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Lewis JS, Beadle B, Bishop JA, Chernock RD, Colasacco C, Kalicanin T, Krane JF, Lacchetti C, Moncur JT, Rocco JW, Schwartz MR, Seethala RR, Faquin WC. Human Papillomavirus Testing in Head and Neck Carcinomas: Guideline Update. Arch Pathol Lab Med 2025; 149:e115-e150. [PMID: 40126379 DOI: 10.5858/arpa.2024-0388-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2025] [Indexed: 03/25/2025]
Abstract
CONTEXT.— In 2018, an evidence-based guideline was published by the College of American Pathologists to develop recommendations for the testing, application, interpretation, and reporting of high-risk human papillomavirus and surrogate marker tests in head and neck carcinomas. Substantial new evidence has prompted a review, including data on human papillomavirus (HPV) in nonoropharyngeal anatomic sites, HPV global rates, p16 immunohistochemistry, and HPV testing performance in cytology specimens, and performance of p16 immunohistochemistry as a surrogate marker. OBJECTIVE.— To assess research published since the release of the original 2018 guideline and to update evidence-based recommendations for HPV testing in head and neck carcinomas. DESIGN.— The College of American Pathologists convened a panel of experts to update the guideline following the standards established by the National Academy of Medicine for developing trustworthy clinical practice guidelines. The expert panel defined the key questions and performed a systematic review of the literature. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, recommendations were updated on the basis of available evidence, certainty of that evidence, and key judgments. RESULTS.— Seven strong recommendations, 4 conditional recommendations, and 5 good practice statements are offered in the guideline update. CONCLUSIONS.— The updated guideline statements provide direction on the nature of HPV testing in various head and neck specimens (including key updates based on new research on sinonasal squamous cell carcinoma) and expanded guidance on specific scenarios and practice settings. The goal is to improve and standardize, where possible, HPV testing across diverse pathology practice settings and different countries.
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Affiliation(s)
- James S Lewis
- From Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Lewis)
- the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Lewis)
| | - Beth Beadle
- the Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (Beadle)
| | - Justin A Bishop
- the Department of Pathology, UT Southwestern Medical Center, Dallas, Texas (Bishop)
| | - Rebecca D Chernock
- the Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri (Chernock)
| | - Carol Colasacco
- Pathology and Laboratory Quality Center for Evidence-Based Guidelines, College of American Pathologists, Northfield, Illinois (Colasacco, Kalicanin)
| | - Tanja Kalicanin
- Pathology and Laboratory Quality Center for Evidence-Based Guidelines, College of American Pathologists, Northfield, Illinois (Colasacco, Kalicanin)
| | - Jeffrey F Krane
- Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Krane)
| | - Christina Lacchetti
- Policy and Advocacy, American Society of Clinical Oncology, Alexandria, Virginia (Lacchetti)
| | - Joel T Moncur
- Office of the Director, The Joint Pathology Center, Silver Spring, Maryland (Moncur)
| | - James W Rocco
- the Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus (Rocco)
| | - Mary R Schwartz
- the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Schwartz)
| | - Raja R Seethala
- the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Seethala)
| | - William C Faquin
- the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (Faquin)
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Helou V, Smith JD, Harris M, Earland N, Contrera KJ, Chaudhuri AA, Zevallos JP. Emerging Proximal Liquid Biopsy Approaches for Detecting Residual Disease and Predicting Recurrence in Head and Neck Cancer: A Review and Proposal of Novel Liquid Staging. Head Neck 2025; 47:1779-1787. [PMID: 40114519 PMCID: PMC12068541 DOI: 10.1002/hed.28138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 03/10/2025] [Accepted: 03/11/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma remains challenging due to high recurrence rates and poor survival outcomes. Developing precise technologies for disease burden assessment, treatment response, and minimal residual disease (MRD) surveillance is crucial for improving prognosis. METHODS This review explores the potential of liquid biopsy for MRD and recurrence detection. A novel liquid TNM (LiTNM) staging system is introduced, integrating biomarkers from saliva, surgical drain lymphatic fluid (SLF), and peripheral blood. RESULTS Proximal liquid biopsies, particularly saliva and SLF, offer advantages due to their proximity to the tumor microenvironment. Saliva demonstrates high sensitivity in HPV-associated oropharyngeal cancers, while SLF holds potential in identifying early postoperative recurrence. Despite these advancements, standardization and validation remain challenges. CONCLUSIONS Liquid biopsy approaches show promise for postoperative disease monitoring, yet their clinical implementation remains in the early stages. The proposed LiTNM staging system could complement TNM staging by providing a molecular framework for risk stratification. However, rigorous prospective studies are necessary to validate its clinical utility and facilitate adoption.
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Affiliation(s)
- Vanessa Helou
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Joshua D. Smith
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Micah Harris
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Noah Earland
- Division of Cancer Biology, Department of Radiation OncologyWashington University School of MedicineSt. LouisMissouriUSA
- Division of Biology and Biomedical SciencesWashington University School of MedicineSt. LouisMissouriUSA
| | - Kevin J. Contrera
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
- UPMC Hillman Cancer CenterUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Aadel A. Chaudhuri
- Department of Radiation OncologyMayo ClinicRochesterMinnesotaUSA
- Mayo Clinic Comprehensive Cancer CenterRochesterMinnesotaUSA
| | - Jose P. Zevallos
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
- UPMC Hillman Cancer CenterUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
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3
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Chen AM, Tjoa T, Armstrong WB. Circulating Tumor HPV-DNA in the Management of HPV-Positive Oropharyngeal Carcinoma: A Systematic Review. Head Neck 2025; 47:1674-1679. [PMID: 39846227 PMCID: PMC12068533 DOI: 10.1002/hed.28057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 12/10/2024] [Accepted: 12/22/2024] [Indexed: 01/24/2025] Open
Abstract
PURPOSE Blood-borne, cell-free DNA has been proposed as a means of individualizing the management of human papillomavirus (HPV)-positive oropharyngeal carcinoma. METHODS AND MATERIALS This study was designed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. A comprehensive literature search of peer-reviewed publications from January 2013 to January 2024 was undertaken to identify prospective studies pertaining to the use of circulating HPV-DNA for oropharyngeal carcinoma. RESULTS A total of 11 prospective studies were identified and differed in their clinical design, methods, and endpoints. Five included patients treated by chemoradiation; 3 by surgery; 2 by both; and 1 not specified. The timing and frequency of HPV-DNA draws was highly variable. The sample size ranged from 16 to 262 (mean, 99 patients). CONCLUSIONS While interest is growing with integrating circulating HPV-DNA into clinical practice, the supporting evidence is limited by the heterogeneity of the evidence.
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Affiliation(s)
- Allen M. Chen
- Department of Radiation OncologyUniversity of California, Irvine, Chao Family Comprehensive Cancer CenterOrangeCaliforniaUSA
| | - Tjoson Tjoa
- Department of OtolaryngologyUniversity of California, Irvine, Chao Family Comprehensive Cancer CenterOrangeCaliforniaUSA
| | - William B. Armstrong
- Department of OtolaryngologyUniversity of California, Irvine, Chao Family Comprehensive Cancer CenterOrangeCaliforniaUSA
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Lee NY, Hanna GJ, Faden DL. The Challenge and Promise of Circulating Tumor HPV DNA for Minimal Residual Disease Detection-Catching the Unseen. JAMA Otolaryngol Head Neck Surg 2025:2834563. [PMID: 40402546 DOI: 10.1001/jamaoto.2025.0923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2025]
Affiliation(s)
- Nancy Y Lee
- Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Glenn J Hanna
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston
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Routman DM, Van Abel KM, Price KA, Moore EJ, Patel SH, Hinni ML, Fruth B, Foster NR, Yin LX, Neben-Wittich M, Garces YI, McGee LA, Lester SC, Gamez ME, Rwigema JCM, Holtzman AL, Price DL, Janus JR, Kasperbauer JL, Chintakuntlawar AV, Garcia JJ, Foote RL, Ma DJ. ctDNA and Recurrence Risk for Adjuvant De-Escalation in HPV-Positive Oropharyngeal Carcinoma: A Secondary Analysis of the DART Phase 3 Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2025:2834560. [PMID: 40402484 PMCID: PMC12100506 DOI: 10.1001/jamaoto.2025.0903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 03/30/2025] [Indexed: 05/23/2025]
Abstract
Importance The De-escalated Adjuvant Radiation Therapy (DART) phase 3 randomized clinical trial (RCT) showed that in patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma, postoperative minimal residual disease (MRD), detected through circulating tumor HPV DNA (ctHPVDNA), was associated with a higher risk of disease progression. When considered along with pathologic factors, postoperative ctHPVDNA assessment may improve patient selection for adjuvant treatment de-escalation; however, more data are needed to demonstrate how it may be used in personalizing treatment intensity. Objective To determine the association of postoperative MRD status with progression-free survival (PFS) after surgery for HPV-associated oropharyngeal squamous cell carcinoma. Design, Setting, and Participants This was a secondary analysis of the DART RCT, which was conducted from October 2016 to August 2020 in multiple sites in the US. Participants from the de-escalated adjuvant radiation therapy group and the standard of care group with available blood specimen data were included. Reports from 3-month posttreatment surveillance visits were used to assess associations and outcomes. Data analyses were performed from March 2023 to March of 2025. Interventions The DART group received 30 to 36 Gy of radiation therapy in 1.5 to 1.8 Gy twice daily, plus docetaxel, 15 mg/m2, on days 1 and 8. The standard of care group received 60 Gy with or without weekly cisplatin, 40 mg/m2. Main Outcome and Measure PFS. Results The analysis included 140 patients (mean [SD] age, 59.1 [8.4] years; 12 [8.6%] females and 128 [91.4%] males; 97 [69.3%] with no smoking history); characteristics were similar to the overall DART RCT population. Of these, 17 patients (12.1%) had postoperative MRD (13 of 96 [13.5%] receiving DART and 4 of 44 [9.1%] receiving standard of care). For all patients, postoperative MRD positivity was strongly associated with worsened PFS at 24 months (MRD positivity, 69.5%; MRD negativity, 95.9%; hazard ratio [HR], 0.19; 95% CI, 0.06-0.59). MRD positivity was associated with PFS when evaluating only those patients in the DART group, where 24-month PFS was 68.4% compared to 92.6% for MRD-negative patients (HR, 0.28; 95% CI, 0.08-0.93). Three months after completion of all treatment, 8 of 117 patients (6.8%) had detectable ctHPVDNA, whereas 109 of 117 (93.2%) did not, and detection was highly associated with PFS (HR, 20.48; 95% CI, 6.91-60.67). Conclusions and Relevance This secondary analysis of the DART RCT found that patients with detectable ctHPVDNA after surgery had a higher risk of disease progression. When added to the pathologic factors considered, ctHPVDNA assessment may improve selection of patients for treatment de-escalation. In addition, the 3-month posttreatment time point, early in surveillance, may identify a sizable portion of patients with progression and may guide intervention and surveillance after surgery for HPV-associated oropharyngeal squamous cell carcinoma. Trial Registration ClinicalTrials.gov Identifier: NCT02908477.
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Affiliation(s)
- David M. Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Kathryn M. Van Abel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Eric J. Moore
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Samir H. Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Briant Fruth
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Nathan R. Foster
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Linda X. Yin
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Lisa A. McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Adam L. Holtzman
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Daniel L. Price
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey R. Janus
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida
| | - Jan L. Kasperbauer
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Joaquin J. Garcia
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J. Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Yin LX, Hidalgo CM, Bogan AW, Hunter DE, Bartemes KR, Tasche KK, Moore EJ, Price DL, Ma DJ, Neben-Wittich MA, Lester SC, Price KA, McGarrah PW, Fuentes Bayne HE, Routman DM, Van Abel KM. Postoperative ctHPVDNA Kinetics in Patients With HPV-Related Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2025:2834215. [PMID: 40367049 PMCID: PMC12079564 DOI: 10.1001/jamaoto.2025.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Accepted: 04/28/2025] [Indexed: 05/16/2025]
Abstract
Importance Circulating tumor human papillomavirus DNA (ctHPVDNA) is an important biomarker for the presence of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC), but little is known about early postoperative kinetics of ctHPVDNA clearance. Objective To investigate early postoperative kinetics of ctHPVDNA in patients with HPV-associated OPSCC. Design, Setting, and Participants This prospective cohort study was conducted at a single tertiary care center from January 4, 2020, to January 26, 2023. Patients with newly diagnosed HPV-associated OPSCC undergoing surgical management were enrolled. HPV status was defined as positive if findings of p16 immunohistochemistry and/or HPV DNA in situ hybridization and/or E6/E7 RNA in situ hybridization were positive. Exclusion criteria included history of prior head and neck cancer and metastatic disease at presentation. Data were analyzed from September 1, 2024, to April 25, 2025. Exposures Transoral robotic surgery with concurrent neck dissection. Main Outcomes and Measures Blood was drawn prior to surgery (pretreatment), 1 to 2 days after surgery (postoperative days 1 to 2), and approximately 2 weeks after surgery (postoperative week 2; range, 8 to 20 days). ctHPVDNA was quantified by a tumor tissue-modified viral (TTMV) HPV DNA test. Correlations were tested between the pretreatment and postoperative day 1 to 2 TTMV HPV DNA levels using Gaussian regression. Concordance between detectability at postoperative day 1 to 2 and postoperative week 2 was explored using negative predictive value and positive predictive value. Results Of 57 included patients with detectable pretreatment TTMV HPV DNA, 51 (89%) were male, and the median (IQR) age was 59 (54-66) years. A total of 35 patients (61%) had blood draws at all 3 time points; 16 (28%) had detectable TTMV HPV DNA on postoperative day 1 to 2. Pretreatment and postoperative day 1 to 2 TTMV HPV DNA levels had a medium positive linear correlation (r = 0.31; 95% CI, 0.04-0.54). Undetectable TTMV HPV DNA on postoperative day 1 to 2 blood draw had a negative predictive value of 0.95 (95% CI, 0.74-1.00) for an undetectable level on postoperative week 2 blood draw, but a detectable level on postoperative day 1 to 2 blood draw only had a positive predictive value of 0.19 (95% CI, 0.04-0.46). Of the 16 patients with detectable TTMV HPV DNA pretreatment and at postoperative day 1 to 2, only 3 (19%) continued to have detectable TTMV HPV DNA at postoperative week 2. One patient had undetectable levels at postoperative day 1 to 2 and detectable levels at postoperative week 2. Conclusions and Relevance In this study, ctHPVDNA detectability early after surgery did not predict detectability at 2 weeks after surgery. ctHPVDNA clearance early after surgery could predict a negative test at 2 weeks. A negative blood draw finding on postoperative day 1 may be used to omit a postoperative blood draw at 2 weeks for minimal residual disease detection in future clinical trials.
