Resolution of Squamous-Cell Carcinoma by Restoring T-Cell Receptor Signaling

N Engl J Med. 2025 Jul 31;393(5):469-478. doi: 10.1056/NEJMoa2502114.

Abstract

Cutaneous squamous-cell carcinoma (SCC) is primarily caused by oncogenesis mediated by ultraviolet radiation, and β-human papillomavirus (β-HPV) is believed to be a mere facilitator that is dispensable for the maintenance of cutaneous SCC. Here, we describe a woman with benign and malignant HPV-related diseases that include a recurrent, unresectable, invasive cutaneous SCC with β-HPV19 genomic integration in the context of germline pathogenic mutations in ZAP70, an adapter required for T-cell receptor (TCR) signal transduction. Restoration of the integrity of TCR signaling by allogeneic hematopoietic-cell transplantation led to the resolution of all HPV-related diseases, thereby revealing a direct role of β-HPV in skin carcinogenesis in hosts with defective adaptive T-cell responses. (Funded by the National Institutes of Health.).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Carcinogenesis / genetics
  • Carcinogenesis / immunology
  • Carcinoma, Squamous Cell* / genetics
  • Carcinoma, Squamous Cell* / immunology
  • Carcinoma, Squamous Cell* / therapy
  • Carcinoma, Squamous Cell* / virology
  • Female
  • Germ-Line Mutation
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Papillomaviridae / genetics
  • Papillomavirus Infections* / complications
  • Papillomavirus Infections* / genetics
  • Papillomavirus Infections* / therapy
  • Papillomavirus Infections* / virology
  • Receptors, Antigen, T-Cell* / metabolism
  • Signal Transduction / genetics
  • Signal Transduction / immunology
  • Skin / immunology
  • Skin / pathology
  • Skin Neoplasms* / genetics
  • Skin Neoplasms* / immunology
  • Skin Neoplasms* / therapy
  • Skin Neoplasms* / virology
  • Virus Integration
  • ZAP-70 Protein-Tyrosine Kinase* / genetics
  • ZAP-70 Protein-Tyrosine Kinase* / metabolism

Substances

  • Receptors, Antigen, T-Cell
  • ZAP-70 Protein-Tyrosine Kinase
  • ZAP70 protein, human