Evaluation of pemetrexed and etoposide as therapeutic regimens for human papillomavirus-positive oral and oropharyngeal cancer

PLoS One. 2018 Jul 11;13(7):e0200509. doi: 10.1371/journal.pone.0200509. eCollection 2018.

Abstract

Although human papillomavirus (HPV) positive oral and oropharyngeal cancers have distinct epidemiologic and molecular characteristics compared to HPV-negative cancers, all patients with oral and oropharyngeal cancers received same standard regimen regardless of HPV status. For these reasons, specific regimens for patients with HPV-positive oral and oropharyngeal cancer are needed. Differentially expressed genes (DEG) between HPV-positive and HPV-negative oropharyngeal cancers were re-analyzed and categorized from public database. Then, druggable targets to HPV-positive oral and oropharyngeal cancer were identified and were validated with E6/E7, which is oncogene of HPV, transfected oral and oropharyngeal cancer cell lines and HPV infected cell lines. In DEG analysis, HPV-positive oral and oropharyngeal cancer showed distinct disease entity from HPV-negative cancers. Unlike HPV-negative oral and oropharyngeal cancer, thymidylate synthase (TS) and topoisomerase II (Topo II) were overexpressed in HPV-positive cancers. Transfection of Lenti-virus containing E6/ E7 to HPV-negative oral and oropharyngeal cancer cells induced upregulation of TS and Topo II in those cells. Although cisplatin, which is standard regimen in head and neck cancers, showed more effectiveness in HPV-negative cells, 5-FU and pemetrexed, which are TS inhibitors, or etoposide, which is Topo II inhibitors, worked more effectively in HPV-positive cells. In addition, cisplatin/etoposide and cisplatin/pemetrexed combination regimens showed synergic effects in HPV-positive cells. Pemetrexed or etoposide alone, or in combination with other chemotherapeutic agents such as cisplatin, can be used as novel substitutes in a regimen of concurrent chemoradiotherapy or a palliative regimen for HPV-positive oral and oropharyngeal cancer patients. However, a well-designed clinical trial is needed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / pharmacology*
  • Cell Line, Tumor
  • Drug Screening Assays, Antitumor
  • Etoposide / pharmacology
  • Humans
  • Mouth Neoplasms* / drug therapy
  • Mouth Neoplasms* / metabolism
  • Mouth Neoplasms* / pathology
  • Mouth Neoplasms* / virology
  • Oncogene Proteins, Viral / metabolism*
  • Papillomaviridae / metabolism*
  • Papillomavirus Infections* / drug therapy
  • Papillomavirus Infections* / metabolism
  • Papillomavirus Infections* / pathology
  • Pemetrexed / pharmacology
  • Pharyngeal Neoplasms* / drug therapy
  • Pharyngeal Neoplasms* / metabolism
  • Pharyngeal Neoplasms* / pathology
  • Pharyngeal Neoplasms* / virology

Substances

  • Oncogene Proteins, Viral
  • Pemetrexed
  • Etoposide

Grants and funding

This work was supported by grants from National Research Foundation of Korea (2014R1A1A1002431, NRF-2014R1A1A1002431, and NRF-2016R1D1A1B03930490). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.