HPV and penile cancer

Some notable advances presented at the EAU strongly suggest that HPV probably does not affect fertility and that targeted therapies for penile cancer are on the near horizon.

Human papilloma virus (HPV) is a major public health problem not only in malignant disease (see Table) but also in benign disease. The group of Dr Andrea Salonia (University of Milan, Italy) presented their recently published research that the presence of HPV in sperm affects motility [1]. Furthermore, the group of Prof. Stéphane Droupy (University of Nîmes, France) performed a prospective study in a cohort of 350 couples undergoing assisted reproductive techniques with the aim to study the association between the presence of at least on HPV subtype and the outcome of pregnancies. They showed that at least one HPV subtype was present in 26.9% of women and 14.4% of men. Exposed couples gave birth in 23.3% of the cases to live children and non-exposed couples gave birth in 30% of the cases, which was not statistically significant (P=0.2). This study probably disposes the hypothesis that the HPV has an impact on fertility because they applied a really hard endpoint. Further research is understandably needed, and we will hear more about this association in the coming years.

Table: Number of all cancer cases annually attributable to HPV by region, cancer site, and gender. Modified from de Martel et al. Int J Cancer 2017.



HPV, human papilloma virus.

In penile cancer there is clear evidence for a pathophysiological relationship with HPV infection and the development of penile cancer [2]. In a very well attended and interesting thematic session about penile cancer, we heard that vaccination coverage rates are insufficient in most countries in Europe. Female/girl vaccination is reasonably well implemented with fairly good coverage, but boys are lagging behind and there is data that are really convincing to start vaccinating boys in those countries that have not implemented this yet. Dr Philippe Spiess (Moffitt Cancer Center, USA) gave an exceptional overview of targeted therapies being developed for penile cancer: “Advances in our understanding of the molecular pathways and driving mutations implicated in penile squamous cell carcinoma will with all likelihood result in additional personalised therapeutic options being integrated in our treatment armamentarium.” For example, he pointed to a recent phase 2 clinical trial [3], where a combination of immune checkpoint blockade using nivolumab and a tumour-specific vaccine for patients with incurable HPV16-related cancer was explored. Although most of these tumours were oropharyngeal tumours, the results were very impressive with overall response rates of 33%, including complete responses seen in 8%, and several patients exhibiting durable responses up to 5 years. What made the results all the more exciting is that this combination approach has been trialled in a high-risk study population with patients often failing prior platinum-based chemotherapy or multiple lines of systemic therapy.

1. Boeri L et al. Hum Reprod. 2019 Feb 1;34(2):209-217.
2. Olesen TB et al. Lancet Oncol. 2019 Jan;20(1):145-158.
3. Massarelli E et al. JAMA Oncol. 2019 Jan 1;5(1):67-73.

Posted on 21 May, 201917 March, 2021