were used in the analysis. Samples from 39 patients with OSCC were studied. Most had well-differentiated histology and 61.5% were HPV+. Cx43 expression was significantly associated with HPV infection (p = 0.047), differentiation (p < 0.001), and survival (p = 0.009), and HPV positivity was also associated with the degree of differentiation (p = 0.012). Cx43 shows potential as a prognostic biomarker for OSCC. Lower Cx43 expression, correlated with poorer differentiation, is associated with an unfavorable prognosis. Further studies are needed to confirm its clinical utility.

The global, regional, and national burden of oral cancer, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

PURPOSE

This epidemiological study leverages data from the Global Burden of Disease (GBD) database spanning from 1990 to 2021 to analyze the global burden of oral cancer. The research aims to provide a comprehensive assessment of the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASDR), and disability-adjusted life years (DALYs) for oral cancer, examining trends over three decades.

METHODS

The study used age standardized rate (ASRs) as an indicator of oral cancer epidemiological data. Trend analysis uses estimated annual percentage change (EAPC) to track changes in oral cancer indicators.

RESULTS

The study identifies a global increase in oral cancer incidence, mortality, and DALYs. From 1990 to 2021, the global incidence rate increased significantly from 3.26 (95% UI 3.14-3.41) to 5.34 (95% UI 4.94-5.70), the global mortality rate rose from 1.83 (95% UI 1.73-1.92) to 2.64 (95% UI 2.42-2.84), and the global estimate of DALYs increased from 55.05 (95% UI 52.38-57.97) to 74.44 (95% UI 67.50-80.44). High-risk regions include Palau and certain areas in Asia. Middle SDI regions show the most significant growth, while economically underdeveloped areas like parts of Africa show less significant trends.

CONCLUSION

The research underscores the need for heightened awareness, surveillance, and prevention efforts, especially in regions with high oral cancer incidence. Policymakers are urged to implement screening programs and public health education to combat the disease.

Narrow-Band Imaging in Head and Neck Carcinomas: A Systematic Review and Meta-Analysis

OBJECTIVE

The purpose of this study was to assess the diagnostic performance of narrow-band imaging (NBI) in monitoring patients with head and neck carcinomas posttreatment and to compare it with that of white light endoscopy (WLE).

DATA SOURCES

PubMed, Embase, Web of Science (WOS), Cochrane Library, China Biology Medicine disc (CBM disc), China National Knowledge Internet (CNKI), Wanfang Data, China Science and Technology Journal Database (CSTJ), Chinese Clinical Trial Register.

REVIEW METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), literature published before July 2024 was searched. Patients who underwent surgery, radiotherapy (RT), or chemo-RT for head and neck carcinomas with posttreatment follow-up using NBI were analyzed. The main outcomes were sensitivity, specificity, and diagnostic odds ratio (DOR) for NBI and WLE in posttreatment follow-up.

RESULTS

The sensitivity, specificity, and DOR for NBI and WLE in posttreatment follow-up for head and neck carcinomas were 95% (95% confidence interval [CI]: 88%-98%), 96% (95% CI: 92%-98%), 433 (95% CI: 120-1560) and 72% (95% CI: 49%-87%), 72% (95% CI: 4%-99%), 7 (95% CI: 0-191). Additionally, the area under the curve (AUC) values for NBI and WLE were 0.99 (95% CI: 0.97-0.99) and 0.75 (95% CI: 0.71-0.79), respectively. The number of lesions and patients, treatment modality, follow-up time, disease, and endoscopic system might be sources of heterogeneity.

CONCLUSION

Compared to WLE, NBI demonstrated superior diagnostic performance in follow-up patients with head and neck carcinoma posttreatment. NBI offers technical support and a clinical foundation for early detection of head and neck carcinoma recurrence.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:34-44, 2025.

Benchtop to at-home test: Amplicon-depleted CRISPR-regulated loop mediated amplification at skin-temperature for viral load monitoring

CoRPLA (CRISPR-regulated One-pot Recombinase Polymerase Loop-mediated Amplification) is an amplicon-depleted skin-temperature operated iNAAT designed for at-home testing. It uses specially designed loop primers to enhance isothermal amplification, triggering Cas12 for in-situ amplicon depletion and signal amplification. This method addresses issues like amplicon-derived aerosol contamination and complex assay formats, enabling quantitative detection with sub-attomolar sensitivity (0.5 cps/μL). CoRPLA employs a DNA hydrogel wearable tape for real-time, colorimetric readout, allowing visual differentiation of pathogen loads. It was validated with clinical samples for SARS-CoV-2, RSV, influenza A, and HPV, successfully identifying multi-level viral loads of the positive cases with results consistent with qPCR. Offering high sensitivity while eliminating false positives from aerosol contamination, CoRPLA bridges the molecular assay from benchtop to home for daily viral infections monitoring.

Precision meets repurposing: Innovative approaches in human papillomavirus and Epstein-Barr virus-driven cancer therapy

Viral malignancies represent a distinct entity among cancers. Oncoviruses like the Human Papilloma Virus (HPV) and the Epstein Barr Virus (EBV) are highly potent inducers of oncogenic transformation leading to tumor development. HPV and EBV are known to be increasingly involved in the pathogenesis of various classes of cancers like cervical, head and neck, colorectal, breast, oral and anogenitial. Therapeutic vaccines directed at such oncoviruses, often fail to unleash the desired immune response against the tumor. This is largely due to the immunosuppressive microenvironment of the virus-induced tumors. Consequently, metronomic chemotherapies administered in conjunction with therapeutic viral vaccines have considerably enhanced the antitumor activity of these vaccines. Moreover, given the unique attributes of HPV and EBV-associated cancers, therapeutic agents directly targeting the oncoproteins of these viruses are still obscure. In this light, an increasing number of reports have evidenced the repurposing of drugs for therapeutic benefits in such cancers. This work delineates the significance and implications of metronomic chemotherapy and drug repurposing in HPV and EBV-associated cancers.

Diffusion-Weighted MRI and Human Papillomavirus (HPV) Status in Oropharyngeal Cancer

BACKGROUND

This study aimed to explore the differences in quantitative diffusion-weighted (DW) MRI parameters in oropharyngeal squamous cell carcinoma (OPC) based on Human Papillomavirus (HPV) status before and during radiotherapy (RT).

METHODS

Echo planar DW sequences acquired before and during (chemo)radiotherapy (CRT) of 178 patients with histologically proven OPC were prospectively analyzed. The volumetric region of interest (ROI) was manually drawn on the apparent diffusion coefficient (ADC) map, and 105 DW-MRI radiomic parameters were extracted. Change in ADC values (Δ ADC) was calculated as the difference between baseline and during RT at week 4, normalized by the baseline values.

