According to ¿Global Cancer Statistics 2020¿, lung cancer is the first cause of cancer death worldwide. Tobacco has been recognized the main risk factor, together with environmental exposure. Nevertheless, it is well known that a sizeable subset (nearly 25%) of lung carcinomas develop among never-smokers. Thus indicating that factors other than cigarette smoking must exist among causative agents. Lung cancer occurs more commonly in non-smoking women then in non-smoking men, with a higher prevalence of EGFR mutation. Lung cancer among non-smokers presents different molecular characteristics from lung cancer in smoker patients, justifying a different possible aetiology. Among the different factors investigated (hormones, previous lung disease, dietary factors, genetic susceptibility), also a correlation with viral infection by Human Papilloma Virus was investigated. In fact, it appears that HPV chronic infection could be responsible for nearly a 5% of all human cancers. We would select a population of female patients affected by lung cancer (adenocarcinoma or squamocellular) and analyse HPV virus detection in the tissue. Patients would be tested with HPV-DNA Test (through cervix brushing) before surgery and then a PCR analysis would be made on operatory sample to detect HPV presence. The aim of the study is to confirm an aetiological role of HPV infection for lung cancer in childbearing age women. The second aim is to propose innovative treatments (based on therapeutic vaccines or immunomodulants agent) in addition to the traditional oncologic therapies.
Recent studies have found HPV expression in non-small cell lung cancer (NSCLC), and the virus appears to play a carcinogenic role for this disease.158 HPV infection was also shown to correlate with higher PD-L1 and EGFR expression, related to invasive carcinomas. The primary outcome of the study is to confirm an aetiological role of HPV chronic infection for lung cancer development in childbearing female patients. The real innovation consists on the application of molecular analysis for HPV detection both in cervix and in lung cancer parenchyma. The identification of the contemporaneous expression of HPV specific subtype in both tissue, would significantly enforce the current acknowledgement about the possible cancerogenic role of HPV infection in lung carcinogenesis. This analysis would certainly confirm the importance of prevention through prophylactic vaccination for people aged 11¿26 and the importance of screening tests to detect an early stage of cervical disease, potentially at risk for hematogenous virus dissemination and lung invasion.
The aim of evaluate novel therapeutic prospective, identifying the role of therapeutic HPV vaccines for additional benefit in this patient population is extremely innovative and it is a still debated matter. Therapeutic vaccines for HPV-associated malignancies are a rapidly evolving subject, with many candidates. Any treatment approved for this use would be a great advancement to this field research.