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Affiliation(s)
- Linda X. Yin
- Department of Otolaryngology−Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cecelia M. Hidalgo
- Department of Otolaryngology−Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Aaron W. Bogan
- Division of Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | - Danielle E. Hunter
- Department of Otolaryngology−Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kathleen R. Bartemes
- Department of Otolaryngology−Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kendall K. Tasche
- Department of Otolaryngology−Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Eric J. Moore
- Department of Otolaryngology−Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel L. Price
- Department of Otolaryngology−Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J. Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - David M. Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Kathryn M. Van Abel
- Department of Otolaryngology−Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Chennareddy S, Chen S, Levinson C, Genden EM, Posner MR, Roof SA. Circulating tumor DNA in human papillomavirus-associated oropharyngeal cancer management: A systematic review. Oral Oncol 2025; 164:107262. [PMID: 40163959 DOI: 10.1016/j.oraloncology.2025.107262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 03/14/2025] [Indexed: 04/02/2025]
Abstract
OBJECTIVE Circulating tumor DNA (ctDNA) has emerged as a promising tool in the treatment of HPV-associated oropharyngeal squamous cell cancer (OPSCC). This systematic review sought to answer the question: what is the current role of ctDNA in the diagnosis, treatment, and surveillance of HPV-associated OPSCC? DATA SOURCES Medline (Ovid), Embase (Ovid), Scopus. REVIEW METHODS Original articles studying the role of ctDNA in the diagnosis or surveillance of HPV-associated OPSCC were eligible for inclusion. Two authors independently reviewed studies for inclusion and abstracted data, including study design, characterization of liquid biopsy technology, and diagnostic outcomes. RESULTS After a preliminary screening of 441 studies, 23 were selected for inclusion. Ten studies were conducted retrospectively, and 13 were conducted prospectively. In these studies, diagnostic testing included plasma-based droplet digital polymerase chain reaction (ddPCR, n = 13), quantitative PCR (qPCR, n = 4), digital PCR (dPCR, n = 3), next-generation sequencing (NGS) (n = 3), or a ctDNA detection kit (n = 1). Diagnostic outcomes were reported for pre-diagnosis (n = 1), pre-treatment (n = 17), during treatment (n = 6), and surveillance/recurrence (n = 11) timepoints. Test sensitivities ranged from 20.6 %-100 % pre-treatment and 72 %-100 % during surveillance, while test specificities ranged from 95 %-100 % pre-treatment and 87.2 %-100 % during surveillance. CONCLUSION The majority of studied ctDNA technologies allow for detection of HPV-associated OPSCC with high diagnostic accuracy. However, heterogeneity is introduced by test type and assay used. These findings highlight the utility, as well as limitations, of ctDNA in the diagnosis, treatment monitoring, and surveillance of HPV-associated OPSCC. Future studies and clinical consensus will need to address acceptable diagnostic accuracy thresholds for clinical use.
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Affiliation(s)
- Susmita Chennareddy
- Department of Otolaryngology-Head& Neck Surgery, Mount Sinai Hospital, New York, NY, USA.
| | - Sida Chen
- Department of Otolaryngology-Head& Neck Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Carrie Levinson
- Gustave L. and Janet W. Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric M Genden
- Department of Otolaryngology-Head& Neck Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Marshall R Posner
- TGH/Cancer Center of South Florida, USA; University of Southern Florida, USA
| | - Scott A Roof
- Department of Otolaryngology-Head& Neck Surgery, Mount Sinai Hospital, New York, NY, USA
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8
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Almerén AO, Waenerlund M, Landström F, von Beckerath M, Qvick A, Carlsson J, Helenius G. Circulating Tumour DNA as a Complementary Tool for Treatment Evaluation in HPV-Associated Head and Neck Squamous Cell Carcinoma: An Observational Cohort Study. Clin Otolaryngol 2025. [PMID: 40260766 DOI: 10.1111/coa.14317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 09/09/2024] [Accepted: 03/29/2025] [Indexed: 04/24/2025]
Abstract
OBJECTIVES HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) and head and neck carcinoma of unknown primary (HNCUP) are increasing. Despite good prognosis, recurrence rates range from 10% to 25%. Surveillance with clinical controls and imaging is not always reliable. Circulating tumour human papillomavirus DNA (ctHPV-DNA) has emerged as a potential biomarker for treatment evaluation and detection of recurrence. We aimed to investigate the correlation between ctHPV-DNA in HPV+ OPSCC/HNCUP and radiologic tumour burden. Additionally, we sought to assess whether ctHPV-DNA could serve as a tool in treatment evaluation. DESIGN A prospective observational cohort study. SETTING This multicenter study involved three otolaryngology units located in central Sweden. We utilised HPV genotype-specific assays for droplet digital PCR (ddPCR) to detect ctHPV-DNA in plasma at diagnosis and follow-up. ctHPV-DNA levels were correlated to radiological tumour burden and radiological response using the Kendall Rank correlation coefficient and the Kruskal-Wallis test. PARTICIPANTS Patients with HPV+ OPSCC/HNCUP undergoing definitive (chemo)radiotherapy and enrolled in the CIRCOS study. RESULTS Out of 54 patients, 51 were eligible for analyses. At baseline, ctHPV-DNA was detectable in 88%. A majority of patients with a favourable radiological evaluation according to RECIST had a corresponding undetectable ctHPV-DNA at follow-up. The levels of ctHPV-DNA at baseline correlated with total tumour volume and nodal volume (rτ = 0.39, p < 0.01, respectively rτ = 0.26, p < 0.01). CONCLUSION ctHPV-DNA shows correlation with tumour burden. This study strengthens the role of ctHPV-DNA as a promising biomarker for treatment evaluation in HPV-related OPC/HNCUP. With further research on serial plasma sampling, ctHPV-DNA could complement radiological treatment evaluation in HPV+ OPSCC/HNCUP. TRIAL REGISTRATION NCT05904327 [ClinicalTrials.gov].
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Affiliation(s)
- Anna Oldaeus Almerén
- Department of Otolaryngology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Max Waenerlund
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Otolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fredrik Landström
- Department of Otolaryngology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mathias von Beckerath
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Clinical Sciences Intervention and Technology, Division of Ear Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Head and Neck Surgery, Medical Unit Head Neck Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Alvida Qvick
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jessica Carlsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gisela Helenius
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- ATMP Center, Skåne University Hospital, Lund, Sweden
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Ziltzer RS, Jafary ZI, Hunt C, Hasan I, Turner MT. Association Between HPV Circulating Tumor DNA and Prognostic Inflammatory Indices in Oropharyngeal Squamous Cell Carcinoma: A Pilot Study. OTO Open 2025; 9:e70116. [PMID: 40255408 PMCID: PMC12006750 DOI: 10.1002/oto2.70116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 03/07/2025] [Accepted: 04/04/2025] [Indexed: 04/22/2025] Open
Abstract
Circulating tumor DNA (ctDNA) has been developed as a marker of tumor burden in human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Inflammatory indices are also increasingly being used as prognostic surrogate markers in solid tumors, including head and neck cancers. The relationship between ctDNA levels and inflammatory indices has not been studied in HPV-associated OPSCC. We hypothesize that higher levels of inflammation are associated with higher ctDNA levels. Herein, we demonstrate an association between high pretreatment ctDNA levels and specific inflammatory indices, which may be lower-cost surrogate markers of high HPV ctDNA levels and may act as a surrogate marker for the body's immune response to HPV-positive OPSCC.
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Affiliation(s)
- Ryan S. Ziltzer
- Department of Otolaryngology–Head and Neck SurgeryWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Zulkifl I. Jafary
- West Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Connor Hunt
- West Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Iraj Hasan
- West Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Meghan T. Turner
- Department of Otolaryngology–Head and Neck SurgeryWest Virginia UniversityMorgantownWest VirginiaUSA
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10
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Ma D, Routman DM. De-escalation of Adjuvant Therapy in Operatively Managed HPV Associated Oropharyngeal Carcinoma: Current Status and Future Directions. Semin Radiat Oncol 2025; 35:166-172. [PMID: 40090743 DOI: 10.1016/j.semradonc.2025.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Accepted: 02/12/2025] [Indexed: 03/18/2025]
Abstract
Human papillomavirus (HPV) associated oropharyngeal carcinoma is currently the most frequently diagnosed head and neck cancer in the United States. Due to the generally high cure rates with standard therapies, de-intensification strategies are being explored to reduce acute and long-term side effects. For patients treated with definitive chemoradiation, unselected de-escalation has shown worse progression-free survival compared to standard therapy. Concurrently, surgical management is becoming more prevalent, and adjuvant de-escalation appears promising. Further research is required to identify optimal candidacy for adjuvant de-escalation and to understand the relationship between dose and volume de-escalation. Biomarkers such as ctDNA may assist in candidate selection, but validation and alignment with pathological criteria are necessary.
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Affiliation(s)
- Daniel Ma
- Department of Radiation Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, MN..
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, MN
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Hutcheson J, Conway D, Kumar S, Wiseman C, Chakraborty S, Skrypkin E, Horan M, Gunning A, Williams CK, Kuperwasser C, Naber SP, Gupta PB. Analytical Validation of NavDx+Gyn, a cfDNA-Based Fragmentomic Profiling Assay for HPV-Driven Gynecologic Cancers. Diagnostics (Basel) 2025; 15:825. [PMID: 40218175 PMCID: PMC11988370 DOI: 10.3390/diagnostics15070825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 03/19/2025] [Accepted: 03/21/2025] [Indexed: 04/14/2025] Open
Abstract
Background/Objectives: The NavDx+Gyn blood test detects and quantifies fourteen HPV types in various sample types to provide a reliable means of detecting and monitoring HPV-driven gynecologic cancers. NavDx+Gyn is an extension of the NavDx assay, which identifies five high-risk HPV types. NavDx has been clinically validated in multiple independent studies for the surveillance of HPV-driven oropharyngeal cancer and has been integrated into clinical practice by over 1300 healthcare providers at over 500 medical sites in the US. The NavDx+Gyn assay incorporates an analysis of nine additional high-risk HPV types. Here, we report a detailed analytical validation of the NavDx+Gyn assay for use in cervical, vaginal, and vulvar cancer patients to detect fourteen high-risk HPV types related to HPV-driven gynecologic cancers. Methods: Parameters include specificity as measured by limits of blank (LoBs) and sensitivity illustrated via limits of detection and quantitation (LoDs and LoQs). Results: The LoBs were between 0 and 0.0926 copies/μL, LoDs were 0.1009 to 0.3147 copies/μL, and LoQs were 0.1009 to 0.3147 copies/μL, demonstrating the high analytic sensitivity and specificity provided by NavDx+Gyn. In-depth evaluations, including accuracy and intra- and inter-assay precision studies, were shown to be within acceptable ranges. Regression analysis revealed a high degree of correlation between expected and effective concentrations, demonstrating excellent linearity (R2 > 0.99) across a broad range of analyte concentrations. Conclusions: These results demonstrate that NavDx+Gyn accurately and reproducibly detects fourteen types of high-risk HPV, which aids in the diagnosis and surveillance of the vast majority of HPV-driven gynecologic cancers.
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12
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Morse RT, Nelson TJ, Liu HC, Sangchan P, Chitti B, Thompson CA, Henderson G, Williamson CW, Todd JR, Prajapati DP, Vitzthum LK, Sharabi AB, Zou J, Sacco AG, Coffey CS, Sanghvi P, Rahn DA, Lominska CE, Shen CJ, Chera BS, Mell LK. Redefining Candidates for Deintensification in Locoregionally Advanced P16+ Oropharyngeal Cancer Based on Relative Risk. Int J Radiat Oncol Biol Phys 2025; 121:684-692. [PMID: 39307324 DOI: 10.1016/j.ijrobp.2024.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 08/23/2024] [Accepted: 09/14/2024] [Indexed: 10/17/2024]
Abstract
PURPOSE Randomized trials have found that patients with locoregionally advanced p16+ oropharyngeal squamous cell carcinoma (OPSCC) do not benefit from treatment deintensification, even among favorable risk groups. Although various methods have been used to identify candidates for treatment deintensification, the optimal approach is unknown. METHODS AND MATERIALS We conducted a multi-institutional cohort study of 444 patients with previously untreated p16+ OPSCC undergoing definitive radiation therapy with or without systemic therapy between 2009 and 2022. We compared the following 2 approaches for identifying candidates for deintensification: (1) favorable versus unfavorable risk, using NRG-HN005 eligibility criteria, and (2) low versus high relative risk of cancer events, using the Head and Neck Cancer Intergroup predictive classifier ("omega score"). We tested differences in outcomes and systemic therapy allocation by risk group using multivariable Cox models, competing event models, and logistic regression, and compared characteristics of hypothetical deintensification trials using the 2 approaches. Progression-free survival events were defined as cancer recurrence (locoregional or distant) or death from any cause. RESULTS Median follow-up time was 52 months; 120 patients (27.0%) were favorable risk; a different 120 patients had low omega score; 28 patients (6.3%) met both criteria; 184 patients (41.4%) had discordant classification. On ordinal logistic regression, decreasing omega score was associated with a statistically significantly lower odds of receiving intensive therapy (normalized odds ratio, 0.37 per SD; 95% CI, 0.24-0.57), with a greater magnitude than favorable risk group (odds ratio, 0.66; 95% CI, 0.44-0.99). Among patients receiving cisplatin and/or platinum-based induction (n = 374), favorable risk was associated with significantly improved progression-free survival (hazard ratio, 0.59; 95% CI, 0.36-0.99), whereas lower omega score was associated with a significantly decreased relative hazard for cancer events (relative hazard ratio, 0.18; 95% CI, 0.070-0.46). In simulations, selecting patients with low omega scores increased the efficiency of hypothetical noninferiority trials. CONCLUSIONS Considering patients' relative risk of cancer events can help define optimal populations for treatment deintensification in p16+ OPSCC.