RESULTS

Pre-treatment first-order 10th percentile ADC and Gray Level co-occurrence matrix (GLCM)-correlation were significantly lower in HPV-positive compared with HPV-negative tumors (82.4 × 10-5 mm2/s vs. 90.3 × 10-5 mm2/s, p = 0.03 and 0.18 vs. 0.30, p < 0.01). In the fourth week of RT, all first-order ADC values were significantly higher in HPV-positive tumors (p < 0.01). Δ ADC mean was significantly higher for the HPV-positive compared with the HPV-negative OPC group (95% vs. 55%, p < 0.01). A predictive model for HPV status based on smoking status, alcohol consumption, GLCM correlation, and mean ADC and 10th percentile ADC values yielded an area under the curve of 0.77 (95% CI 0.70-0.84).

CONCLUSIONS

Our results highlight the potential of DW-MR imaging as a non-invasive biomarker for the prediction of HPV status, although its current role remains supplementary to pathological confirmation.

Fibroblasts regulate the transcriptional signature of human papillomavirus-positive keratinocytes

Persistent human papillomavirus (HPV) infection is necessary but insufficient for viral oncogenesis. Additional contributing co-factors, such as immune evasion and viral integration have been implicated in HPV-induced cancer progression. It is widely accepted that HPV + keratinocytes require co-culture with fibroblasts to maintain viral DNA as episomes. How fibroblasts regulate viral episome maintenance is a critical knowledge gap. Here we present comprehensive RNA sequencing and proteomic analysis demonstrating that coculture with fibroblasts is supportive of the viral life cycle, and is confirmatory of previous observations. Novel observations suggest that errors in "cross-talk" between fibroblasts and infected keratinocytes may regulate HPV integration and drive oncogenic progression. Our co-culture models offer new insights into HPV-related transformation mechanisms.

HDAC Inhibitors Can Enhance Radiosensitivity of Head and Neck Cancer Cells Through Suppressing DNA Repair

Background/Objectives: The incidence of head and neck squamous cell carcinoma (HNSCC), currently ~800,000 cases per year worldwide, is rising. Radiotherapy remains a mainstay for the treatment of HNSCC, although inherent radioresistance, particularly in human papillomavirus (HPV)-negative disease subtypes, remains a significant barrier to effective treatment. Therefore, combinatorial strategies using drugs or inhibitors against specific cellular targets are necessary to enhance HNSCC radiosensitivity to lead to an improvement in patient outcomes. Given that radiotherapy acts through targeting and damaging DNA, a common strategy is to focus on enzymes within DNA-dependent cellular pathways, such as DNA damage repair. Methods: Here, we have employed a 3D spheroid model of HNSCC (FaDu) in combination with a targeted drug screen to identify novel radiosensitisers that suppress tumour growth. Results: We identified that histone deacetylases (HDACs) were prominent candidates, and subsequently identified that the HDAC inhibitors mocetinostat and pracinostat, as well as the combined HDAC-epidermal growth factor receptor inhibitor CUDC-101, were effective at radiosensitising cell models of HNSCC (FaDu, A253, UMSCC11b) through their impact on both spheroid growth and clonogenic survival assays. We also demonstrated that this combinatorial strategy leads to inhibition of the repair of DNA double-strand breaks through the neutral comet assay and γH2AX foci analysis using immunofluorescence microscopy, providing a mechanism of action through which HDAC inhibition functions in HNSCC radiosensitisation. Conclusions: We believe that this approach should be further investigated in preclinical models, in order to realise the full therapeutic potential of HDAC inhibition for the radiosensitisation of HNSCC, eventually leading to improved patient treatment efficacy and outcomes.

Association of HPV with Oral and Oropharyngeal Cancer: Current Evidence

Oral cancer is a significant worldwide health issue which has an annual incidence of over 377,000 new cases. It was historically associated with tobacco and alcohol use, but recent research has also emphasized the role of human papilloma virus (HPV), specifically types 16 and 18, to the development of oropharyngeal malignancies. Human papilloma virus, a common sexually transmitted infection, impacts approximately 9-13% of the worldwide population. Currently, there have been 202 recognized virus types associated with HPV. HPV-positive oral cancers have different clinical and molecular features compared to HPV-negative ones. The HPV-positive tumors tend to better respond to radiation and chemotherapy treatments. This review compiles findings from an extensive literature search in PubMed and Google Scholar. It highlights the growing occurrence of HPV-positive oropharyngeal malignancies, especially among younger age groups, in different regions of the world. There has been a noticeable increase in the occurrence of these tumors, particularly in Europe and the Middle East. The rates of HPV infection are influenced by factors such as inadequate oral hygiene, sexual habits and gender differences. The research emphasizes the necessity for enhanced diagnostic methods, such as PCR-based assays, and shows the potential advantages of HPV vaccination and public health education in reducing the increasing cancer burden. Conducting additional research is crucial in order to create efficient methods for preventing and treating these conditions.

Can we safely de-escalate HPV+ oropharyngeal cancers? - A review of current practices and novel approaches

Oropharyngeal carcinomas linked to high-risk types of human papillomavirus (HPV+OPC) as a distinct tumor entity, have a better prognosis than HPV-OPC. Current treatment approaches do not differentiate between HPV-positive and negative disease, but ongoing studies are exploring de-escalation strategies, aiming to reduce therapy-related morbidity and improve patient quality of life, particularly focusing on reducing late effects from radiotherapy.We performed a literature search for both published and ongoing clinical trials and critically discussed the presented concepts and results. Those include reduction in radiotherapy dose or volume, omission or modification of concomitant chemotherapy/immunotherapy, usage of induction chemotherapy and utilization of advanced molecular and imaging biomarkers and radiomics for selected subgroups of HPV+OPC patients. While promising data have been reported from various Phase II trials, evidence from Phase III de-escalation trials has failed to demonstrate improved outcomes. Therefore, further data and an improved risk stratification are required before de-escalated radiation treatments can be recommended outside of clinical trials.The review aims to outline current de-escalation strategies and future possibilities for enhancing patient outcomes in HPV+OPC.

Transformation zone at the vallate papillae: a significant source of papillomavirus infection at the base of the tongue?

OBJECTIVE

The aim of this study was to investigate whether the base of the tongue harbours a transformation zone (TZ), i.e., an initiation site for papillomavirus infection, analogous to that in the uterine cervix by examining the histological structure of Von Ebner's gland ducts in the vallate papillae.

