HPV and CSC in HNSCC cisplatin resistance

Cisplatin (DNA intercalator), a standard chemotherapy drug often used to treat head and neck squamous cellular carcinoma (HNSCC) has very low response rates in recurrent disease of HNSCC, this is a major clinical problem today. However, a valuable window to look in to the underlying molecular aspects of a favorable and unfavorable cisplatin response is offered by a distinct disease entity in HNSCC - HPV+ OPSCC. It responds far more favorably to cisplatin than non-HPV driven HNSCC. Another intriguing aspect of head and neck cancer biology is the emergence of the CD44+ cancer stem cell - the tumor initiating population that in all likelihood is the root cause of therapeutic resistance. The critical question is, are there any differences between the CD44+ CSC population of an HPV+ OPSCC and a non-HPV HNSCC? In this regard, the inverse relation between EGFR levels and HPV status in OPSCC may be a common thread that connects the better response rates of HPV+ OPSCC with the contribution of CD44+ stem cells of HNSCC to chemoresistance.