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Affiliation(s)
- Ryan T Morse
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Tyler J Nelson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Hannah C Liu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Prangrawee Sangchan
- Division of Radiation Oncology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Bhargava Chitti
- Bronxcare Health System, Mount Sinai School of Medicine, New York, New York
| | - Caroline A Thompson
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gerald Henderson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Casey W Williamson
- Department of Radiation Oncology, Oregon Health Sciences University, Portland, Oregon
| | - Jake R Todd
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Divya P Prajapati
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Lucas K Vitzthum
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Andrew B Sharabi
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Jingjing Zou
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - Assuntina G Sacco
- Department of Medicine, Division of Hematology and Oncology, University of California San Diego, La Jolla, California
| | - Charley S Coffey
- Department of Otolaryngology, University of California San Diego, La Jolla, California
| | - Parag Sanghvi
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Douglas A Rahn
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Christopher E Lominska
- Department of Radiation Oncology, The University of Kansas Health System, Kansas City, Kansas
| | - Colette J Shen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bhishamjit S Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
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13
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Thomas J, Mazzara E, Guller M, Landsberger H, Tham T, Cooper D, Pereira L, Kamdar D, Frank D, Miles B, Mandal R. Methodology of cfHPV-DNA Detection in Head and Neck Cancer: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2025; 172:798-810. [PMID: 39624913 DOI: 10.1002/ohn.1056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 10/03/2024] [Accepted: 11/01/2024] [Indexed: 02/22/2025]
Abstract
OBJECTIVE We aim to compare the diagnostic accuracy of the different methodologies used in the detection of cell-free human papillomavirus (HPV) DNA in HPV-associated head and neck squamous cell carcinoma detection using bivariate analysis methods. DATA SOURCES Pubmed, Embase, and Scopus were queried using a broad search strategy to search for relevant studies. REVIEW METHODS Test characteristics were extracted from 33 studies following literature screening, and underwent analyses utilizing a bivariate approach. Summary statistics were identified for each type of methodology, and forest plots and summary receiver operating characteristic curves were constructed. Bias was estimated using Deek's Funnel Plot and the QUADAS-2 tool. RESULTS In terms of diagnostic accuracy, digital droplet polymerase chain reaction (ddPCR) based testing exhibited the highest diagnostics odds ratio at 138 (59.5, 318), followed closely by next-generation sequencing (NGS) at 120 (39.7, 362), then by polymerase chain reaction (PCR) at 31.4 (14.4, 68.6), and quantitative PCR at 8.74 (4.63, 16.5). CONCLUSION NGS and ddPCR are comparable in overall diagnostic accuracy, bringing into question their relative roles in diagnosis and screening. Cost-effective ddPCR assays may serve as useful diagnostic and screening tests in the clinic with their low false positive rates and high sensitivity. However, NGS assays also offer high sensitivity and companion metrics, suggesting they may have a more precise role in disease monitoring. Importantly, assay development and benchmarking need further standardization to improve comparison between assays. Finally, saliva-based testing needs to be further investigated using NGS and ddPCR to further understand its limitations in disease detection and monitoring.
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Affiliation(s)
- Jerin Thomas
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Eden Mazzara
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Meytal Guller
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Hannah Landsberger
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Tristan Tham
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Dylan Cooper
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Lucio Pereira
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Dev Kamdar
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Douglas Frank
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rajarsi Mandal
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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14
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Wotman MT, Xiao W, Du RR, Jiang B, Akagi K, Liu S, Gillison ML. Development and Validation of an Assay to Quantify Plasma Circulating Tumor Human Papillomavirus DNA for 13 High-Risk Types that Cause 98% of HPV-Positive Cancers. Head Neck Pathol 2025; 19:25. [PMID: 39998590 PMCID: PMC11861489 DOI: 10.1007/s12105-025-01752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Accepted: 01/18/2025] [Indexed: 02/27/2025]
Abstract
PURPOSE Plasma circulating tumor HPV DNA (ctHPVDNA) persistence after curative-intent treatment may identify patients with HPV-positive cancers at risk for recurrence. Technical validation is required for use as an integral biomarker in a prospective clinical trial. METHODS Development and analytical validation of a digital droplet PCR assay for detection and quantification of 13 high-risk HPV types (i.e., Cell-Free 13) was performed with oligonucleotides/plasmids encoding type-specific E6/E7 coding regions. Clinical performance, determinants of detection/quantification, and associations of pre-treatment ctHPVDNA with progression-free survival (PFS) were also evaluated in a prospective cohort of 272 head and neck cancer patients. RESULTS Limit of detection, limit of quantification, and linear range of quantification were 5, 16 and 16-200,000 virus copies for all 13 high-risk HPV types. No cross-reactivity was detected across all 13 HPV types. At 10,000 copies, inter-assay coefficients of variation ranged from 0.3 to 4.6%. Multiplexing, DNA purification method, input plasma volume, total input cell-free (< 1800 ng) or genomic (< 700 ng) DNA did not affect HPV detection or quantification. The assay had a sensitivity of 91.7% (95%CI 87.3-94.9%) and specificity of 97.7% (95%CI 87.7-99.9%) for ctHPVDNA detection in the setting of newly diagnosed HPV-positive oropharyngeal cancer. Tumor and nodal stage categories, tumor viral load (ρ = 0.41, p < 0.05), and HPV integration status were associated with ctHPVDNA quantitative level. Pre-treatment ctHPVDNA greater than the median (231 copies/ml) was associated with worse PFS (HR = 2.14, 95%CI 1.16-3.97, p = 0.0156) in univariate analysis. However, this was no longer significant after adjustment for clinical covariates (HRadj = 1.81, 95%CI 0.97-3.37, p = 0.0635). CONCLUSION Cell-Free 13 demonstrated excellent analytical performance and clinical sensitivity/specificity in HPV-positive oropharyngeal cancer. Pre-treatment ctHPVDNA may be associated with oncologic outcomes.
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Affiliation(s)
- Michael T Wotman
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weihong Xiao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 432, Houston, TX, 77030, USA
| | - Robyn R Du
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 432, Houston, TX, 77030, USA
| | - Bo Jiang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 432, Houston, TX, 77030, USA
| | - Keiko Akagi
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 432, Houston, TX, 77030, USA
| | - Suyu Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maura L Gillison
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 432, Houston, TX, 77030, USA.
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15
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Huttinger ZM, Gogineni E, Baliga S, Blakaj DM, Bhateja P, Bonomi M, Kang SY, Old MO, Seim NB, VanKoevering KK, Agrawal A, Ozer E, Rocco JW, Haring CT. Circulating tumor DNA determines induction chemotherapy response in HPV associated oropharyngeal squamous cell carcinoma: A pilot study. Oral Oncol 2025; 161:107179. [PMID: 39827592 DOI: 10.1016/j.oraloncology.2025.107179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 10/15/2024] [Accepted: 01/07/2025] [Indexed: 01/22/2025]
Abstract
BACKGROUND Induction chemotherapy (IC) followed by chemoradiation (CRT) is one treatment approach for patients with locoregionally advanced oropharyngeal squamous cell carcinoma (OPSCC) associated with human papillomavirus (HPV). This pilot study aimed to assess whether a circulating tumor (ct) DNA assay outperforms PET-CT in assessing treatment response in patients with HPV + OPSCC treated with induction chemotherapy (IC) followed by chemoradiation (CRT). MATERIALS AND METHODS Patients treated with IC and definitive CRT for HPV + OPSCC were included. HPV ctDNA and PET-CT were performed pre-treatment, 2-3 weeks after IC and 3 months after CRT. CtDNA levels were correlated with tumor volumes. Post-IC and post- CRT ctDNA levels were correlated post-induction and post-treatment imaging responses. RESULTS Seventeen patients were included. Baseline ctDNA levels correlated with volume of primary tumor (R2 = 0.33, p = 0.02), but did not correlate with nodal volumes (R2 = 0.01, p = 0.7) or total disease burden (R2 = 0.02, p = 0.6). After IC, 5.9 % (1/17) of patients had complete response by PET- CT, whereas 52.9 % (9/17) had complete molecular response by ctDNA testing. After completion of CRT, 76.5 % (13/17) patients had complete clinical response to treatment. Of patients who had ctDNA clearance after IC, 88.9 % (8/9) remained disease free after definitive CRT, whereas one had progressive disease diagnosed by both imaging and ctDNA. HPV ctDNA clearance after IC predicted disease control after CRT more strongly than PET-CT IC response (61.5 % (8/13) vs 7.7 % (1/13), p = 0.01). CONCLUSIONS HPV ctDNA clearance following IC outperforms standard imaging in assessing response and may help identify patients with favorable prognosis.
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Affiliation(s)
- Zachary M Huttinger
- The Ohio State University, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA
| | - Emile Gogineni
- The Ohio State University, Department of Radiation Oncology, Columbus, OH, USA
| | - Sujith Baliga
- The Ohio State University, Department of Radiation Oncology, Columbus, OH, USA
| | - Dukagjin M Blakaj
- The Ohio State University, Department of Radiation Oncology, Columbus, OH, USA
| | - Priyanka Bhateja
- The Ohio State University, Department of Medical Oncology, Columbus, OH, USA
| | - Marcelo Bonomi
- The Ohio State University, Department of Medical Oncology, Columbus, OH, USA
| | - Stephen Y Kang
- The Ohio State University, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA
| | - Matthew O Old
- The Ohio State University, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA
| | - Nolan B Seim
- The Ohio State University, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA
| | - Kyle K VanKoevering
- The Ohio State University, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA
| | - Amit Agrawal
- The Ohio State University, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA
| | - Enver Ozer
- The Ohio State University, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA
| | - James W Rocco
- The Ohio State University, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA
| | - Catherine T Haring
- The Ohio State University, Department of Otolaryngology - Head and Neck Surgery, Columbus, OH, USA.
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16
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Clark P, Karasik N, Campbell SR, Woody NM, Ku JA, Silver N, Bottalico D, Prendes BL, Lamarre ED, Scharpf J, Sussman TA, Geiger JL, Wang H, Chan TA, Koyfman SA, Miller JA. Highly-multiplex detection of plasma cell-free human papillomavirus-16 DNA in oropharyngeal carcinoma. J Clin Virol 2025; 176:105760. [PMID: 39793474 DOI: 10.1016/j.jcv.2025.105760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 12/30/2024] [Accepted: 01/01/2025] [Indexed: 01/13/2025]
Abstract
BACKGROUND Plasma cell-free Human Papillomavirus DNA (cfHPVDNA) is a biomarker for oropharyngeal carcinoma. Existing diagnostics may be limited by inadequate sensitivity or high cost/complexity for longitudinal monitoring. OBJECTIVES We hypothesized that sensitive and specific plasma cfHPVDNA detection may be achieved via a highly-multiplex qPCR method. STUDY DESIGN We designed and validated a single-tube one-step genotype-specific qPCR assay for detection of cfHPV16DNA in human plasma using >8,000 genomes spanning 18 genotypes. Amplicons were optimized for cfHPVDNA fragment size. RESULTS The cfHPV16DNA qPCR amplicons spanned 16 % of the HPV16 genome. Amplicons were conserved in a median of 99.0 % of 3,944 genomes in silico. The 95 % lower limit of detection was 0.35 genome copies/reaction and the limit of blank was 0. Multiplexing achieved a tenfold improvement in sensitivity compared with single amplicons using in silico simulations of cfHPVDNA fragmentation, which was in close agreement with experimental observations. An assay was replicated for HPV18 with similar observations. Among 36 patients with head/neck mucosal carcinomas (26 HPV-positive, 12 HPV-negative), there was 100 % concordance with tissue HPV status and with NavDx digital PCR. Pre-treatment specimens with sub-genomic cfHPVDNA concentration were detected. False negatives were observed with single amplicons but not with this multiplexed method. Among 17 patients with post-treatment landmark specimens, there was 100 % PPV and 100 % NPV for recurrence. CONCLUSIONS This assay is specific for plasma cfHPVDNA detection and prognostic for recurrence. Sub-genomic sensitivity was in close agreement with in silico simulations. The format might be more accessible than dPCR or NGS for longitudinal testing.
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Affiliation(s)
- Payton Clark
- Center for Immunotherapy and Precision Immuno-Oncology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Natalya Karasik
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jamie A Ku
- Department of Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Natalie Silver
- Department of Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Danielle Bottalico
- Department of Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brandon L Prendes
- Department of Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric D Lamarre
- Department of Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Scharpf
- Department of Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tamara A Sussman
- Department of Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jessica L Geiger
- Department of Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hannah Wang
- Department of Laboratory Medicine, Diagnostics Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Timothy A Chan
- Center for Immunotherapy and Precision Immuno-Oncology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jacob A Miller
- Center for Immunotherapy and Precision Immuno-Oncology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
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17
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Spindler KLG, Jakobsen AV, Eriksen JG, Fokdal L, Nordsmark M, Thorsen LBJ, Wind KL, Lefevre AC, Overgaard J. The clinical utility of circulating human papillomavirus across squamous cell carcinomas. Acta Oncol 2025; 64:1-12. [PMID: 39748655 PMCID: PMC11711493 DOI: 10.2340/1651-226x.2025.41288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 12/08/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND AND PURPOSE The similarities in biology, treatment regimens and outcome between the different human papillomavirus (HPV) associated squamous cell carcinomas (SCCs) allow for extrapolation of results generated from one SC tumor type to another. In HPV associated cancers, HPV is integrated into the tumor genome and can consequently be detected in the circulating fragments of the tumor DNA. Thus, measurement of HPV in the plasma is a surrogate for circulating tumor DNA (ctDNA) and holds promise as a clinically relevant biomarker in HPV associated cancers. With the present overview we aim to present the status of circulating HPV studies in SCCs, the clinical potential and the gaps of knowledge, with the overall aim to facilitate the next steps into clinically relevant prospective trials. MATERIAL AND METHODS We reviewed the literature and presented the data for each tumor type as well as analyses of the clinical utility across the SCC. RESULTS AND INTERPRETATION A total of 41 studies were identified in cervical, head and neck and anal SCC and we discuss the common signals from the results across the different tumor sites. Our results not only confirm the strong clinical potential but also emphasize an urgent need to coordinate studies to allow for relevant sample sizes and statistical validations.