METHODS

Immunohistochemical staining and immunofluorescence techniques were used to detect markers associated with the uterine cervical TZ in the vallate papillae, and these results were compared with those in uterine cervical tissue. Additionally, tongue samples from mouse papillomavirus (MmuPV1)-infected mice were analysed to test our hypothesis.

RESULTS

The specific expression of CK17 in the squamous epithelium of the vallate papillae indicated the presence of immature squamous epithelium, arising from the transformation of reserve cells in this region. Moreover, a s determined using virus-infected mice, the TZ at the base of the tongue was a significant site for papilloma virus infection.

CONCLUSIONS

This is the first study to reveal the presence of a TZ in the vallate papillae, as determined by the presence of reserve cells and immature squamous epithelium, suggesting that the base of the tongue is a significant site for papillomavirus infection. This finding provides an entry point for the early prevention and diagnosis of HPV-associated lesions in the oropharynx.

Challenges and Considerations in Diagnosing and Managing p16+-Related Oropharyngeal Squamous Cell Carcinoma (OPSCC) with Neck Metastasis: Implications of p16 Positivity, Tobacco Exposure, and De-Escalation Strategies

BACKGROUND

The incidence of patients showing neck metastasis and no obvious primary tumor at the initial diagnostic evaluation or neck cancer of unknown primary (NCUP) is rising. It is estimated that a relevant part of these tumors arises in the tonsillar crypts or base of the tongue and are p16+-related. However, today, the detection rate of the primary tumor is suboptimal. Identifying the primary tumor and its biomolecular characterization is essential since it influences the treatment administered, possibly reducing radiation fields and providing de-escalation to primary surgical management. However, p16 IHC (immunohistochemistry) might not be sufficient to diagnose HPV-related OPSCC. The other subset of patients discussed are the HPV-positive patients who have a history of tobacco exposure and/or p53 mutations. Possible factors that could negatively influence the outcomes of these patients are investigated and discussed below. So, this paper aims to analyze the diagnostic, bio-molecular, clinico-radiological, morphological, prognostic and therapeutical aspects of p16-positive OPSCC, highlighting the possible bias that can occur during the diagnostic and prognostic process.

METHODS

A narrative review was conducted to investigate the biases in the diagnostic and therapeutic process of two groups of patients: those who are p16-positive but HPV-negative patients, and those who are p16-positive and HPV-positive with exposure to traditional risk factors and/or p53 mutations. The keywords used for the literature research included the following: NCUP, OPSCC, p16IHC, HPV testing, p16 positive HPV negative OPSCC, p16 positive HPV positive OPSCC, tonsillectomy, tobacco exposure, p53 mutations, cystic neck metastasis, extranodal extension (ENE), radiotherapy, de-escalation and neck neck dissection.

RESULTS

HPV-positive OPSCC has specific clinico-radiological features. Bilateral tonsillectomy should be considered for the identification of the primary tumor. P16 IHC alone is not sufficient for diagnosing HPV-related OPSCC; additional detection methods are required. The role of tobacco exposure and p53 mutations should be investigated especially in cases of HPV-positive tumors. Extranodal extension (ENE) must be taken into consideration in the prognostic staging of HPV-positive tumors. Surgical primary treatment involving neck dissection (ND) and bilateral tonsillectomy followed by adjuvant radiation may represent the most appropriate approach for N3 cases. Diagnosis, prognosis and therapeutical implications must be addressed considering clinical, biomolecular and morphological aspects. At least today, the numerous biases that are still present influencing the diagnostic and prognostic process do not permit considering de-escalation protocols.

CONCLUSIONS

A precise and accurate diagnosis is required in order to adequately stage and manage p16+ OPSCC, particularly with neck metastasis. The role of tobacco exposure and/or p53 mutations must be considered not only in p16+ OPSCC but especially in HPV-positive OPSCC. Until a more accurate diagnosis is possible, ENE should be considered even in p16+HPV+ OPSCC. Primary surgery with unilateral ND and bilateral tonsillectomy might be the treatment of choice given the numerous diagnostic and prognostic pitfalls. Therefore, it is inappropriate and risky to propose de-escalation protocols in routine clinical practice due to the risk of undertreatment.

Curcumin: A Potential Weapon in the Prevention and Treatment of Head and Neck Cancer

Head and neck cancers (HNC) are aggressive, difficult-to-treat tumors that can be caused by genetic factors but mainly by lifestyle or infection caused by the human papillomavirus. As the sixth most common malignancy, it presents a formidable therapeutic challenge with limited therapeutic modalities. Curcumin, a natural polyphenol, is appearing as a promising multitarget anticancer and antimetastatic agent. Numerous studies have shown that curcumin and its derivatives have the potential to affect signaling pathways (NF-κB, JAK/STAT, and EGFR) and molecular mechanisms that are crucial for the growth and migration of head and neck tumors. Furthermore, its ability to interact with the tumor microenvironment and trigger the immune system may significantly influence the organism's immune response to the tumor. Combining curcumin with conventional therapies such as chemotherapy or radiotherapy may improve the efficacy of treatment and reduce the side effects of treatment, thereby increasing its therapeutic potential. This review is a comprehensive overview that discusses both the benefits and limitations of curcumin and its therapeutic effects in the context of tumor biology, with an emphasis on molecular mechanisms in the context of HNC. This review also includes possibilities to improve the limiting properties of curcumin both in terms of the development of new derivatives, formulations, or combinations with conventional therapies that have potential as a new type of therapy for the treatment of HNC and subsequent use in clinical practice.

Association of Herpes simplex infection with significantly increased risk of head and neck cancer: real-world evidence of about 500,000 patients

BACKGROUND

The role of viral agents in the development of head and neck cancers has remained controversial. While markers of viral origin have been isolated from oral cancer tissues, a causative relationship has yet to be shown. The aim of this study was to evaluate the relationship between head and neck cancers and Herpes simplex virus, one of the most common viral infections of the oral orifice.

METHODS

Here, we conducted a retrospective analysis of two age- and gender-matched cohorts extracted from the real-world database TriNetX on March 10th, 2023, each consisting of 249,272 patients with and without Herpes simplex infections (ICD-10: B00). The diagnoses C00-C14 were analyzed, and risk analysis and Kaplan-Meier survival statics were computed.

RESULTS

The strongest association was found for lip cancer (ICD-10: C00) with a hazard ratio [HR (CI 95% low-high)] of 3.08 (1.77-5.35). A significant association with HR of 1.17 (1.02-1.34) was found for the entire group of head and neck cancers. Confounders like smoking and alcohol dependence were considered using propensity score matching.

