It’s not too late to inoculate.
The Study: Thinking back, our discovery of myriad HPV-mediated cancers is almost a prologue to the current immunotherapy era. It really got us thinking about the intricate interplay between cancer and the immune system. The puzzle is that immunotherapy hasn’t worked out that great in HPV-mediated disease. But shouldn’t it? You’ve got a tumor driven by viral proteins that should be prime targets for an activated immune system, be it through vaccination or immunotherapy. Unfortunately, these malignancies have been a frustration on both ends. In this trial, patients with “incurable” HPV-16 mediated malignancies were treated with a combination of HPV-16 E6/E7 vaccination and nivolumab. Vaccination was done on days 1, 22, and 50 while nivo started on day 8 and continued q2 weeks thereafter for a year. The majority of patients (22/24) had oropharyngeal cancer, and 8 of these had a clinical response. While this response rate isn't overwhelming, the median duration of response was over 10 months. Plus there were no apparent increases in toxicity. Ultimately, we’re left hopeful that such a combination could be beneficial in this difficult-to-salvage population.
Bottom Line: Vaccination to HPV-16 E6 and E7 appears to be safe during immunotherapy and may afford a viable salvage option for refractory HPV-mediated cancers. | Massarelli, JAMA Oncol 2018