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Affiliation(s)
- Karen-Lise G Spindler
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Anne V Jakobsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jesper G Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Fokdal
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Oncology, Vejle Hospital, Vejle, Denmark
| | - Marianne Nordsmark
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lise B J Thorsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karen L Wind
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anna C Lefevre
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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18
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Yang R, Li T, Zhang S, Shui C, Ma H, Li C. The effect of circulating tumor DNA on the prognosis of patients with head and neck squamous cell carcinoma: a systematic review and meta-analysis. BMC Cancer 2024; 24:1434. [PMID: 39574043 PMCID: PMC11580464 DOI: 10.1186/s12885-024-13116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 10/28/2024] [Indexed: 11/25/2024] Open
Abstract
BACKGROUND Circulating tumour DNA (ctDNA) has emerged as a valuable liquid biopsy biomarker in the field of oncology, including head and neck squamous cell carcinomas (HNSCCs), offering potential insights into cancer diagnosis, progression, and prognosis. This review aims to comprehensively evaluate the utility of ctDNA as a prognostic biomarker in HNSCC. METHODS PubMed and Ovid were searched as part of our review. Studies that investigated the relationship between ctDNA and prognosis in HNSCC patients were included. Outcomes extracted included basic characteristics, ctDNA details and survival data. Meta-analysis was performed on eligible studies to determine pooled progression-free/recurrence-free survival (RFS/PFS) and overall survival (OS). RESULTS Twenty-two studies were included, involving 5062 HNSCC patients from 11 countries. The meta-analysis demonstrated that the positive ctDNA/methylation detection was associated with worse OS (HR = 2.00, 95% CI 1.35-2.96) and worse PFS/RFS (HR = 3.54, 95% CI 1.05-11.85). Positive ctEBV DNA was associated with poorer OS (HR = 2.86, 95% CI 1.84-4.45) and poorer PFS/RFS (HR = 1.93, 95% CI 1.74-2.13). Positive ctHPV DNA was associated with poorer OS (HR = 1.38, 95% CI 1.07-1.38) but not PFS/PFS (HR = 1.33, 95% CI 0.96-1.85). CONCLUSION Meta-analysis indicates that the status of ctDNA is significantly associated with the prognosis of HNSCC patients, with ctDNA/methylation-negative patients demonstrating better PFS/RFS and OS.
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Affiliation(s)
- Ruoyi Yang
- Head and Neck Surgery Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Guizhou Medical University, Guiyang, 550004, China
| | - Teng Li
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Guizhou Medical University, Guiyang, 550004, China
| | - Sicheng Zhang
- Head and Neck Surgery Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Chunyan Shui
- Head and Neck Surgery Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Hong Ma
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Guizhou Medical University, Guiyang, 550004, China.
| | - Chao Li
- Head and Neck Surgery Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China.
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Hanna GJ, Jabalee J, Lukens JN, Sun L, Rettig EM, Ferrandino R, Posner MR, Misiukiewicz KJ, Routman DM, Van Abel KM, Del Vecchio Fitz C, Roof SA. Circulating tumor tissue modified viral (TTMV)-HPV DNA in Recurrent, metastatic HPV-driven oropharyngeal cancer. Oral Oncol 2024; 158:107002. [PMID: 39159525 DOI: 10.1016/j.oraloncology.2024.107002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Human papillomavirus (HPV) is causally linked to oropharyngeal squamous cell carcinoma (OPSCC). Testing for plasma tumor tissue modified viral (TTMV)-HPV DNA has emerged as a biomarker strategy for post-treatment surveillance to identify recurrent disease. We aimed to understand the prognostic and predictive potential of TTMV-HPV DNA when monitoring patients who had developed recurrent or metastatic (R/M) HPV+OPSCC. METHODS This retrospective observational cohort study included 80 patients from 4 academic centers with R/M HPV+OPSCC if they had ≥ 1 plasma TTMV-HPV DNA test obtained at any point during their R/M disease course. Physician-reported clinical data and treatment history were captured in a centralized database, along with investigator-assessed response to therapy and survival. Descriptive statistics and non-parametric tests of association were employed along with survival analyses (Kaplan-Meier method). RESULTS Sixteen (20 %) patients had ≥ 5 test results over time. Consecutive TTMV-HPV DNA tests were performed a median of 73 days apart. Median TTMV-HPV DNA scores were higher with an increasing per-patient number of metastatic sites (<2 vs. 2+; p < 0.01). Score changes over time were influenced by R/M treatment modality and became undetectable in 67 % (12/18) of patients who achieved a complete response to R/M therapy. Patients with detectable scores at last follow-up had significantly worse survival compared with those who were undetectable (log-rank test, p < 0.01). CONCLUSIONS TTMV-HPV DNA appears useful as a prognostic tool for monitoring response to therapy in the R/M setting. In the future, TTMV-HPV DNA could be explored as an exploratory clinical trial endpoint in the metastatic setting.
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Affiliation(s)
- Glenn J Hanna
- Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | | | - John N Lukens
- Head & Neck Service, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lova Sun
- Head & Neck Service, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Eleni M Rettig
- Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Rocco Ferrandino
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marshall R Posner
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Scott A Roof
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Qvick A, Andersson E, Oldaeus Almerén A, Waenerlund M, Stenmark B, Karlsson C, Karlsson MG, Helenius G. Sensitive and Specific Droplet Digital PCR Assays for Circulating Tumor HPV DNA: Development, Validation, and Clinical Application in HPV-Associated Cancers. Mol Diagn Ther 2024; 28:835-845. [PMID: 39325260 PMCID: PMC11512825 DOI: 10.1007/s40291-024-00743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Human papillomavirus (HPV) has emerged as a significant contributor to cancer incidence globally, particularly in the context of oropharyngeal squamous cell carcinoma (OPSCC) and cancer of unknown primary (HNCUP). This study aimed to develop and validate droplet digital PCR (ddPCR) assays for the detection of circulating tumor HPV DNA (ctHPV-DNA) in plasma, focusing on high-risk HPV genotypes associated with these cancers. METHODS ddPCR assays for HPV16, 18, 33, 35, 56, and 59 were developed and tested using gBlocks, HPV cell-free DNA, fragmented tumor HPV+ DNA, and plasma samples from patients with HPV+ OPSCC (n = 110) and HNCUP (n = 9). RESULTS Assays demonstrated robust technical sensitivity across all tested HPV genotypes. Clinical application of the assays on a cohort of patients with HPV+ OPSCC and HNCUP revealed high sensitivity (91.6%) and wide variability in ctHPV-DNA levels. Analyses revealed correlations between ctHPV-DNA levels and TNM stage and tumor viral load. The association between ctHPV-DNA and tumor viral load persisted even after adjusting for TNM stage. At posttreatment, 72.5% of samples had reached undetectable ctHPV-DNA levels. Having detectable ctHPV-DNA posttreatment was associated with a higher ctHPV-DNA level at diagnosis and higher viral load at diagnosis. CONCLUSION The findings underscore the potential of ctHPV-DNA as a biomarker for monitoring HPV+ cancers and offer insights into tumor dynamics. Implementation of these assays in clinical practice could enhance no-invasive treatment monitoring and recurrence detection in HPV-associated cancers. CLINICAL TRIALS NCT05904327.
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Affiliation(s)
- Alvida Qvick
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Elin Andersson
- Clinical Research Center, Örebro University Hospital, Örebro, Sweden
| | - Anna Oldaeus Almerén
- Department of Otolaryngology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Max Waenerlund
- Department of Otolaryngology, Sahlgrenska University Hospital, Göteborg, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Bianca Stenmark
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Mats G Karlsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Frechette KM, Breen WG, Brown PD, Sener UT, Webb LM, Routman DM, Laack NN, Mahajan A, Lehrer EJ. Radiotherapy and Systemic Treatment for Leptomeningeal Disease. Biomedicines 2024; 12:1792. [PMID: 39200256 PMCID: PMC11351760 DOI: 10.3390/biomedicines12081792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 09/02/2024] Open
Abstract
Leptomeningeal disease (LMD) is a devastating sequelae of metastatic spread that affects approximately 5% of cancer patients. The incidence of LMD is increasing due to advancements in systemic therapy and enhanced detection methods. The purpose of this review is to provide a detailed overview of the evidence in the detection, prognostication, and treatment of LMD. A comprehensive literature search of PUBMED was conducted to identify articles reporting on LMD including existing data and ongoing clinical trials. We found a wide array of treatment options available for LMD including chemotherapy, targeted agents, and immunotherapy as well as several choices for radiotherapy including whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and craniospinal irradiation (CSI). Despite treatment, the prognosis for patients with LMD is dismal, typically 2-4 months on average. Novel therapies and combination approaches are actively under investigation with the aim of improving outcomes and quality of life for patients with LMD. Recent prospective data on the use of proton CSI for patients with LMD have demonstrated its potential survival benefit with follow-up investigations underway. There is a need for validated metrics to predict prognosis and improve patient selection for patients with LMD in order to optimize treatment approaches.
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Affiliation(s)
- Kelsey M. Frechette
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA; (W.G.B.); (P.D.B.); (D.M.R.); (N.N.L.); (A.M.); (E.J.L.)
| | - William G. Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA; (W.G.B.); (P.D.B.); (D.M.R.); (N.N.L.); (A.M.); (E.J.L.)
| | - Paul D. Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA; (W.G.B.); (P.D.B.); (D.M.R.); (N.N.L.); (A.M.); (E.J.L.)
| | - Ugur T. Sener
- Department of Neuro-Oncology, Mayo Clinic, Rochester, MN 55905, USA; (U.T.S.); (L.M.W.)
| | - Lauren M. Webb
- Department of Neuro-Oncology, Mayo Clinic, Rochester, MN 55905, USA; (U.T.S.); (L.M.W.)
| | - David M. Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA; (W.G.B.); (P.D.B.); (D.M.R.); (N.N.L.); (A.M.); (E.J.L.)
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA; (W.G.B.); (P.D.B.); (D.M.R.); (N.N.L.); (A.M.); (E.J.L.)
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA; (W.G.B.); (P.D.B.); (D.M.R.); (N.N.L.); (A.M.); (E.J.L.)
| | - Eric J. Lehrer
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA; (W.G.B.); (P.D.B.); (D.M.R.); (N.N.L.); (A.M.); (E.J.L.)
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22
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Krsek A, Baticic L, Braut T, Sotosek V. The Next Chapter in Cancer Diagnostics: Advances in HPV-Positive Head and Neck Cancer. Biomolecules 2024; 14:925. [PMID: 39199313 PMCID: PMC11352962 DOI: 10.3390/biom14080925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 09/01/2024] Open
Abstract
Human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC), particularly oropharyngeal squamous cell carcinoma (OPSCC), is an increasingly prevalent pathology worldwide, especially in developed countries. For diagnosing HPV in HNSCC, the combination of p16 immunohistochemistry (IHC) and polymerase chain reaction (PCR) offers high sensitivity and specificity, with p16 IHC being a reliable initial screen and PCR confirming HPV presence. Advanced techniques like next-generation sequencing (NGS) and RNA-based assays provide detailed insights but are primarily used in research settings. Regardless of HPV status, standard oncological treatments currently include surgery, radiation, and/or chemotherapy. This conventional approach does not account for the typically better prognosis of HPV-positive HNSCC patients, leading to increased chemo/radiation-induced secondary morbidities and reduced quality of life. Therefore, it is crucial to identify and detect HPV positivity and other molecular characteristics of HNSCC to personalize treatment strategies. This comprehensive review aims to summarize current knowledge on various HPV detection techniques and evaluate their advantages and disadvantages, with a focus on developing methodologies to identify new biomarkers in HPV-positive HNSCC. The review discusses direct and indirect HPV examination in tumor tissue, DNA- and RNA-based detection techniques, protein-based markers, liquid biopsy potentials, immune-related markers, epigenetic markers, novel biomarkers, and emerging technologies, providing an overall insight into the current state of knowledge.
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Affiliation(s)
- Antea Krsek
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Lara Baticic
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Tamara Braut
- Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia;
| | - Vlatka Sotosek
- Department of Anesthesiology, Reanimatology, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
- Department of Clinical Medical Sciences I, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
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23
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Flach S, Maniam P, Hey SY, Manickavasagam J. The molecular characteristics of recurrent/metastatic HPV-positive head and neck squamous cell carcinoma: A systematic review of the literature. Clin Otolaryngol 2024; 49:384-403. [PMID: 38658385 DOI: 10.1111/coa.14161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES About 17% of patients with human papillomavirus (HPV)-positive head and neck squamous cell carcinoma (HNSCC), which is mainly comprised of oropharyngeal SCC (OPSCC), will experience disease recurrence, which is often considered incurable when manifested at a metastatic and/or recurrent stage. We conducted a critical qualitative systematic review. Our objectives were to provide an overview of the molecular landscape of recurrent/metastatic HPV-positive HNSCC as well as novel molecular biomarkers. DESIGN A literature review was conducted to identify studies reporting on the molecular characteristics of recurrent/metastatic HPV-positive HNSCC, novel molecular biomarkers and treatment options. The reviews of abstracts, full articles, and revision of the included studies, followed by data extraction and quality assessment were performed by three independent assessors. All primary literature, such as retrospective, prospective, and clinical trials as well as basic research studies were considered, and the final search was conducted at the end of February 2023. The level of evidence was rated using the guidelines published by the Oxford Centre for Evidence-based Medicine and quality was assessed using the Newcastle-Ottawa Scale criteria. RESULTS AND CONCLUSIONS The literature search resulted in the identification of 1991 articles. A total of 181 full articles were screened, and 66 articles were included in this analysis. Several studies reported that recurrent/metastatic HPV-positive HNSCC had higher rates of TP53 mutation and were genomically similar to HPV-negative HNSCC. The detection of circulating tumour tissue-modified HPV DNA (ctHPVDNA) as a specific biomarker has shown promising results for monitoring treatment response and recurrence in the subset of HPV-positive HNSCC. In addition, evidence for targeted therapy in recurrent/metastatic HPV-positive HNSCC has emerged, including agents that inhibit overexpressed EGFR. Studies of combination immunotherapy are also underway. Our review outlines the latest evidence on the distinct molecular profiles of recurrent/metastatic HPV-positive HNSCC as well as the clinical potential of ctHPVDNA testing in routine practice. More controlled and longitudinal studies are needed to identify additional molecular targets and to assess the performance and benefits of novel molecular biomarkers in clinical practice.