CONCLUSION

The surprisingly strong correlation with lip, oral cavity, and pharynx neoplasms sheds new light on supposedly harmless herpes simplex infections, suggesting them as a possible new factor for risk stratification.

Spontaneous regression of head and neck squamous cell carcinoma: a systematic review and meta-analysis of case reports

OBJECTIVE

A systematic review of case reports in spontaneous regression of head and neck squamous cell carcinoma (SCC) was carried out to investigate the pattern and characteristics of this phenomenon.

METHODS

A systematic search of case studies of spontaneously regressed head and neck SCC was carried out in Ovid Embase, Ovid Medline and Pubmed. Methodological quality was assessed by ascertainment of diagnosis and overall details of reports. Outcomes included patient demographics, head and neck SCC characteristics and clinical course of disease.

RESULTS

A total of 8 cases were included and 50 per cent (n = 4) of the reported cases were SCC of the vocal folds. All cases received a surgical biopsy and three cases had possible febrile episodes preceding regression. The mean length of time to regression was 4.3 months.

DISCUSSION

Spontaneous regression in head and neck SCC is likely to be under-reported. A better understanding of how the host immune system can instigate an antitumour response will shed light on the development of novel treatments.

War or peace: Viruses and metastasis

Metastasis, the dissemination of malignant cells from a primary tumor to secondary sites, poses a catastrophic burden to cancer treatment and is the predominant cause of mortality in cancer patients. Metastasis as one of the main aspects of cancer progression could be strongly under the influence of viral infections. In fact, viruses have been central to modern cancer research and are associated with a great number of cancer cases. Viral-encoded elements are involved in modulating essential pathways or specific targets that are implicated in different stages of metastasis. Considering the continuous emergence of new viruses and the establishment of their contribution to cancer progression, the warfare between viruses and cancer appears to be endless. Here we aimed to review the critical mechanism and pathways involved in cancer metastasis and the influence of viral machinery and various routes that viruses adopt to manipulate those pathways for their benefit.

Circulating tumor tissue modified viral (TTMV)-HPV DNA in Recurrent, metastatic HPV-driven oropharyngeal cancer

BACKGROUND

Human papillomavirus (HPV) is causally linked to oropharyngeal squamous cell carcinoma (OPSCC). Testing for plasma tumor tissue modified viral (TTMV)-HPV DNA has emerged as a biomarker strategy for post-treatment surveillance to identify recurrent disease. We aimed to understand the prognostic and predictive potential of TTMV-HPV DNA when monitoring patients who had developed recurrent or metastatic (R/M) HPV+OPSCC.

METHODS

This retrospective observational cohort study included 80 patients from 4 academic centers with R/M HPV+OPSCC if they had ≥ 1 plasma TTMV-HPV DNA test obtained at any point during their R/M disease course. Physician-reported clinical data and treatment history were captured in a centralized database, along with investigator-assessed response to therapy and survival. Descriptive statistics and non-parametric tests of association were employed along with survival analyses (Kaplan-Meier method).

RESULTS

Sixteen (20 %) patients had ≥ 5 test results over time. Consecutive TTMV-HPV DNA tests were performed a median of 73 days apart. Median TTMV-HPV DNA scores were higher with an increasing per-patient number of metastatic sites (<2 vs. 2+; p < 0.01). Score changes over time were influenced by R/M treatment modality and became undetectable in 67 % (12/18) of patients who achieved a complete response to R/M therapy. Patients with detectable scores at last follow-up had significantly worse survival compared with those who were undetectable (log-rank test, p < 0.01).

CONCLUSIONS

TTMV-HPV DNA appears useful as a prognostic tool for monitoring response to therapy in the R/M setting. In the future, TTMV-HPV DNA could be explored as an exploratory clinical trial endpoint in the metastatic setting.

Navigating the landscape of HPV-associated cancers: From epidemiology to prevention

Human Papillomavirus (HPV) is a widespread infection associated with various cancers, including cervical, oropharyngeal, anal, and genital cancers. This infection contributes to 5 % of global cancer cases annually, affecting approximately 625,600 women and 69,400 men. Cervical cancer remains the most prevalent HPV-linked cancer among females, with the highest incidence seen in low and middle-income countries (LMICs). While most HPV infections are transient, factors such as HPV variants, age, gender, and socioeconomic status influence transmission risks. HPV is categorized into high-risk (HR-HPV) and low-risk types, with strains like HPV 16 and 18 displaying distinct demographic patterns. The intricate pathogenesis of HPV involves genetic and epigenetic interactions, with HPV oncogenes (E6 and E7) and integration into host DNA playing a pivotal role in driving malignancies. Early diagnostics, utilizing HPV DNA testing with surrogate markers such as p16, and advanced molecular techniques like PCR, liquid biopsy, and NGS, significantly impact the management of HPV-induced cancers. Effectively managing HPV-related cancers demands a multidisciplinary approach, including immunotherapy, integrating current therapies, ongoing trials, and evolving treatments. Prevention via HPV vaccination and the inclusion of cervical cancer screening in national immunization programs by conventional Pap smear examination and HPV DNA testing remains fundamental.Despite the preventability of HPV-related cancers, uncertainties persist in testing, vaccination, and treatment. This review article covers epidemiology, pathogenesis, diagnostics, management, prevention strategies, challenges, and future directions. Addressing issues like vaccine hesitancy, healthcare disparities, and advancing therapies requires collaboration among researchers, healthcare providers, policymakers, and the public. Advancements in understanding the disease's molecular basis and clinical progression are crucial for early detection, proper management, and improved outcomes.

Outcomes for potentially Resectable patients undergoing primary chemoradiation treatment for T1-T2 HPV Negative oropharyngeal squamous cell carcinoma

BACKGROUND

Transoral surgical resectability (TOS) is a prognostic factor for patients with HPV+ T1-2 oropharyngeal squamous cell carcinoma (OPSCC) disease undergoing radiotherapy (RT), but it is unclear whether this holds for HPV-negative (HPV-) patients. We aimed to compare outcomes of potential TOS-candidates vs. non-TOS candidates, among patients who underwent RT/CRT for early T-stage HPV- OPSCC.

METHODS

For patients treated with RT/CRT for early T-stage HPV-negative OPSCC between 2014 and 2021, pretreatment imaging was reviewed by four head-and-neck surgeons, masked to clinical outcomes, to assess primary-site suitability for TOS. Extracapsular extension (ECE) was assessed by a head-and-neck neuroradiologist. We compared outcomes based on surgical resectability relating to: (1) the primary site tumor alone, and (2) the primary site plus the absence/presence of ECE (overall assessment). Kaplan-Meier curves for overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS) were compared using the log-rank test.

