Contribution of beta-HPV infection and UV damage to rapid-onset cutaneous squamous cell carcinoma during BRAF-inhibition therapy

Daniel N. Cohen*, Steven K. Lawson, Aaron C. Shaver, Liping Du, Harrison P. Nguyen, Qin He, Douglas B. Johnson, Wilfred A. Lumbang, Brent R. Moody, James L. Prescott, Pranil K. Chandra, Alan S. Boyd, Jeffrey P. Zwerner, Jason B. Robbins, Stephen K. Tyring, Peter L. Rady, James D. Chappell, Yu Shyr, Jeffrey R. Infante, Jeffrey A. Sosman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Purpose: BRAF-inhibition (BRAFi) therapy for advanced melanoma carries a high rate of secondary cutaneous squamous cell carcinoma (cSCC) and risk of other cancers. UV radiation and α-genus human papillomavirus (HPV) are highly associated with SCC, but a novel role for β-genus HPV is suspected in BRAFi-cSCC. Cutaneous β-HPV may act in concert with host and environmental factors in BRAFi-cSCC. Experimental Design: Primary BRAFi-cSCC tissue DNA isolated from patients receiving vemurafenib or dabrafenib from two cancer centers was analyzed for the presence of cutaneous oncogenic viruses and host genetic mutations. Diagnostic specimens underwent consensus dermatopathology review. Clinical parameters for UV exposure and disease course were statistically analyzed in conjunction with histopathology. Results: Twenty-nine patients contributed 69 BRAFi-cSCC lesions. BRAFi-cSCC had wart-like features (BRAFi-cSCC-WF) in 22% of specimens. During vemurafenib therapy, BRAFi-cSCC-WF arose 11.6 weeks more rapidly than conventional cSCC when controlled for gender and UV exposure (P value = 0.03). Among all BRAFi-cSCC, β-genus HPV-17, HPV-38, HPV-111 were most frequently isolated, and novel β-HPV genotypes were discovered (CTR, CRT-11, CRT-22). Sequencing revealed 63% of evaluated BRAFi-cSCCs harbored RAS mutations with PIK3CA, CKIT, ALK, and EGFR mutations also detected. Conclusions: We examined clinical, histopathologic, viral, and genetic parameters in BRAFi-cSCC demonstrating rapid onset; wart-like histomorphology; β-HPV-17, HPV-38, and HPV-111 infection; UV damage; and novel ALK and CKIT mutations. Discovered β-HPV genotypes expand the spectrum of tumor-associated viruses. These findings enhance our understanding of factors cooperating with BRAF inhibition that accelerate kerati-nocyte oncogenesis as well as broaden the knowledge base of multifactorial mediators of cancer in general.

Original languageEnglish (US)
Pages (from-to)2624-2634
Number of pages11
JournalClinical Cancer Research
Issue number11
StatePublished - Jun 1 2015

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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