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Affiliation(s)
- Susanne Flach
- Department of Otorhinolaryngology, Head and Neck Surgery, LMU Klinikum, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Pavithran Maniam
- Department of Otolaryngology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Shi Ying Hey
- Department of Otolaryngology & Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jaiganesh Manickavasagam
- Department of Otorhinolaryngology and Head & Neck Surgery and Tayside Medical Sciences Centre, Ninewells Hospital, Dundee, UK
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
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24
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Fearington FW, Zhao CY, Romero-Brufau S, Moore EJ, Price DL, Tasche KK, Yin LX, Kunkel ET, Kisiel JB, Giridhar KV, Routman DM, Van Abel KM. Addressing positive multi-cancer early detection tests in head and neck Surgery: Experience with head and neck work up for high-risk referrals. Oral Oncol 2024; 152:106809. [PMID: 38621326 DOI: 10.1016/j.oraloncology.2024.106809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Blood-based multi-cancer early detection (MCED) tests are now commercially available. However, there are currently no consensus guidelines available for head and neck cancer (HNC) providers to direct work up or surveillance for patients with a positive MCED test. We seek to describe cases of patients with positive MCED tests suggesting HNC and provide insights for their evaluation. METHODS Retrospective chart review of patients referred to Otolaryngology with an MCED result suggesting HNC. Patients enrolled in prospective MCED clinical trials were excluded. Cancer diagnoses were confirmed via frozen-section pathology. RESULTS Five patients were included (mean age: 69.2 years, range 50-87; 4 male) with MCED-identified-high-risk for HNC or lymphoma. Only patient was symptomatic. After physical exam and follow-up head and neck imaging, circulating tumor HPV DNA testing, two patients were diagnosed with p16 + oropharyngeal squamous cell carcinomas and underwent appropriate therapy. A third patient had no evidence of head and neck cancer but was diagnosed with sarcoma of the thigh. The remaining two patients had no evidence of malignancy after in-depth workup. CONCLUSIONS In this retrospective study, 2 of 5 patients referred to Otolaryngology with a positive MCED result were diagnosed with HPV + oropharyngeal squamous cell carcinoma. We recommend that positive HNC MCED work up include thorough head and neck examination with flexible laryngoscopy and focused CT or MRI imaging. Given the potential for inaccurate MCED tissue of origin classification, PET/CT may be useful in specific situations. For a patient with no cancer identified, development of clear guidelines is warranted.
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Affiliation(s)
| | - Conan Y Zhao
- Mayo Clinic Alix School of Medicine, 200 1(st) St SW, Rochester, MN, USA
| | - Santiago Romero-Brufau
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Daniel L Price
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Kendall K Tasche
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Elizabeth T Kunkel
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - John B Kisiel
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Karthik V Giridhar
- Department of Oncology, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA.
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Bhardwaj S, Gitman M, Ramirez JD, Paniz-Mondolfi A, Westra WH. Reappraisal of p16 for Determining HPV Status of Head and Neck Carcinomas Arising in HPV Hotspots. Am J Surg Pathol 2024; 48:581-587. [PMID: 38482860 DOI: 10.1097/pas.0000000000002204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
In an era of head and neck oncology where HPV status will soon dictate patient management, reliable HPV detection is critical. P16 immunohistochemistry (IHC) is currently recommended as the test of choice for oropharyngeal squamous cell carcinomas (OPSCCs). The purpose of this study was to determine the performance characteristics of p16 IHC based on a large clinical experience of squamous cell carcinomas (SCC) arising from HPV hot-spot regions of the head and neck. Consecutive OPSCCs, sinonasal SCCs, and metastatic SCCs of unknown primary sites were evaluated for the presence of HPV by p16 IHC and PCR-based HPV DNA testing as part of clinical care. For discrepant cases, high-risk HPV E6/E7 mRNA in situ hybridization (ISH) and, when possible, matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (MassArray) genotyping were performed. 746 cancers underwent HPV testing by p16 IHC and DNA PCR genotyping. There was a 95.6% concordance between the 2 assays. Of the 33 discrepant cases, 32 cases (4.3%) were p16 positive but HPV DNA negative. In these cases, 68% were positive for mRNA ISH, invariably related to a non-16 HPV genotype. P16 IHC had an overall accuracy of 98.8%, a sensitivity of 99.8%, and a specificity of 92.1%. P16 IHC is a sensitive and specific assay for determining HPV status. HPV DNA PCR appears vulnerable to HPV genotype diversity and is prone to missing rare non-16 genotypes. HPV mRNA ISH is a practical and reliable direct measure of HPV that may help eliminate the small number of false-positive p16 cases and avoid potential patient harm related to erroneous HPV classification.
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Affiliation(s)
- Swati Bhardwaj
- Department of Pathology, The Icahn School of Medicine at Mount Sinai Hospital, New York, NY
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26
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Kais A, Santiago SP, Han PC, Clump DA, Stokes WA, Fancy T, Cui R, Martin E, Turner MT. Human papillomavirus circulating tumor DNA: a diagnostic tool in squamous cell carcinoma of unknown primary-a pilot study. Front Oncol 2024; 14:1376595. [PMID: 38628671 PMCID: PMC11018957 DOI: 10.3389/fonc.2024.1376595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Neck mass is the most common presentation of human papillomavirus-related (HPV-related) oropharyngeal squamous cell carcinoma (OPSCC). Recently, circulating tumor HPV-DNA (ctHPVDNA) assays have been developed to detect active OPSCC. This pilot study investigates the diagnostic accuracy of ctHPVDNA in establishing HPV status for known vs. unknown OPSCC presenting as a neck mass. Methods A single-institution pilot study was conducted on all patients with OPSCC presenting as a neck mass between 2021 and 2022. The diagnostic accuracy of ctHPVDNA was compared to that of standard diagnostic procedures used to obtain HPV status according to the American Society of Clinical Oncology (ASCO) guideline for squamous cell carcinoma of unknown primary (SCCUP). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ctHPVDNA were calculated. Results A total of 27 patients were included; 70.4% were current or former smokers, 48.1% (N = 13) had identifiable primaries, and 51.9% (N = 14) had SCCUP. Four patients with known primaries required operative direct laryngoscopy with biopsy (DLB) to establish HPV status. Two patients with SCCUP underwent diagnostic transoral robotic surgery (TORS) to establish HPV status and localize the primary. Twelve patients underwent therapeutic TORS and neck dissection. The gold standard for HPV status was based on final histopathologic p16 or HPV in situ hybridization (ISH) staining during workup/treatment. ctHPVDNA had 95.8% sensitivity, 100% specificity, 100% PPV, and 75% NPV in predicting HPV-positive OPSCC in the whole sample. Binary logistic regression model using ctHPVDNA results to predict HPV-positive OPSCC was significant (-2 log likelihood = 5.55, χ2 = 8.70, p <.01, Nagelkerke's R squared = .67). Among patients with identifiable primaries, all patients had HPV-positive tumors on final pathology, and ctHPVDNA was positive in 100%. In the unknown primary patients, ctHPVDNA had 90.9% sensitivity, 100% specificity, 100% PPV, and 75% NPV. Discussion ctHPVDNA demonstrated good diagnostic accuracy for both known and unknown primaries. Incorporation of ctHPVDNA into the diagnostic algorithm for SCCUP may reduce the need for multiple procedures to establish HPV status.
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Affiliation(s)
- Amani Kais
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV, United States
| | - Stell Patadji Santiago
- Department of Pathology, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV, United States
| | - Peng Cheng Han
- Department of Pathology, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV, United States
| | - David A. Clump
- Department of Radiation Oncology, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV, United States
| | - William A. Stokes
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV, United States
| | - Tanya Fancy
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV, United States
| | - Ruifeng Cui
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV, United States
| | - Elizabeth Martin
- Department of Pathology, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV, United States
| | - Meghan T. Turner
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV, United States
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Earland N, Semenkovich NP, Ramirez RJ, Gerndt SP, Harris PK, Gu Z, Hearn AI, Inkman M, Szymanski JJ, Whitfield D, Wahle BM, Xu Z, Chen K, Alahi I, Ni G, Chen A, Winckler W, Zhang J, Chaudhuri AA, Zevallos JP. Sensitive MRD Detection from Lymphatic Fluid after Surgery in HPV-Associated Oropharyngeal Cancer. Clin Cancer Res 2024; 30:1409-1421. [PMID: 37939112 PMCID: PMC10982646 DOI: 10.1158/1078-0432.ccr-23-1789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Our goal was to demonstrate that lymphatic drainage fluid (lymph) has improved sensitivity in quantifying postoperative minimal residual disease (MRD) in locally advanced human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) compared with plasma, and leverage this novel biofluid for patient risk stratification. EXPERIMENTAL DESIGN We prospectively collected lymph samples from neck drains of 106 patients with HPV (+) OPSCC, along with 67 matched plasma samples, 24 hours after surgery. PCR and next-generation sequencing were used to quantify cancer-associated cell-free HPV (cf-HPV) and tumor-informed variants in lymph and plasma. Next, lymph cf-HPV and variants were compared with TNM stage, extranodal extension (ENE), and composite definitions of high-risk pathology. We then created a machine learning model, informed by lymph MRD and clinicopathologic features, to compare with progression-free survival (PFS). RESULTS Postoperative lymph was enriched with cf-HPV compared with plasma (P < 0.0001) and correlated with pN2 stage (P = 0.003), ENE (P < 0.0001), and trial-defined pathologic risk criteria (mean AUC = 0.78). In addition, the lymph mutation number and variant allele frequency were higher in pN2 ENE (+) necks than in pN1 ENE (+) (P = 0.03, P = 0.02) or pN0-N1 ENE (-) (P = 0.04, P = 0.03, respectively). The lymph MRD-informed risk model demonstrated inferior PFS in high-risk patients (AUC = 0.96, P < 0.0001). CONCLUSIONS Variant and cf-HPV quantification, performed in 24-hour postoperative lymph samples, reflects single- and multifeature high-risk pathologic criteria. Incorporating lymphatic MRD and clinicopathologic feature analysis can stratify PFS early after surgery in patients with HPV (+) head and neck cancer. See related commentary by Shannon and Iyer, p. 1223.
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Affiliation(s)
- Noah Earland
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Nicholas P. Semenkovich
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ricardo J. Ramirez
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sophie P. Gerndt
- Division of Otolaryngology-Head and Neck Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Peter K. Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Zhuosheng Gu
- Droplet Biosciences, Inc., Cambridge, Massachusetts
| | - Andrew I. Hearn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew Inkman
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey J. Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Benjamin M. Wahle
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Zhongping Xu
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kevin Chen
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Irfan Alahi
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Gabris Ni
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew Chen
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Jin Zhang
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Aadel A. Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Jose P. Zevallos
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Shannon NB, Iyer NG. Unveiling Liquid Gold: Lymph as an HPV Marker in OPSCC to Guide Treatment Decisions. Clin Cancer Res 2024; 30:1223-1225. [PMID: 38252056 DOI: 10.1158/1078-0432.ccr-23-3549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
Distinguishing low- versus high-risk HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) is pivotal for tailoring treatment. Liquid biopsy, measuring cell-free HPV-DNA in serum and saliva, assesses treatment response and early-recurrence risk. Postoperative lymphatic fluid may better guide future adjuvant therapy decisions due to its proximity to primary lesions and lymph nodes. See related article by Earland et al., p. 1409.
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Affiliation(s)
- Nicholas B Shannon
- Department of Head and Neck Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - N Gopalakrishna Iyer
- Department of Head and Neck Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
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Souza SS, Stephens EM, Bourdillon AT, Bhethanabotla R, Farzal Z, Plonowska-Hirschfeld K, Qualliotine JR, Heaton CM, Ha PK, Ryan WR. Circulating tumor HPV DNA assessments after surgery for human papilloma virus-associated oropharynx carcinoma. Am J Otolaryngol 2024; 45:104184. [PMID: 38101135 DOI: 10.1016/j.amjoto.2023.104184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE To understand the utility of circulating tumor human papillomavirus DNA (ctHPVDNA) blood testing for HPV-associated oropharynx squamous cell carcinoma (HPV + OPSCC) after definitive surgery. MATERIALS AND METHODS Prospective cohort study of HPV(+)OPSCC patients with ctHPVDNA test data to assess its accuracy in detecting biopsy-confirmed disease at various post-treatment time points. Eligible patients had p16(+)/HPV(+) OPSCC and ctHPVDNA testing performed at any time pre-operatively and/or postoperatively. In cases of recurrence, patients were excluded from analysis if ctHPVDNA testing was not performed within 6 months of biopsy. RESULTS 196 all-treatment-type patients had at least one PT ctHPVDNA test. The initial post-treatment (PT) ctHPVDNA sensitivity, specificity, PPV, and NPV were 69.2 % (9/13), 96.7 % (177/183), 60.0 % (9/15), and 97.8 % (177/181). 61 surgery alone (SA) patients underwent 128 PT tests. The initial PT SA ctHPVDNA sensitivity, specificity, PPV, and NPV were 100 % (2/2), 96.0 % (48/50), 50 % (2/4), and 100 % (48/48). 35 of 61 (57.4 %) SA patients had NCCN-based histopathologic indications for adjuvant (chemo)radiation but declined. 3 of 35 (8.57 %) had a positive PT ctHPVDNA test of which 1 of 3 (33 %) had biopsy-proven recurrence. Prospectively, ten patients had a PreT positive ctHPVDNA, underwent SA, refused adjuvant treatment, had an undetectable ctHPVDNA within 2 weeks of SA, and remained free of disease (mean 10.3 months). CONCLUSION The high specificity and NPV of ctHPVDNA after SA suggest ctHPVDNA may have a role in determining the omission of PT adjuvant (chemo)radiation in select patients.