RESULTS

Seventy patients were included in the analysis. The primary site was TOS-favorable in 46/70 (66%). Based on the overall assessment, 41/70 (58.6%) were TOS-favorable. The 3-year OS, DSS and PFS for primary site TOS-favorable versus unfavorable were OS: 76.9% versus 37.4%; DSS: 78.1% versus 46.2%, PFS: 69.9% versus 41.3%, (log-rank test = 0.01, 0.03, 0.04; respectively). Additionally, patients with an overall assessment of TOS favorability demonstrated better survival outcomes compared with TOS-unfavorable patients (OS: 77.3% vs. 46.2%; DSS: 78.2% vs. 56.5%, PFS: 72.3% vs. 42.1%, log-rank test = 0.01, 0.04, 0.01; respectively).

CONCLUSION

Patients with TOS-favorable HPV-negative early T-stage OPSCC have superior survival outcomes than TOS-unfavorable patients.

Multilevel Disparities of Sex-Differentiated Human Papilloma Virus-Positive Oropharyngeal Cancers in the United States

Objectives: This study used multilevel social determinants of health (SDoH) models to determine how SDoH influence different sexes of patients diagnosed with HPV-positive oropharyngeal squamous cell cancers (OPSCC) across the US. Methods: This was a retrospective cohort study assessing HPV-confirmed patients with oropharyngeal squamous cell cancers from 2010 to 2018 using census-level Yost Index socioeconomic status (SES) score and rurality-urbanicity measures alongside individual-level race-ethnicity while stratifying by biological sex. Age-adjusted multivariate regressions were performed for survival, treatment receipt, and delay of treatment initiation (of 3+ months). Results: Across 14,076 OPSCC-HPV-positive patients, delay of treatment uniquely featured positive predictors for males of black race-ethnicity (OR, 2.07; 95% CI, 1.68-2.54) and poor Yost SES (1.43; 1.24-1.65). Five-year all-cause mortality uniquely showed positive predictors of females of black race-ethnicity (2.74; 1.84-4.71) and of males with poor Yost SES (1.98; 1.79-2.19). Three-year all-cause mortality shared positive predictors across sexes but were exacerbated in females of black race-ethnicity (2.50; 1.82-3.44) compared to males (2.23; 1.91-2.60); this was reversed for poor Yost SES (male, 1.92, 1.76-2.10; female, 1.60, 1.32-1.95). Surgery showed negative predictors of black race-ethnicity that displayed worsened effects in females (0.60, 0.44-0.79) versus males (0.75, 0.66-0.86). First-line radiation receipt uniquely featured negative predictors for males of black race-ethnicity (0.73; 0.62-0.86) with poor Yost SES (0.74; 0.68-0.82). Conclusions: Comprehensive models of multilevel SDoH displayed exacerbated disparity effects of community-level SES in males and black race-ethnicity among female HPV-positive OPSCC patients. These objective comparisons of specific SDoH factors inform providers and policy direction on how to strategically target the most pertinent SDoH factors affecting a rapidly growing cancer population.

Fibroblast stromal support model for predicting human papillomavirus-associated cancer drug responses

Currently, there are no specific antiviral therapeutic approaches targeting Human papillomaviruses (HPVs), which cause around 5% of all human cancers. Specific antiviral reagents are particularly needed for HPV-related oropharyngeal cancers (HPV+OPCs) whose incidence is increasing and for which there are no early diagnostic tools available. We and others have demonstrated that the estrogen receptor alpha (ERα) is overexpressed in HPV+OPCs, compared to HPV-negative cancers in this region, and that these elevated levels are associated with an improved disease outcome. Utilizing this HPV+-specific overexpression profile, we previously demonstrated that estrogen attenuates the growth and cell viability of HPV+ keratinocytes and HPV+ cancer cells in vitro. Expansion of this work in vivo failed to replicate this sensitization. The role of stromal support from the tumor microenvironment (TME) has previously been tied to both the HPV lifecycle and in vivo therapeutic responses. Our investigations revealed that in vitro co-culture with fibroblasts attenuated HPV+-specific estrogen growth responses. Continuing to monopolize on the HPV+-specific overexpression of ERα, our co-culture models then assessed the suitability of the selective estrogen receptor modulators (SERMs), raloxifene and tamoxifen, and showed growth attenuation in a variety of our models to one or both of these drugs in vitro. Utilization of these SERMs in vivo closely resembled the sensitization predicted by our co-culture models. Therefore, the in vitro fibroblast co-culture model better predicts in vivo responses. We propose that utilization of our co-culture in vitro model can accelerate cancer therapeutic drug discovery.

IMPORTANCE

Human papillomavirus-related cancers (HPV+ cancers) remain a significant public health concern, and specific clinical approaches are desperately needed. In translating drug response data from in vitro to in vivo, the fibroblasts of the adjacent stromal support network play a key role. Our study presents the utilization of a fibroblast 2D co-culture system to better predict translational drug assessments for HPV+ cancers. We also suggest that this co-culture system should be considered for other translational approaches. Predicting even a portion of treatment paradigms that may fail in vivo with a co-culture model will yield significant time, effort, resource, and cost efficiencies.

Multi-omics reveals lactylation-driven regulatory mechanisms promoting tumor progression in oral squamous cell carcinoma

BACKGROUND

Lactylation, a post-translational modification, is increasingly recognized for its role in cancer progression. This study investigates its prevalence and impact in oral squamous cell carcinoma (OSCC).

RESULTS

Immunohistochemical staining of 81 OSCC cases shows lactylation levels correlate with malignancy grading. Proteomic analyses of six OSCC tissue pairs reveal 2765 lactylation sites on 1033 proteins, highlighting its extensive presence. These modifications influence metabolic processes, molecular synthesis, and transport. CAL27 cells are subjected to cleavage under targets and tagmentation assay for accessible-chromatin with high-throughput sequencing, and transcriptomic sequencing pre- and post-lactate treatment, with 217 genes upregulated due to lactylation. Chromatin immunoprecipitation-quantitative PCR and real-time fluorescence quantitative PCR confirm the regulatory role of lactylation at the K146 site of dexh-box helicase 9 (DHX9), a key factor in OSCC progression. CCK8, colony formation, scratch healing, and Transwell assays demonstrate that lactylation mitigates the inhibitory effect of DHX9 on OSCC, thereby promoting its occurrence and development.

