Human papillomavirus (HPV)-related lower genital cancers, including cervical cancer, anal squamous cell carcinoma (SCC), vaginal cancer, vulvar cancer, and penile cancer, pose a significant health burden, with approximately 45,000 new cases diagnosed annually. Current effective treatment modalities include chemoradiotherapy, systemic chemotherapy, and immune checkpoint inhibitors (ICIs). The tumor microenvironment in HPV-related cancers is characterized by immune evasion mechanisms, including the modulation of immune checkpoints such as PD-L1/PD-1. HPV oncoproteins E5, E6, and E7 play crucial roles in this process, altering the expression of immune inhibitory molecules and the recruitment of immune cells. ICIs, such as programmed cell death protein 1 (PD-1) inhibitors, have shown efficacy in enhancing the immune response against HPV-associated tumors by blocking proteins that allow cancer cells to evade immune surveillance. Recent studies have demonstrated that HPV-positive tumors exhibit a more favorable response to ICI-based therapies compared to HPV-negative tumors. The integration of ICIs into treatment regimens for HPV-related cancers has been supported by several clinical trials. The inclusion of ICIs in the treatment approach for HPV-related lower genital cancers presents a promising opportunity for improving patient outcomes. Ongoing research and clinical trials are advancing our understanding of the immune microenvironment and the therapeutic potential of immunotherapy for these cancers.

PURPOSE: The purpose of this study was to evaluate the complication rates associated with fecal management systems (FMS) and assess compliance with manufacturer guidelines at our institution. DESIGN: Retrospective review. SUBJECTS AND SETTING: Patients with FMS inserted between September 2010 and April 2019 at a tertiary care center located in the Midwestern United States. METHODS: Variables collected included demographics, history of liver cirrhosis, anticoagulation, indications for insertion, complications, and diagnostic or therapeutic interventions. Univariate analysis and Fisher exact test were performed to calculate odds ratio of potential predictive factors. RESULTS: A total of 202 patients were included, with a median age of 63 years. Of these, 3.5% (7 patients) experienced FMS-related complications, all presenting with rectal bleeding; 57% had rectal ulcerations, 71% required transfusions, and 1 patient required operative intervention. Notably, 96% of cases lacked documentation of a digital rectal examination before insertion. The median duration of FMS use was significantly longer in patients with complications (11 days) compared with those without (6 days, P = .05), suggesting that prolonged use may be associated with an increased risk of adverse effects. CONCLUSION: Prolonged use of FMS was associated with an increased risk of complications, and overall adherence to recommended guidelines was poor. Implementing structured documentation and assessment protocols may help improve adherence and promote safer use.