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Affiliation(s)
- Spenser S Souza
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, United States of America
| | - Erika M Stephens
- School of Medicine, University of California-San Francisco, United States of America
| | - Alexandra T Bourdillon
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, United States of America
| | | | - Zainab Farzal
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, United States of America
| | - Karolina Plonowska-Hirschfeld
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, United States of America
| | - Jesse R Qualliotine
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, United States of America
| | - Chase M Heaton
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, United States of America
| | - Patrick K Ha
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, United States of America
| | - William R Ryan
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, United States of America.
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Eberly HW, Sciscent BY, Lorenz FJ, Rettig EM, Goyal N. Current and Emerging Diagnostic, Prognostic, and Predictive Biomarkers in Head and Neck Cancer. Biomedicines 2024; 12:415. [PMID: 38398017 PMCID: PMC10886579 DOI: 10.3390/biomedicines12020415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Head and neck cancers (HNC) are a biologically diverse set of cancers that are responsible for over 660,000 new diagnoses each year. Current therapies for HNC require a comprehensive, multimodal approach encompassing resection, radiation therapy, and systemic therapy. With an increased understanding of the mechanisms behind HNC, there has been growing interest in more accurate prognostic indicators of disease, effective post-treatment surveillance, and individualized treatments. This chapter will highlight the commonly used and studied biomarkers in head and neck squamous cell carcinoma.
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Affiliation(s)
- Hänel W. Eberly
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
| | - Bao Y. Sciscent
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
| | - F. Jeffrey Lorenz
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
| | - Eleni M. Rettig
- Department of Otolaryngology Head and Neck Surgery, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02108, USA
| | - Neerav Goyal
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
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31
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Haring CT, Rocco JW. Emerging role of blood-based biomarker testing in HPV-mediated head and neck squamous cell carcinoma. Cancer Cytopathol 2024; 132:7-9. [PMID: 37350366 DOI: 10.1002/cncy.22735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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32
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Lang Kuhs KA, Brenner JC, Holsinger FC, Rettig EM. Circulating Tumor HPV DNA for Surveillance of HPV-Positive Oropharyngeal Squamous Cell Carcinoma: A Narrative Review. JAMA Oncol 2023; 9:1716-1724. [PMID: 37824111 PMCID: PMC12011137 DOI: 10.1001/jamaoncol.2023.4042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Importance Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma has an overall favorable prognosis, yet a subset of patients will experience devastating disease recurrence. Current surveillance standards for detection of recurrent disease are imperfect. There is growing interest in improving detection of recurrent disease through the use of plasma-based assays able to detect circulating tumor HPV DNA. Observations Although most circulating tumor HPV DNA assays remain in the research domain, the circulating tumor tissue-modified viral HPV DNA assay became commercially available in the United States in early 2020 and has been increasingly used in the clinical setting. With the rapidly increasing incidence of HPV-positive oropharyngeal squamous cell carcinoma and concomitant expansion of biomarker capabilities for this disease, it is critical to reexamine current posttreatment surveillance practices and to determine whether emerging technologies may be used to improve outcomes for a growing survivor population. However, caution is advised; it is not yet known whether biomarker-based surveillance is truly beneficial, and as is true with any intervention, it has the capacity to cause harm. Conclusions and Relevance Using Margaret Pepe's classic 5 phases of biomarker development for early detection of cancer as a framework, this article reviews the current state of knowledge, highlights existing knowledge gaps, and suggests research that should be prioritized to understand the association between biomarker-based surveillance and patient outcomes. Specific attention is paid to the commercially available tumor tissue-modified viral HPV DNA assay, given its increasing clinical use. This review may serve as a road map for future research and a guide for clinicians considering its adoption in practice. Enrollment of patients into clinical trials incorporating biomarker-based surveillance should be prioritized.
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Affiliation(s)
- Krystle A Lang Kuhs
- Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington
- Markey Cancer Center, University of Kentucky, Lexington
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
- Rogel Cancer Center, University of Michigan, Ann Arbor
- Department of Pharmacology, University of Michigan, Ann Arbor
| | - F Chris Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California
| | - Eleni M Rettig
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- The Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Head and Neck Oncology Center, Dana-Farber Cancer Institute, Boston, Massachusetts
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33
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Bartemes KR, Gochanour BR, Routman DM, Ma DJ, Doering KA, Burger KN, Foote PH, Taylor WR, Mahoney DW, Berger CK, Cao X, Then SS, Haller TJ, Larish AM, Moore EJ, Garcia JJ, Graham RP, Bakkum-Gamez JN, Kisiel JB, Van Abel KM. Assessing the capacity of methylated DNA markers of cervical squamous cell carcinoma to discriminate oropharyngeal squamous cell carcinoma in human papillomavirus mediated disease. Oral Oncol 2023; 146:106568. [PMID: 37717549 PMCID: PMC10591712 DOI: 10.1016/j.oraloncology.2023.106568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/11/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Early identification of human papillomavirus associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) is challenging and novel biomarkers are needed. We hypothesized that a panel of methylated DNA markers (MDMs) found in HPV(+) cervical squamous cell carcinoma (CSCC) will have similar discrimination in HPV(+)OPSCC tissues. MATERIALS AND METHODS Formalin-fixed, paraffin-embedded tissues were obtained from patients with primary HPV(+)OPSCC or HPV(+)CSCC; control tissues included normal oropharynx palatine tonsil (NOP) and cervix (NCS). Using a methylation-specific polymerase chain reaction, 21 previously validated cervical MDMs were evaluated on tissue-extracted DNA. Discrimination between case and control cervical and oropharynx tissue was assessed using area under the curve (AUC). RESULTS 34 HPV(+)OPSCC, 36 HPV(+)CSCC, 26 NOP, and 24 NCS patients met inclusion criteria. Within HPV(+)CSCC, 18/21 (86%) of MDMs achieved an AUC ≥ 0.9 and all MDMs exhibited better than chance classifications relative to control cervical tissue (all p < 0.001). In contrast, within HPV(+)OPSCC only 5/21 (24%) MDMs achieved an AUC ≥ 0.90 but 19/21 (90%) exhibited better than chance classifications relative to control tonsil tissue (all p < 0.001). Overall, 13/21 MDMs had statistically significant lower AUCs in the oropharyngeal cohort compared to the cervical cohort, and only 1 MDM exhibited a statistically significant increase in AUC. CONCLUSIONS Previously validated MDMs exhibited robust performance in independent HPV(+)CSCC patients. However, most of these MDMs exhibited higher discrimination for HPV(+)CSCC than for HPV(+)OPSCC. This suggests that each SCC subtype requires a unique set of MDMs for optimal discrimination. Future studies are necessary to establish an MDM panel for HPV(+)OPSCC.
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Affiliation(s)
- Kathleen R Bartemes
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Daniel J Ma
- Department of Radiation Oncology, Rochester, MN, USA
| | | | - Kelli N Burger
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Douglas W Mahoney
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Xiaoming Cao
- Department of Gastroenterology, Rochester, MN, USA
| | - Sara S Then
- Department of Gastroenterology, Rochester, MN, USA
| | - Travis J Haller
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Alyssa M Larish
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Kathryn M Van Abel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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Paolini F, Campo F, Iocca O, Manciocco V, De Virgilio A, De Pascale V, Moretto S, Dalfino G, Vidiri A, Blandino G, Pimpinelli F, Venuti A, Pellini R. It is time to improve the diagnostic workup of oropharyngeal cancer with circulating tumor HPV DNA: Systematic review and meta-analysis. Head Neck 2023; 45:2945-2954. [PMID: 37715656 DOI: 10.1002/hed.27515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/18/2023] Open
Abstract
The possibility of detecting circulating tumor HPV DNA (ctHPVDNA) in plasma in patients with oropharyngeal cancer has been demonstrated in several reports. However, these data are from small cohorts and available tests for detection of ctHPVDNA are not fully validated. The aim is to evaluate sensitivity, specificity, and accuracy of ctHPVDNA by ddPCR to define its efficacy in the clinical setting for the diagnosis of HPV + OPSCC. A comprehensive search of three different databases: MEDLINE, Embase, and Cochrane Library databases. A total of 998 patients were evaluated from the 13 studies. OPSSC p16+ were 729, while controls p16- were 269. The meta-analytic study estimated the diagnostic performance of ctHPVDNA as follows: pooled sensitivity and specificity of 0.90 (95% CI: 0.82-0.94) and 0.94 (95% CI: 0.85-0.98), respectively; positive and negative likelihood ratios of 12.6 (95% CI: 4.9-32.1) and 0.05 (95% CI: 0.02-0.13), respectively. ddPCR for ctHPVDNA has good accuracy, sensitivity, and specificity for diagnosis of HPV + OPSCC. ctHPVDNA kinetic represents a great reliable opportunity to improve diagnostic and therapeutic management of cancer patients and could open new perspectives for understanding tumor biology.
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Affiliation(s)
- Francesca Paolini
- HPV-Unit, UOSD Tumor Immunology and Immunotherapy IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
- Department of Biochemical Sciences A. Rossi Fanelli, Sapienza University of Rome, Rome, Italy
| | - Flaminia Campo
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Oreste Iocca
- Division of Maxillofacial Surgery, Surgical Science Department, University of Torino, Torino, Italy
| | - Valentina Manciocco
- HPV-Unit, UOSD Tumor Immunology and Immunotherapy IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Valentina De Pascale
- Translational oncologic research, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Silvia Moretto
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Gianluca Dalfino
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Antonello Vidiri
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Giovanni Blandino
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Fulvia Pimpinelli
- Department of Microbiology and Virology, IRCCS San Gallicano Dermatological Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Aldo Venuti
- HPV-Unit, UOSD Tumor Immunology and Immunotherapy IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
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35
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Hanna GJ, Roof SA, Jabalee J, Rettig EM, Ferrandino R, Chen S, Posner MR, Misiukiewicz KJ, Genden EM, Chai RL, Sims J, Thrash E, Stern SJ, Kalman NS, Yarlagadda S, Raben A, Clements L, Mendelsohn A, Kaczmar JM, Pandey Y, Bhayani M, Gupta P, Kuperwasser C, Del Vecchio Fitz C, Berger BM. Negative Predictive Value of Circulating Tumor Tissue Modified Viral (TTMV)-HPV DNA for HPV-driven Oropharyngeal Cancer Surveillance. Clin Cancer Res 2023; 29:4306-4313. [PMID: 37566241 PMCID: PMC10570676 DOI: 10.1158/1078-0432.ccr-23-1478] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/29/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Human papillomavirus (HPV) is causally linked to oropharyngeal squamous cell carcinoma (OPSCC). Consensus guidelines recommend clinical exams and imaging in decreasing frequency as part of posttreatment surveillance for recurrence. Plasma tumor tissue modified viral (TTMV)-HPV DNA testing has emerged as a biomarker which can inform disease status during surveillance. EXPERIMENTAL DESIGN This retrospective observational cohort study involved 543 patients who completed curative-intent therapy for HPV-associated OPSCC between February 2020 and January 2022 at eight U.S. cancer care institutions. We determined the negative predictive value (NPV) of TTMV-HPV DNA for recurrence when matched to physician-reported clinical outcome data (median follow-up time: 27.9 months; range: 4.5-154). RESULTS The cohort included mostly men with a median age of 61 who had locoregionally advanced disease. HPV status was determined by p16 positivity in 87% of patients, with a positive HPV PCR/ISH among 55%; while pretreatment TTMV-HPV DNA status was unknown for most (79%) patients. Patients had a mean of 2.6 tests and almost half had three or more TTMV-HPV DNA results during surveillance. The per-test and per-patient sensitivity of the assay was 92.5% [95% confidence interval (CI): 87.5-97.5] and 87.3% (95% CI: 79.1-95.5), respectively. The NPV for the assay was 99.4% (95% CI: 98.9-99.8) and 98.4% (95% CI: 97.3-99.5), respectively. CONCLUSIONS TTMV-HPV DNA surveillance testing yields few false negative results and few missed recurrences. These data could inform decisions on when to pursue reimaging following first disease restaging and could inform future surveillance practice. Additional study of how pretreatment TTMV-HPV DNA status impacts sensitivity for recurrence is needed.