CONCLUSIONS

Lactylation actively modulates gene expression in OSCC, with significant effects on chromatin structure and cellular processes. This study provides a foundation for developing targeted therapies against OSCC, leveraging the role of lactylation in disease pathogenesis.

Human PapillomaVirus vaccination in gay and bi men: Predictors, dynamic norms, and connectedness to the LGBT+ community

OBJECTIVES

This study tested social cognitive predictors of vaccination and a dynamic norms intervention for increasing HPV vaccination intentions in gay, bisexual, and other men who have sex with men (gbMSM).

DESIGN

The study employed an experiment embedded in a cross-sectional survey.

METHODS

Participants (N = 217; gbMSM aged 18-45 in Ireland) provided cross-sectional data on sociodemographic constructs and constructs from the Theory of Planned Behaviour and the Health Belief Model. Unvaccinated participants (n = 94) were randomised to one of three experimental conditions (no norms, static norms, dynamic norms) and presented with information on HPV vaccine uptake in gbMSM in Ireland before reporting vaccination intentions.

RESULTS

In an adjusted logistic regression, significant predictors of vaccination included being in a relationship (OR = 8.69 [1.09, 38.91]), perceived susceptibility (OR = 1.11 [1.04, 1.19]), healthcare provider recommendation (OR = 107.24 [26.87, 427.99]), and perceived barriers (OR = 0.83 [.7, 0.98]). Adjusted linear regression models showed no significant differences in HPV vaccination intentions between no norms and static norms (B = -1.24 [-4.6, 2.12]), dynamic norms and static norms (B = -0.62 [-3.86, 2.63]), and dynamic norms and no norms (B = 0.62 [-2.74, 3.98]). Connectedness to the LGBT+ community did not moderate these differences.

CONCLUSIONS

The need for greater awareness of susceptibility, the impact of barriers, and the strong influence of a recommendation from a healthcare provider in predicting HPV vaccination among gbMSM are critical considerations for policymakers. Dynamic norm messaging may be less effective for vaccination than other behaviours more easily influenced by social norms. Efforts to implement dynamic norm-based interventions in gbMSM should consider the limited evidence of efficacy.

Histologic spectrum and outcome of Human papillomavirus (HPV)-associated oral cavity squamous cell carcinoma: a single center experience and a survey of The Cancer Genome Atlas (TGCA) cohort

While high-risk human papillomavirus (HPV) serves as an essential pathogen and an important prognostic and predictive biomarker for oropharyngeal squamous cell carcinoma, it occurs at low frequency (2.2-6%) in oral cavity squamous cell carcinoma (OCSCC). To date, the pathologic features of HPV-associated OCSCC (HPV( +)-OCSCC) have been sparsely reported and its prognosis is not well-defined. We herein described detailed clinicopathologic features and outcomes of a retrospective series of 27 HPV( +)-OCSCC, including 13 from Memorial Sloan Kettering Cancer Center (MSKCC) and 14 from The Cancer Genomic Atlas program (TCGA). The frequency of HPV positivity in OCSCC was 0.7% in MSKCC cohort and 4.9% in TCGA cohort. Although HPV( +)-OCSCC was predominantly non-keratinizing (in 81%) with various degree of maturation, its histologic spectrum was expanded to include keratinizing subtype (19%), adenosquamous carcinoma (7%), and papillary architecture (subtype, 7%). HPV( +)-OCSCC predominantly affected male patients (male:female ratio = 12.5:1) and (ex) smokers (77%). It might occur in mandibular mucosa, floor of mouth, tongue, retromolar trigone, buccal mucosa, maxillary mucosa, or hard palate. In oral cavity, positivity of HPV by RNA in situ hybridization was required, and p16 immunohistochemistry alone was insufficient to confirm the HPV + status. The positive predictive value of p16 immunopositivity in detecting HPV infection was 68%. HPV-positivity did not appear to affect outcomes, including disease specific survival and progression free survival in OCSCC.

HPV overtakes smoking as the leading cause of oropharyngeal cancer in Ireland: experience of a head and neck surgery tertiary referral centre

BACKGROUND

Worldwide, the incidence of oropharyngeal squamous cell carcinoma (OPSCC) caused by human papillomavirus (HPV), a sexually transmitted virus, is increasing. This increase has yet to be demonstrated in an Irish cohort.

AIMS

To evaluate the number of OPSCC presentations locally, to stratify cases by HPV status and to estimate if any changes in the patient population had occurred over a 10-year period.

METHODS

A STROBE-compliant, retrospective evaluation of patients with OPSCC at St James's Hospital between 2012 and 2022 was performed. Patients with non-SCC histology, undocumented HPV status and residual or recurrent tumours were excluded.

RESULTS

We included 294 patients with a mean age of 60.4 years (95% CI 59.2-61.5 years) and 175 (59.5%) patients had HPV+ OPSCC. The number of new OPSCC diagnoses increased from 115 patients (39.1%) between 2012 and 2016 to 179 patients (60.9%) between 2017 and 2021. This was associated with an increased proportion of HPV-linked OPSCC (50.4% 2012-2016 vs. 65.4% 2017-2021, p = 0.011). Over time, more patients had a functionally limiting comorbidity (p = 0.011). The mean age of HPV+ OPSCC cases increased by 3.6 years (p = 0.019). Patients with HPV+ OPSCC had greater 2-year OS (83.9% vs. 54.9%; p < 0.001) and 2-year DFS (73.5% vs. 45.6%; p < 0.001). The 2-year OS and DFS did not change over time for HPV+ or HPV- patients.

CONCLUSIONS

In our institution, the number of patients with OPSCC is increasing due to an escalation in cases associated with HPV. Population-level interventions such as vaccination programs may alter the current increase in the incidence of these tumours.

Association of Neighborhood-Level Area Deprivation with Demographics and Outcomes in Oropharyngeal Squamous Cell Carcinoma

Objective

To characterize neighborhood-level area deprivation's association with oropharyngeal carcinoma clinicodemographics, tumor staging, recurrence, and overall survival.

Study Design

Retrospective study.

Setting

Single institution academic medical center.

Methods

Patients diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) between 2007 and 2022 at our institution were included in this study. The Area Deprivation Index (ADI) was used to quantify neighborhood-level disadvantage based on patients' primary residence at the time of their diagnosis. Continuous variables were compared between groups using the Wilcoxon rank sum test. For categorical variables, proportions were compared using Fisher's exact test. Overall survival (OS) and recurrence-free survival (RFS) distributions were estimated using the Kaplan-Meier method and log-rank test. OS and RFS were further assessed by univariable and multivariable analyses performed using the Cox proportional hazards model.

