A biomarker that can be identified by blood test was discovered to be a potential indicator of prognosis for human papillomavirus (HPV)-associated oropharyngeal cancer.
"Head and neck cancers that are caused by HPV infection tend to have a better overall outcome than head and neck cancers related to other factors like smoking and alcohol," said Gaorav Gupta, MD, PhD, Assistant Professor in the Department of Radiation at the University of North Carolina School of Medicine and senior author of the study, which has now been published in Clinical Cancer Research. "There's been a lot of interest in exploring whether we can give less treatment to these patients and still achieve the same level of cure while reducing the toxicities of treatment. The goal of this study was to investigate whether a blood test for circulating tumor HPV DNA can potentially be used to monitor the response of a patient's cancer to chemotherapy and radiation."
The study enrolled 103 patients with p16-positive, nonmetastatic oropharyngeal squamous cell carcinoma (OPSCC). The researchers collected blood specimens from patients at baseline, weekly during chemoradiotherapy, and at follow-up visits. In order to quantify a profile of circulating tumor HPV, the investigators used optimized multianalyte digital PCR assays. A control group of 55 healthy volunteers and 60 patients with non–HPV-associated oropharyngeal cancer were also analyzed to compare results with the experimental group.
The baseline blood sample taken from the HPV-associated head and neck cancer group demonstrated high specificity (97%) and high sensitivity (89%) for detecting HPV-associated OPSCC, indicating that a high level of circulating tumor HPV DNA was in the blood before treatment began. More studies need to be conducted to understand why having a higher initial level of circulating tumor HPV is linked to a better outcome.
They also discovered that patients who had at least 95% clearance of the circulating tumor HPV after treatment were more likely to have a better outcome compared with patients who did not clear that much circulating tumor HPV from their blood. These patients who had less than 95% clearance were less likely to have persistent or recurrent regional disease after receiving chemoradiotherapy. Patients who had adverse risk factors, such as smoking, were less likely to clear the circulating tumor HPV from their blood and had a 35% actuarial rate of persistent or recurrent regional disease after chemoradiotherapy.
The study authors concluded, "A rapid clearance profile of [circulating tumor human papilloma virus DNA] may predict likelihood of disease control in patients with HPV-associated OPSCC patients treated with definitive [chemoradiotherapy] and may be useful in selecting patients for deintensified therapy."
For More Information
Chera BS, Kumar S, Beaty BT, et al (2019). Rapid clearance profile of plasma circulating tumor HPV type 16 DNA during chemoradiotherapy correlates with disease control in HPV-associated oropharyngeal cancer. Clin Cancer Res. [Epub ahead of print] DOI:10.1158/1078-0432.CCR-19-0211
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