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Affiliation(s)
- Glenn J. Hanna
- Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Scott A. Roof
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Eleni M. Rettig
- Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Rocco Ferrandino
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sida Chen
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall R. Posner
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Eric M. Genden
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raymond L. Chai
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Sims
- CARTI Cancer Center, Little Rock, Arkansas
| | | | | | | | | | - Adam Raben
- Christiana Care, Helen F. Graham Cancer Center and Research Institute, Newark, Delaware
| | | | - Abie Mendelsohn
- David Geffen School of Medicine at University of California, Los Angeles, California
| | - John M. Kaczmar
- Medical College of South Carolina Health-University Medical Center, Charleston, South Carolina
| | - Yadav Pandey
- Medical College of South Carolina Health-University Medical Center, Charleston, South Carolina
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Wuerdemann N, Joosse S, Klasen C, Prinz J, Demers I, George J, Speel EJM, Wagner S, Klußmann JP. [ctHPV-DNA based precision oncology for patients with oropharyngeal cancer - Where are we?]. Laryngorhinootologie 2023; 102:728-734. [PMID: 37364603 DOI: 10.1055/a-2092-3837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Human papillomavirus (HPV) is an established etiologic factor for cancers in the head and neck region, specifically for Oropharyngeal Squamous Cell Carcinoma (OPSCC). The comparatively good overall survival justifies the current discussion regarding therapy de-escalation for patients with a low-risk profile. In addition to the immunohistochemistry-based biomarker p16INK4a, there is still a need for diagnostic and prognostic biomarkers that allow risk stratification and monitoring during therapy and follow-up of these patients. In recent years, liquid biopsy, especially in the form of plasma samples, has gained importance and is already used to monitor viral DNA in patients with Epstein-Barr virus-associated nasopharyngeal carcinoma. Circulating DNA (ctDNA) released by the tumor into the bloodstream is particularly suitable for a high specificity in detecting virus-associated tumors. Detection of viral E6 and E7 oncogenes in HPV-positive OPSCC is predominantly performed by droplet digital/quantitative PCR as well as next generation sequencing. Detection of circulating HPV-DNA derived from tumor cells (ctHPV-DNA) at diagnosis is associated with advanced tumor stage, locoregional and distant metastases. Longitudinal studies have further demonstrated that detectable and/or increasing ctHPV-DNA levels are associated with treatment failure and disease relapse. However, a standardization of the diagnostic procedure is necessary before introducing liquid biopsy into the clinical routine. In the future, this might allow a valid reflection of disease progression in HPV-positive OPSCC.
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Affiliation(s)
- Nora Wuerdemann
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Deutschland
- Klinik für Innere Medizin I, Uniklinik Köln, Köln, Deutschland
| | - Simon Joosse
- Abteilung für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Charlotte Klasen
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Deutschland
| | - Johanna Prinz
- Klinik für Innere Medizin I, Uniklinik Köln, Köln, Deutschland
| | - Imke Demers
- Institut für Pathologie, Maastricht Universität, GROW-School für Onkologie und Entwicklungsbiologie, Maastricht, Niederlande
| | - Julie George
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Deutschland
| | - Ernst-Jan Maria Speel
- Institut für Pathologie, Maastricht Universität, GROW-School für Onkologie und Entwicklungsbiologie, Maastricht, Niederlande
- GROW-School für Onkologie und Entwicklungsbiologie, Institut für Pathologie, Maastricht Universität, Maastricht, Niederlande
| | - Steffen Wagner
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Jens Peter Klußmann
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Deutschland
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Ellsworth G, Shen R, Marcellin KA, Majumdar R, Bazil M, Moore G, Nelson M, Alland I, Sepulveda G, Wilkin T, Higginson DS. High Specificity of HPV Cell-Free DNA Tests in Persons With HIV for the Detection of HPV-Related Cancer. J Acquir Immune Defic Syndr 2023; 94:73-81. [PMID: 37276242 PMCID: PMC10500630 DOI: 10.1097/qai.0000000000003231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Persons with HIV (PWH) experience high rates of human papillomavirus (HPV)-associated cancers compared with the general population. Plasma HPV cell-free DNA (cfDNA) tests are sensitive in patients with known HPV-associated cancers. It is not known whether these tests can screen for invasive cancers in populations with high burdens of nonmalignant HPV disease such as PWH. It was not known whether HPV infection and/or noninvasive anal high-grade squamous intraepithelial lesions (HSIL) alone in this population would result in detectable HPV cfDNA, which would result in a high number of false positives if HPV cfDNA is used to screen for invasive cancers. METHODS We conducted a prospective study of PWH in 2 cohorts: 20 without anal HSIL and 20 with anal HSIL. We tested anal and vaginal swabs for HPV infection, and HPV genotyped the biopsies of anal HSIL. Finally, we performed HPV cfDNA droplet digital polymerase chain reaction to test for HPV16/18/33 from plasma samples. RESULTS In the combined cohorts, the median age was 56 years, 12.5% were cisgender women, and none had detectable HIV. In total, 84.6% had prevalent anovaginal HPV infection, including 10 participants with HPV16, 13 with HPV18, and 2 with HPV33 infections. Five and 2 participants had HPV16 and HPV33 detected in anal HSIL, respectively. Despite the high prevalence of HPV infection and anal HSIL, no participant had HPV16/18/33 detectable cfDNA by droplet digital polymerase chain reaction. CONCLUSIONS These results provide a strong rationale for investigating the use of HPV cfDNA in a screening setting for suspected HPV-related invasive cancers in PWH.
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Affiliation(s)
- Grant Ellsworth
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10010
| | - Roger Shen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Kinge-Ann Marcellin
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10010
| | - Rahul Majumdar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Maximillian Bazil
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Grace Moore
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Meredith Nelson
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10010
| | - Isabel Alland
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10010
| | - Gustavo Sepulveda
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10010
| | - Timothy Wilkin
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10010
| | - Daniel S. Higginson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
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Karimi A, Jafari‐Koshki T, Zehtabi M, Kargar F, Gheit T. Predictive impact of human papillomavirus circulating tumor DNA in treatment response monitoring of HPV-associated cancers; a meta-analysis on recurrent event endpoints. Cancer Med 2023; 12:17592-17602. [PMID: 37492996 PMCID: PMC10524070 DOI: 10.1002/cam4.6377] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND HPV infection can cause cancer, and standard treatments often result in recurrence. The extent to which liquid biopsy using HPV circulating tumor DNA (HPV ctDNA) can be used as a promising marker for predicting recurrence in HPV-related cancers remains to be validated. Here we conducted a systematic review and meta-analysis to assess its effectiveness in predicting treatment response. METHODS We conducted a systematic literature search of online databases, including PubMed, Embase, Scopus, and the Cochrane Library, up to December 2022. The goal was to identify survival studies that evaluated the potential of plasma HPV ctDNA at baseline and end-of-treatment (EoT) in predicting recurrence of related cancers. Hazard ratios were estimated directly from models or extracted from Kaplan-Meier plots. RESULTS The pooled effect of HPV ctDNA presence on disease recurrence was estimated to be HR = 7.97 (95% CI: [3.74, 17.01]). Subgroup analysis showed that the risk of recurrence was HR = 2.17 (95% CI: [1.07, 4.41]) for baseline-positive cases and HR = 13.21 (95% CI: [6.62, 26.36]) for EoT-positive cases. Significant associations were also observed between recurrence of oropharyngeal squamous cell carcinoma (HR = 12.25 (95% CI: [2.62, 57.36])) and cervical cancer (HR = 4.60 (95% CI: [2.08, 10.17])) in plasma HPV ctDNA-positive patients. CONCLUSIONS The study found that HPV ctDNA detection can predict the rate of relapse or recurrence after treatment, with post-treatment measurement being more effective than baseline assessment. HPV ctDNA could be used as a surrogate or incorporated with other methods for detecting residual disease.
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Affiliation(s)
- Abbas Karimi
- Department of Molecular Medicine, Faculty of Advanced Medical SciencesTabriz University of Medical SciencesTabrizIran
| | - Tohid Jafari‐Koshki
- Department of Statistics and Epidemiology, Faculty of HealthTabriz University of Medical SciencesTabrizIran
| | - Mojtaba Zehtabi
- Hematology and Oncology Research CenterTabriz University of Medical SciencesTabrizIran
| | - Farzaneh Kargar
- Department of Medical Biotechnology, Faculty of Medical SchoolTabriz University of Medical SciencesTabrizIran
| | - Tarik Gheit
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer (IARC)LyonFrance
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Goswami M, Schlom J, Donahue RN. Peripheral surrogates of tumor burden to guide chemotherapeutic and immunotherapeutic strategies for HPV-associated malignancies. Oncotarget 2023; 14:758-774. [PMID: 38958745 PMCID: PMC11221564 DOI: 10.18632/oncotarget.28487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/22/2023] [Indexed: 07/04/2024] Open
Abstract
With the rapid adoption of immunotherapy into clinical practice for HPV-associated malignancies, assessing tumor burden using "liquid biopsies" would further our understanding of clinical outcomes mediated by immunotherapy and allow for tailoring of treatment based on real-time tumor dynamics. In this review, we examine translational studies on peripheral surrogates of tumor burden derived from peripheral blood in HPV-associated malignancies, including levels and methylation of circulating tumor DNA (ctDNA), miRNA derived from extracellular vesicles, circulating tumor cells (CTCs), and HPV-specific antibodies and T cell responses. We review their utility as prognostic and predictive biomarkers of response to chemotherapy and radiation, with a focus on how they may inform and guide immunotherapies to treat locally advanced and metastatic HPV-associated malignancies. We also highlight unanswered questions that must be addressed to translate and integrate these peripheral tumor biomarkers into the clinic.
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Affiliation(s)
- Meghali Goswami
- Center for Immuno-Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jeffrey Schlom
- Center for Immuno-Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Renee N. Donahue
- Center for Immuno-Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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40
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Andrioaie IM, Luchian I, Dămian C, Nichitean G, Andrese EP, Pantilimonescu TF, Trandabăț B, Prisacariu LJ, Budală DG, Dimitriu DC, Iancu LS, Ursu RG. The Clinical Utility of Circulating HPV DNA Biomarker in Oropharyngeal, Cervical, Anal, and Skin HPV-Related Cancers: A Review. Pathogens 2023; 12:908. [PMID: 37513755 PMCID: PMC10383289 DOI: 10.3390/pathogens12070908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Human papillomavirus (HPV) is recognized as being related to a wide variety of known cancers: cervical, oropharyngeal, anal, vaginal, penile, and skin. For some of these cancers, rigorous algorithms for screening, therapeutical interventions, and follow-up procedures have been established. Vaccination using the nonvalent anti-HPV vaccine, which prevents infection regarding the most frequently involved high-risk HPV types (16, 18, 31, 33, 45, 52, and 58) and low-risk HPV types (6 and 11), has also extensively prevented, controlled, and even eradicated HPV infections. Still, even with all of these multidisciplinary interventions, the burden of HPV cancers is still high worldwide. The circulating DNA of HPV-induced cancers is thought to be an adequate biomarker for optimizing the control of these virus-related cancers. We analyzed the literature published in the last 5 years regarding ctDNA and four of the above-mentioned cancers. The most frequently used assay for ctDNA detection was the droplet digital PCR assay, used for the management of therapy in the late stages of cancer. ctDNA could not be used for early detection in any of the studied cancers. The OPSCCs were the most frequent cancers analyzed via ctDNA assays. Larger, properly designed cohort studies might establish the clinical utility of this biomarker.
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Affiliation(s)
- Ioana Maria Andrioaie
- Department and Preventive Medicine and Interdisciplinarity (IX)-Microbiology, Faculty of Medicine, "Grigore, T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ionut Luchian
- Department of Periodontology, Faculty of Dental Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Costin Dămian
- Department and Preventive Medicine and Interdisciplinarity (IX)-Microbiology, Faculty of Medicine, "Grigore, T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Giorgio Nichitean
- Department of Periodontology, Faculty of Dental Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Porumb Andrese
- Department of Medical Specialties (III)-Dermatology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Theodor Florin Pantilimonescu
- Department of Morpho-Functional Sciences II-Physiology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | | | - Dana Gabriela Budală
- Department of Removable Dentures, Faculty of Dental Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Daniela Cristina Dimitriu
- Department of Biochemistry, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Gynecology and Obstetrics Hospital-Cuza Voda, 700038 Iasi, Romania
| | - Luminita Smaranda Iancu
- Department and Preventive Medicine and Interdisciplinarity (IX)-Microbiology, Faculty of Medicine, "Grigore, T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ramona Gabriela Ursu
- Department and Preventive Medicine and Interdisciplinarity (IX)-Microbiology, Faculty of Medicine, "Grigore, T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Gynecology and Obstetrics Hospital-Cuza Voda, 700038 Iasi, Romania
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41
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Heft Neal ME, Walline HM, Haring CT. Circulating Tumor DNA in Human Papillomavirus-Mediated Oropharynx Cancer: Leveraging Early Data to Inform Future Directions. Cancer J 2023; 29:215-219. [PMID: 37471611 DOI: 10.1097/ppo.0000000000000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
ABSTRACT Circulating tumor DNA (ctDNA) has become an area of intense study in many solid malignancies including head and neck cancer. This is of particular interest for human papillomavirus-mediated oropharyngeal squamous cell carcinoma as this cohort of patients has excellent survival and is undergoing current clinical trials aimed at treatment de-escalation. Recent studies have demonstrated the prognostic implications of pretreatment ctDNA and the utility of monitoring ctDNA during and posttreatment; however, there is a need for a more critical understanding of ctDNA as it is beginning to be incorporated into clinical trials. This review discusses the current state of ctDNA in oropharynx cancer focusing on ctDNA kinetics and minimal residual disease detection and ends with a discussion of future applications.
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Affiliation(s)
| | - Heather M Walline
- From the Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH
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42
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Earland N, Chen K, Semenkovich NP, Chauhan PS, Zevallos JP, Chaudhuri AA. Emerging Roles of Circulating Tumor DNA for Increased Precision and Personalization in Radiation Oncology. Semin Radiat Oncol 2023; 33:262-278. [PMID: 37331781 DOI: 10.1016/j.semradonc.2023.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Recent breakthroughs in circulating tumor DNA (ctDNA) technologies present a compelling opportunity to combine this emerging liquid biopsy approach with the field of radiogenomics, the study of how tumor genomics correlate with radiotherapy response and radiotoxicity. Canonically, ctDNA levels reflect metastatic tumor burden, although newer ultrasensitive technologies can be used after curative-intent radiotherapy of localized disease to assess ctDNA for minimal residual disease (MRD) detection or for post-treatment surveillance. Furthermore, several studies have demonstrated the potential utility of ctDNA analysis across various cancer types managed with radiotherapy or chemoradiotherapy, including sarcoma and cancers of the head and neck, lung, colon, rectum, bladder, and prostate . Additionally, because peripheral blood mononuclear cells are routinely collected alongside ctDNA to filter out mutations associated with clonal hematopoiesis, these cells are also available for single nucleotide polymorphism analysis and could potentially be used to detect patients at high risk for radiotoxicity. Lastly, future ctDNA assays will be utilized to better assess locoregional MRD in order to more precisely guide adjuvant radiotherapy after surgery in cases of localized disease, and guide ablative radiotherapy in cases of oligometastatic disease.