Results

The higher ADI (more disadvantaged) group consisted of a significantly greater proportion of Black race (P < .001), 10+ pack-year smoking history (P = .003), and Medicare patients (P = .018). On logistic regression analysis, neither ADI nor other social factors were significantly associated with increased likelihood of advanced clinical staging in the p16 positive OPSCC population. Furthermore, while ADI did not correspond with significant differences in survival, multivariate cox regression model demonstrated that "Other" insurance type (Medicaid and uninsured) (hazard ratio [HR] = 10.1, P = .008), age at diagnosis (1.10, P < .001), and advanced clinical staging (HR = 3.25, P = .004) were all significantly associated with increased HR of death.

Conclusion

While ADI may not be significantly associated with outcomes in HPV-related OPSCC patients, this study revealed significant sociodemographic and risk factor differences across ADIs, as well as individual factors influencing prognosis. These findings emphasize the need for a comprehensive approach to understanding factors influencing HPV-related OPSCC incidence and prognosis.

Impact of AIM2 on HNSCC Development

Head and neck squamous cell carcinoma (HNSCC) constitutes 90% of head and neck cancers. HNSCC development is linked to chronic inflammation, while established HNSCC tumors are often immune suppressive. However, both occur through mechanisms that are not fully understood. The cytosolic double-stranded DNA sensor Absent in Melanoma 2 (AIM2) is an inflammasome forming protein that also has inflammasome-distinct roles in restricting tumorigenesis by limited PI3K signaling. Here, we used an experimental mouse model of HNSCC, involving treatment of wild type (WT) and Aim2 -/- mice with the carcinogen 4NQO in drinking water. Compared to WT mice, 4NQO-treated Aim2 -/- mice exhibited larger tumor sizes and increased tissue dysplasia. 4NQO-treated wild type and Aim2 -/- mice displayed similar tongue Il6, Tnf, Il1b, Il12, and Il10 expression and no consistent differences in PI3K or inflammasome activation, suggesting AIM2 may not regulate these factors during HNSCC. Instead, Ifng and Irf1 was elevated in 4NQO-treated Aim2 -/- mice, suggesting AIM2 restricts IFNγ. In line with this, RNA-sequencing of total tongue RNA from 4NQO-treated mice revealed Aim2 -/- mice had enhanced expression of genes related to the MHC protein complex, cell killing, and T cell activation compared to wild type mice. In addition, we observed increased macrophage infiltration into the tongue epithelium of 4NQO-treated Aim2 -/- mice. Lastly, using Aim2 -/- / Rag1 -/- -double deficient animals, we found that the adaptive immune compartment was necessary for the enhanced tumorigenesis during AIM2 deficiency. Taken together, these findings suggest AIM2 limits the progression of oral tumor development partially through regulating IFNγ and adaptive immune responses.

Association of Oral Microbiome With Oral Human Papillomavirus Infection: A Population Study of the National Health and Nutrition Examination Survey, 2009-2012

BACKGROUND

Oral human papillomavirus (HPV) infection and the oral microbiome are associated with oropharyngeal cancer. However, population-based data on the association of oral microbiome with oral HPV infection are limited.

METHOD

A cross-sectional analysis of 5496 20-59-year-old participants in the 2009-2012 National Health and Nutrition Examination Survey was performed. Associations with oral HPV infection were assessed using multivariable logistic regression for oral microbiome α-diversity (within-sample diversity), and using principal coordinate analysis and permutational multivariate analysis of variance for β-diversity (between-sample heterogeneity).

RESULTS

Overall, for α-diversity, a lower number of observed amplicon sequence variants (adjusted odds ratio [aOR] = 0.996; 95% confidence interval [CI] = .992-.999) and reduced Faith's phylogenetic diversity (aOR = 0.95; 95% CI = .90-.99) were associated with high-risk oral HPV infection. β-diversity showed differentiation of oral microbiome community by high-risk oral HPV infection as measured by Bray-Curtis dissimilarity (R2 = 0.054%; P = .029) and unweighted UniFrac distance (R2 = 0.046%; P = .045). There were differential associations when stratified by sex.

CONCLUSIONS

Both oral microbiome α-diversity and β-diversity were marginally associated with oral HPV infection. Longitudinal studies are needed to characterize the role of the microbiome in the natural history of oral HPV infection.

Fibroblasts Regulate the Transformation Potential of Human Papillomavirus-positive Keratinocytes

Persistent human papillomavirus (HPV) infection is necessary but insufficient for viral oncogenesis. Additional contributing co-factors, such as immune evasion and viral integration have been implicated in HPV-induced cancer progression. It is widely accepted that HPV+ keratinocytes require co-culture with fibroblasts to maintain viral episome expression, yet the exact mechanisms for this have yet to be elucidated. Here we present comprehensive RNA sequencing and proteomic analysis demonstrating that fibroblasts not only support the viral life cycle, but reduce HPV+ keratinocyte transformation. Our co-culture models offer novel insights into HPV-related transformation mechanisms.

Early-onset cancers: Biological bases and clinical implications

Since the nineties, the incidence of sporadic early-onset (EO) cancers has been rising worldwide. The underlying reasons are still unknown. However, identifying them is vital for advancing both prevention and intervention. Here, we exploit available knowledge derived from clinical observations to formulate testable hypotheses aimed at defining the causal factors of this epidemic and discuss how to experimentally test them. We explore the potential impact of exposome changes from the millennials to contemporary young generations, considering both environmental exposures and enhanced susceptibilities to EO-cancer development. We emphasize how establishing the time required for an EO cancer to develop is relevant to defining future screening strategies. Finally, we discuss the importance of integrating multi-dimensional data from international collaborations to generate comprehensive knowledge and translate these findings back into clinical practice.

Epidemiology, Diagnostics, and Therapy of Oral Cancer-Update Review

Oral cavity and lip cancers are the 16th most common cancer in the world. It is widely known that a lack of public knowledge about precancerous lesions, oral cancer symptoms, and risk factors leads to diagnostic delay and therefore a lower survival rate. Risk factors, which include drinking alcohol, smoking, HPV infection, a pro-inflammatory factor-rich diet, and poor oral hygiene, must be known and avoided by the general population. Regular clinical oral examinations should be enriched in an oral cancer search protocol for the most common symptoms, which are summarized in this review. Moreover, new diagnostic methods, some of which are already available (vital tissue staining, optical imaging, oral cytology, salivary biomarkers, artificial intelligence, colposcopy, and spectroscopy), and newly researched techniques increase the likelihood of stopping the pathological process at a precancerous stage. Well-established oral cancer treatments (surgery, radiotherapy, chemotherapy, and immunotherapy) are continuously being developed using novel technologies, increasing their success rate. Additionally, new techniques are being researched. This review presents a novel glance at oral cancer-its current classification and epidemiology-and will provide new insights into the development of new diagnostic methods and therapies.

Estimating Impacts of p16 Status on Tumor Radiosensitivity in Head and Neck Cancer using Predictive Models

The intrinsic radiosensitivity index (RSI) and genomic-adjusted radiation dose (GARD) were reported to be able to predict the surviving fraction at 2 Gy and therapeutic effect when delivering actual treatment doses using the gene expression profiles of clinical cases. Given the impact of p16 status, a surrogate marker of the human papillomavirus (HPV) infection, on radiosensitivity, we attempted to apply the RSI and GARD to estimate p16-associated radiosensitivity in head and neck squamous cell carcinoma (HNSC). For this purpose, The Cancer Genome Atlas (TCGA) dataset was employed. In the GARD calculation, we assumed that p16-positive patients received 60 Gy in 30 fractions, while p16-negative patients received 70 Gy in 35 fractions. p16 positivity was associated with favorable characteristics compared to negative patients. The RSI and GARD analyses demonstrated increased radiosensitivity and high therapeutic effect in p16-positive patients, compared to p16-negative patients. Additionally, tumor microenvironmental conditions predicted by other models were also significantly affected by p16 status. Collectively, the models used in this study could be a promising tool for estimating p16-associated radiosensitivity in HNSC.

The clinical importance of IFN-γ and human epididymis protein 4 in Egyptian patients with epithelial ovarian cancer combined with HPV infection

BACKGROUND

High-grade Epithelial Ovarian Cancer (HGEOC) is an aggressive disease that usually presents at an advanced stage. Thus, detecting the circulating cytokines (IFNγ and TNF-α) may serve as a biomarker to identify malignancy and manage therapeutic decisions.

OBJECTIVES

Assessing the clinical importance of inflammatory mediators and tumor markers in EOC Egyptian patients compared with benign cases. Moreover, identifying the distinct inflammatory mediators in EOC patients combined with HPV infection.

METHODS

This study was conducted on 61 Egyptian patients, divided into 25 patients with HGEOC, 22 patients with LGEOC, and 14 benign ovarian tumor cases. Measurements of serum HE4, CA125, CEA, and CA19-9 were determined by Roche Elecsys immunoassays. Serum levels of TNF-α and IFN-γ were measured using quantitative sandwich ELISA. Quantitative genotyping of HPV DNA types 16, 18, and 45 was assessed for the HPV DNA-positive samples.

RESULTS

HPV DNA was detected in 25.53 % of malignant cases, HPV 16 was detected in 50 % of HPV-positive cases, and only 1 case of HPV 18 was detected out of 12 positive cases. The Human Epididymis protein 4 (HE4) was statistically different between patients with EOC and benign cases (p-value = 0.007) and between HPV DNA positive and HPV DNA negative cases (p-value = 0.008). The serum levels of IFN- γ were statistically different between HGEOC and LGEOC (p-value < 0.001), while the serum levels of TNF-α didn't differ statistically between the two groups.

CONCLUSION

IFN-γ could be used as a biomarker to discriminate HGEOC and LGEOC. Initial evidence for the possible association between HE4 and the progression of HPV-associated EOC was speculated.

A retrospective study revealing complex viral diversity and a substantial burden of HPV infection in SARS-CoV-2 positive individuals, Sierra Leone

BACKGROUND

The COVID-19 pandemic has underscored the critical role of sequencing technology in disease control and outbreak response. However, resource limitations and challenging environments often impede such efforts in low and middle-income countries. This study aimed to investigate the spectrum of viral co-infections, particularly with human viral pathogens, in SARS-CoV-2 positive individuals in Sierra Leone using metagenomic sequencing, evaluating the feasibility of utilizing this technology for epidemiological and evolutionary surveillance of pathogens related to public health in low-income environments.

METHODS

We retrospectively collected and analyzed 98 nasopharyngeal swab specimens from SARS-CoV-2 positive individuals in Sierra Leone. Samples were pre-processed locally and transferred to China via FTA cards for metagenomic sequencing, which was performed using the Novaseq platform. The study focused on the identification of nasopharyngeal viruses co-infecting with SARS-CoV-2, with a deeper analysis of significant human viral pathogens such as HPV.

RESULTS

The study identified 22 viral taxa from 20 families, including 4 human viruses. Notably, 19.4% of samples showed HPV co-infection with 34 distinct types, predominantly beta and gamma HPVs. Multiple HPV types were found in individual samples, indicating a high complexity of viral co-infections.

CONCLUSIONS

The identification of a wide range of co-infecting viruses, particularly multiple HPV genotypes, highlights the complexity of viral interactions and their potential implications for public health. These findings enhance our understanding of viral co-infections and provide valuable insights for public health interventions in Sierra Leone. Further research is needed to explore the clinical significance of these findings and their impact on disease outcomes.

Connecting the dots: investigating the link between environmental, genetic, and epigenetic influences in metabolomic alterations in oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) accounts for around 90% of all oral cancers and is the eighth most common cancer worldwide. Despite progress in managing OSCC, the overall prognosis remains poor, with a survival rate of around 50-60%, largely due to tumor size and recurrence. The challenges of late-stage diagnosis and limitations in current methods emphasize the urgent need for less invasive techniques to enable early detection and treatment, crucial for improving outcomes in this aggressive form of oral cancer. Research is currently aimed at unraveling tumor-specific metabolite profiles to identify candidate biomarkers as well as discover underlying pathways involved in the onset and progression of cancer that could be used as new targets for diagnostic and therapeutic purposes. Metabolomics is an advanced technological approach to identify metabolites in different sample types (biological fluids and tissues). Since OSCC promotes metabolic reprogramming influenced by a combination of genetic predisposition and environmental factors, including tobacco and alcohol consumption, and viral infections, the identification of distinct metabolites through screening may aid in the diagnosis of this condition. Moreover, studies have shown the use of metabolites during the catalysis of epigenetic modification, indicating a link between epigenetics and metabolism. In this review, we will focus on the link between environmental, genetic, and epigenetic influences in metabolomic alterations in OSCC. In addition, we will discuss therapeutic targets of tumor metabolism, which may prevent oral tumor growth, metastasis, and drug resistance.