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Affiliation(s)
- Noah Earland
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, MO; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Kevin Chen
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Nicholas P Semenkovich
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Pradeep S Chauhan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jose P Zevallos
- Department of Otolaryngology, University of Pittsburgh Medical School, Pittsburgh, PA
| | - Aadel A Chaudhuri
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, MO; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO; Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO; Department of Genetics, Washington University School of Medicine, St. Louis, MO; Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO; Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO.
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43
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Allevato MM, Smith JD, Brenner MJ, Chinn SB. Tumor-Derived Exosomes and the Role of Liquid Biopsy in Human Papillomavirus Oropharyngeal Squamous Cell Carcinoma. Cancer J 2023; 29:230-237. [PMID: 37471614 PMCID: PMC10372688 DOI: 10.1097/ppo.0000000000000671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
ABSTRACT The global incidence of human papillomavirus-positive (HPV+) head and neck squamous cell carcinoma (HNSCC) has surged in recent decades, with HPV+ HNSCC accounting for >70% of oropharynx cancers in the United States. Its incidence in men has surpassed that of HPV+ cervical cancer in women, and reliable assays are needed for early detection and to monitor response to therapy. Human papillomavirus-positive OPSCC has a more favorable response to therapy and prognosis than HPV-negative (HPV-) HNSCC, motivating regimens to deintensify curative surgery or chemoradiotherapy protocols. A barrier to deintensifying and personalizing therapy is lack of reliable predictive biomarkers. Furthermore, HPV- HNSCC survival rates are static without reliable surveillance biomarkers available. The emergence of circulating plasma-based biomarkers reflecting the tumor-immune microenvironment heralds a new era in HNSCC diagnosis and therapy. We review evidence on tumor-derived extracellular vesicles (exosomes) as biomarkers for diagnosis, prognostication, and treatment in HPV+ and HPV- HNSCC.
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Affiliation(s)
- Michael M. Allevato
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D. Smith
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael J. Brenner
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Steven B. Chinn
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Rogel Cancer Center, University of Michigan Health System, Ann Arbor, Michigan, USA
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Regan SN, Mierzwa ML. The Current Role of Human Papillomavirus Circulating Tumor DNA in Oropharynx Cancer. Cancer J 2023; 29:226-229. [PMID: 37471613 DOI: 10.1097/ppo.0000000000000667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
ABSTRACT Human papillomavirus infection is currently implicated in the majority of oropharyngeal squamous cell carcinoma cases diagnosed in the United States. Circulating tumor DNA (ctDNA) has emerged as a potential biomarker for human papillomavirus-related oropharyngeal squamous cell carcinoma and has the opportunity to improve the diagnosis, treatment, and surveillance of patients with this disease. Changes in ctDNA levels during and after primary therapy may be related to disease response, which can possibly have implications for treatment intensification or de-escalation strategies. Further, ctDNA seems to be sensitive and specific for disease recurrence and may improve upon current methods for assessing both treatment response and failure. In this review, we examine the relevant literature on the use of ctDNA for oropharyngeal cancer treatment and surveillance and discuss current limitations and future directions for this promising biomarker.
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Affiliation(s)
- Samuel N Regan
- From the Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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45
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Rettig EM, Waterboer T, Sim E, Faden DL, Butt J, Hanna GJ, Del Vecchio Fitz C, Kuperwasser C, Sroussi H. Relationship of HPV16 E6 seropositivity with circulating tumor tissue modified HPV16 DNA before head and neck cancer diagnosis. Oral Oncol 2023; 141:106417. [PMID: 37148655 DOI: 10.1016/j.oraloncology.2023.106417] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Eleni M Rettig
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA, USA; Dana-Farber Center for Head and Neck Oncology, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Edward Sim
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA; Massachusetts Eye and Ear, Boston, MA, USA
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA; Massachusetts Eye and Ear, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Julia Butt
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Glenn J Hanna
- Dana-Farber Center for Head and Neck Oncology, Boston, MA, USA
| | | | | | - Herve Sroussi
- Dana-Farber Center for Head and Neck Oncology, Boston, MA, USA; Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA
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46
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Tinhofer I, Staudte S, George S. Liquid biopsy in head neck cancer: ready for clinical routine diagnostics? Curr Opin Oncol 2023; 35:151-157. [PMID: 36966499 DOI: 10.1097/cco.0000000000000935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
PURPOSE OF REVIEW The bodily fluids of patients with solid cancers representing a minimally-invasive source of clinically exploitable biomarkers have attracted an increasing amount of attention in recent years. In patients with head and neck squamous cell carcinoma (HNSCC), cell-free tumour DNA (ctDNA) belongs to the most promising liquid biomarkers for monitoring disease burden and identifying patients at high risk of recurrence. In this review, we highlight recent studies, evaluating the analytical validity and clinical utility of ctDNA as a dynamic biomarker in HNSCC, especially as it relates to risk stratification and contrasting human papilloma virus (HPV+ and HPV-) and carcinomas. RECENT FINDINGS The clinical potential of minimal residual disease monitoring through viral ctDNA in identifying HPV+ oropharyngeal carcinoma patients at higher risk of recurrence has recently been demonstrated. Furthermore, accumulating evidence supports a potential diagnostic value of ctDNA dynamics in HPV-negative HNSCC. Altogether, recent data suggest that ctDNA analysis may be a valuable tool in guiding (de)escalation of surgical interventions as well as adaptation in radiotherapy dosage, both in the definitive and adjuvant settings. SUMMARY Rigorous clinical trials with patient-relevant endpoints are critical in order to demonstrate that treatment decisions based on ctDNA dynamics result in better outcomes in HNSCC.
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Affiliation(s)
- Ingeborg Tinhofer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiooncology and Radiotherapy
- German Cancer Research Center (DKFZ), Heidelberg, Germany and German Cancer Consortium (DKTK) partner site Berlin, Germany
| | - Stephanie Staudte
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiooncology and Radiotherapy
- German Cancer Research Center (DKFZ), Heidelberg, Germany and German Cancer Consortium (DKTK) partner site Berlin, Germany
| | - Stephen George
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiooncology and Radiotherapy
- German Cancer Research Center (DKFZ), Heidelberg, Germany and German Cancer Consortium (DKTK) partner site Berlin, Germany
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47
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Lin G, Li J. Circulating HPV DNA in HPV-associated cancers. Clin Chim Acta 2023; 542:117269. [PMID: 36841427 DOI: 10.1016/j.cca.2023.117269] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
Human papillomavirus (HPV) infections are the primary cause of almost all cervical cancers, anal cancers, and a variable proportion of other anogenital tumors, as well as head and neck cancers. Circulating HPV DNA (cHPV-DNA) is emerging as a biomarker with extensive potential in the management of HPV-driven malignancies. There has been a rapid advancement in the development of techniques for analyzing cHPV-DNA for the detection, characterization, and monitoring of HPV-associated cancers. As clinical evidence accumulates, it is becoming evident that cHPV-DNA can be used as a diagnostic tool. By conducting clinical trials assessing the clinical utility of cHPV-DNA, the full potential of cHPV-DNA for the screening, diagnosis, and treatment of HPV-related malignancies can be corroborated. In this review, we examine the current landscape of applications for cHPV-DNA liquid biopsies throughout the cancer care continuum, highlighting future opportunities for research and integration into clinical practice.
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Affiliation(s)
- Guigao Lin
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing, PR China; Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, PR China.
| | - Jinming Li
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing, PR China; Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, PR China.
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Gunning A, Kumar S, Williams CK, Berger BM, Naber SP, Gupta PB, Del Vecchio Fitz C, Kuperwasser C. Analytical Validation of NavDx, a cfDNA-Based Fragmentomic Profiling Assay for HPV-Driven Cancers. Diagnostics (Basel) 2023; 13:diagnostics13040725. [PMID: 36832208 PMCID: PMC9955790 DOI: 10.3390/diagnostics13040725] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
The NavDx® blood test analyzes tumor tissue modified viral (TTMV)-HPV DNA to provide a reliable means of detecting and monitoring HPV-driven cancers. The test has been clinically validated in a large number of independent studies and has been integrated into clinical practice by over 1000 healthcare providers at over 400 medical sites in the US. This Clinical Laboratory Improvement Amendments (CLIA), high complexity laboratory developed test, has also been accredited by the College of American Pathologists (CAP) and the New York State Department of Health. Here, we report a detailed analytical validation of the NavDx assay, including sample stability, specificity as measured by limits of blank (LOBs), and sensitivity illustrated via limits of detection and quantitation (LODs and LOQs). LOBs were 0-0.32 copies/μL, LODs were 0-1.10 copies/μL, and LOQs were <1.20-4.11 copies/μL, demonstrating the high sensitivity and specificity of data provided by NavDx. In-depth evaluations including accuracy and intra- and inter-assay precision studies were shown to be well within acceptable ranges. Regression analysis revealed a high degree of correlation between expected and effective concentrations, demonstrating excellent linearity (R2 = 1) across a broad range of analyte concentrations. These results demonstrate that NavDx accurately and reproducibly detects circulating TTMV-HPV DNA, which has been shown to aid in the diagnosis and surveillance of HPV-driven cancers.
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Rettig EM, Wang AA, Tran NA, Carey E, Dey T, Schoenfeld JD, Sehgal K, Guenette JP, Margalit DN, Sethi R, Uppaluri R, Tishler RB, Annino DJ, Goguen LA, Jo VY, Haddad RI, Hanna GJ. Association of Pretreatment Circulating Tumor Tissue-Modified Viral HPV DNA With Clinicopathologic Factors in HPV-Positive Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2022; 148:1120-1130. [PMID: 36301568 PMCID: PMC9614675 DOI: 10.1001/jamaoto.2022.3282] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/31/2022] [Indexed: 01/10/2023]
Abstract
Importance Circulating tumor tissue-modified viral (TTMV) human papillomavirus (HPV) DNA is a dynamic, clinically relevant biomarker for HPV-positive oropharyngeal squamous cell carcinoma. Reasons for its wide pretreatment interpatient variability are not well understood. Objective To characterize clinicopathologic factors associated with TTMV HPV DNA. Design, Setting, and Participants This cross-sectional study included patients evaluated for HPV-positive oropharyngeal squamous cell carcinoma at Dana-Farber Cancer Institute in Boston, Massachusetts, between December 2019 and January 2022 and who were undergoing curative-intent treatment. Exposures Clinicopathologic characteristics including demographic variables, tumor and nodal staging, HPV genotype, and imaging findings. Main Outcomes and Measures Pretreatment circulating TTMV HPV DNA from 5 genotypes (16, 18, 31, 33, and 35) assessed using a commercially available digital droplet polymerase chain reaction-based assay, considered as either detectable/undetectable or a continuous score (fragments/mL). Results Among 110 included patients, 96 were men (87%) and 104 were White (95%), with a mean (SD) age of 62.2 (9.4) years. Circulating TTMV HPV DNA was detected in 98 patients (89%), with a median (IQR) score of 315 (47-2686) fragments/mL (range, 0-60 061 fragments/mL). Most detectable TTMV HPV DNA was genotype 16 (n = 86 [88%]), while 12 patients (12%) harbored other genotypes. Circulating TTMV HPV DNA detection was most strongly associated with clinical N stage. Although few patients had clinical stage N0 disease, only 4 of these 11 patients (36%) had detectable DNA compared with 94 of 99 patients (95%) with clinical stage N1 to N3 disease (proportion difference, 59%; 95% CI, 30%-87%). Among patients with undetectable TTMV HPV DNA, more than half (7 of 12 [58%]) had clinical stage N0 disease. The TTMV HPV DNA prevalence and score increased with progressively higher clinical nodal stage, diameter of largest lymph node, and higher nodal maximum standardized uptake value on positron emission tomography/computed tomography. In multivariable analysis, clinical nodal stage and nodal maximum standardized uptake value were each strongly associated with TTMV HPV DNA score. Among 27 surgically treated patients, more patients with than without lymphovascular invasion had detectable TTMV HPV DNA (12 of 12 [100%] vs 9 of 15 [60%]). Conclusions and Relevance In this cross-sectional study, circulating TTMV HPV DNA was statistically significantly associated with nodal disease at HPV-positive OPSCC diagnosis. The few patients with undetectable levels had predominantly clinical stage N0 disease, suggesting assay sensitivity for diagnostic purposes may be lower among patients without cervical lymphadenopathy. Mechanisms underlying this association, and the use of this biomarker for surveillance of patients with undetectable baseline values, warrant further investigation.
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Affiliation(s)
- Eleni M. Rettig
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Ngoc-Anh Tran
- Harvard Medical School, Boston, Massachusetts
- Division of Neuroradiology, Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Evan Carey
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tanujit Dey
- Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jonathan D. Schoenfeld
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kartik Sehgal
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jeffrey P. Guenette
- Harvard Medical School, Boston, Massachusetts
- Division of Neuroradiology, Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Danielle N. Margalit
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rosh Sethi
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ravindra Uppaluri
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Roy B. Tishler
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Donald J. Annino
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Laura A. Goguen
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Vickie Y. Jo
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Robert I. Haddad
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Glenn J. Hanna
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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50
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Circulating Human Papillomavirus DNA in Head and Neck Squamous Cell Carcinoma: Possible Applications and Future Directions. Cancers (Basel) 2022; 14:cancers14235946. [PMID: 36497430 PMCID: PMC9740011 DOI: 10.3390/cancers14235946] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
There has been a rising trend in HPV-induced head and neck cancers in the last several decades. This subgroup of squamous cell carcinoma is mostly located in the oropharynx and comprises a subset of patients who are typically younger and without the usual risk factors of smoking and alcohol use. As the prognosis of HPV-induced OPC is more favorable, there is a desire to properly select these patients for de-intensification protocols while identifying individuals who may suffer treatment failure. Here, we describe recent developments in circulating tumor HPV DNA as a marker of HPV-positive oropharyngeal cancer that can potentially be used as a diagnostic tool to stratify patients for de-escalation strategies and to survey for recurrence.
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