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Agarwal A, Bhatt A, Patel S, Bathla G, Murray J, Rhyner P. Preliminary Results from Retrospective Correlation of Circulating Tumor DNA (ct-DNA) with Imaging for HPV-Positive Oropharyngeal Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2024:ajnr.A8242. [PMID: 38471786 DOI: 10.3174/ajnr.a8242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/08/2024] [Indexed: 03/14/2024]
Abstract
The role of molecular markers is increasingly being recognized for head and neck tumors, ranging from benign lesions like paragangliomas to malignancies like squamous cell carcinomas. Multiple studies have recently validated blood tests for circulating tumor tissue-modified viral human papillomavirus DNA (HPV ct-DNA) for posttreatment surveillance of HPV-driven oropharyngeal squamous cell carcinomas. This technology quantifies fragments of circulating DNA that are shed into the blood stream with very high (>95%) positive and negative predictive values and are also highly sensitive in distinguishing tumor HPV-DNA from a noncancerous source. This study has a cohort of 34 patients with HPV-driven oropharyngeal squamous cell carcinomas, having at least 3 sequential imaging studies and ct-DNA values. The study showed a strong positive correlation between the imaging findings and the ct-DNA level in recurrent HPV-positive oropharyngeal squamous cell carcinomas. Findings also include the 100% negative predictive value of HPV ct-DNA tests to rule out tumor recurrence. At our institution, we are now routinely performing the ct-DNA assay for surveillance of treated HPV oropharyngeal squamous cell carcinomas. Correlation among clinical, radiologic, and biomarker findings are now part of routine discussions during the multidisciplinary tumor boards.
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Affiliation(s)
- Amit Agarwal
- From the Department of Radiology (A.A., A.B., J.M., P.R.). Mayo Clinic, Jacksonville, Florida
| | - Alok Bhatt
- From the Department of Radiology (A.A., A.B., J.M., P.R.). Mayo Clinic, Jacksonville, Florida
| | - Samip Patel
- Department of Otolaryngology (S.P.), Mayo Clinic, Jacksonville, Florida
| | - Girish Bathla
- Department of Radiology (G.B.), Mayo Clinic, Rochester, Minnesota
| | - John Murray
- From the Department of Radiology (A.A., A.B., J.M., P.R.). Mayo Clinic, Jacksonville, Florida
| | - Patricia Rhyner
- From the Department of Radiology (A.A., A.B., J.M., P.R.). Mayo Clinic, Jacksonville, Florida
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Deutsch F, Sais D, Keatinge N, Hill M, Tran NH, Elliott M, Tran N. Biplex quantitative PCR to detect transcriptionally active human papillomavirus 16 from patient saliva. BMC Cancer 2024; 24:442. [PMID: 38600473 PMCID: PMC11005208 DOI: 10.1186/s12885-024-12125-9] [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: 07/07/2023] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Head and neck cancers, particularly oropharyngeal cancers (OPC), have been increasingly associated with human papillomavirus (HPV) infections, specifically HPV16. The current methods for HPV16 detection primarily rely on p16 staining or PCR techniques. However, it is important to note the limitations of conventional PCR, as the presence of viral DNA does not always indicate an ongoing viral infection. Moreover, these tests heavily rely on the availability of tissue samples, which can present challenges in certain situations. In this study, we developed a RT-qPCR biplex approach to detect HPV16 oncogenes E6 and E7 RNA in saliva samples from OPC patients. Salivary supernatant was used as the liquid biopsy source. We successfully obtained RNA from salivary supernatant, preserving its integrity as indicated by the detection of several housekeeping genes. Our biplex approach accurately detected E6 and E7 RNA in HPV16-positive cell lines, tissues, and finally in OPC salivary samples. Importantly, the assay specifically targeted HPV16 and not HPV18. This biplexing technique allowed for reduced sample input without compromising specificity. In summary, our approach demonstrates the potential to detect viable HPV16 in saliva from OPC patients. Since the assay measures HPV16 RNA, it provides insights into the transcriptional activity of the virus. This could guide clinical decision-making and treatment planning for individuals with HPV-related OPC.
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Affiliation(s)
- Fiona Deutsch
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Dayna Sais
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Ni Keatinge
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Meredith Hill
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Ngoc Ha Tran
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Michael Elliott
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Nham Tran
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia.
- Chris O'Brien Lifehouse, Sydney, NSW, Australia.
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Rink M, Jung EM, Künzel J. The Use of Contrast-Enhanced Sonography for Therapy Monitoring of Metastatic Lymph Nodes: A Systematic Review. Curr Oncol 2023; 30:6734-6743. [PMID: 37504354 PMCID: PMC10378161 DOI: 10.3390/curroncol30070494] [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: 04/07/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
Metastatic cervical lymph nodes are a frequent finding in head and neck squamous cell carcinoma (HNSCC). If a non-surgical approach is primarily chosen, a therapy response evaluation of the primary tumor and the affected lymph nodes is necessary in the follow-up. Supplementary contrast-enhanced ultrasound (CEUS) can be used to precisely visualize the microcirculation of the target lesion in the neck, whereby malignant and benign findings differ in their uptake behavior. The same applies to many other solid tumors. For various tumor entities, it has already been shown that therapy monitoring is possible through regular contrast-enhanced sonography of the primary tumor or the affected lymph nodes. Thus, in some cases, maybe in the future, a change in therapy strategy can be achieved at an early stage in the case of non-response or, in the case of therapy success, a de-escalation of subsequent (surgical) measures can be achieved. In this paper, a systematic review of the available studies and a discussion of the potential of therapy monitoring by means of CEUS in HNSCC are presented.
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Affiliation(s)
- Maximilian Rink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
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Bhambhani C, Sandford E, Haring CT, Brummel C, Tuck KL, Olesnavich M, Bhangale AD, Walline HM, Dermody SM, Spector ME, Chinn SB, Casper K, Mierzwa M, Swiecicki PL, Chad Brenner J, Tewari M. Development of a high-performance multi-probe droplet digital PCR assay for high-sensitivity detection of human papillomavirus circulating tumor DNA from plasma. Oral Oncol 2023; 143:106436. [PMID: 37269557 DOI: 10.1016/j.oraloncology.2023.106436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/13/2023] [Accepted: 05/26/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To develop a high-performance droplet digital PCR (ddPCR) assay capable of enhancing the detection of human papillomavirus (HPV) circulating tumor DNA (ctDNA) in plasma from patients with HPV-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC). MATERIALS AND METHODS Plasma samples from subjects with HPV+ OPSCC were collected. We developed a high-performance ddPCR assay designed to simultaneously target nine regions of the HPV16 genome. RESULTS The new assay termed 'ctDNA HPV16 Assessment using Multiple Probes' (CHAMP- 16) yielded significantly higher HPV16 counts compared to our previously validated 'Single-Probe' (SP) assay and a commercially available NavDx® assay. Analytical validation demonstrated that the CHAMP-16 assay had a limit of detection (LoD) of 4.1 copies per reaction, corresponding to < 1 genome equivalent (GE) of HPV16. When tested on plasma ctDNA from 21 patients with early-stage HPV+ OPSCC and known HPV16 ctDNA using the SP assay, all patients were positive for HPV16 ctDNA in both assays and the CHAMP-16 assay displayed 6.6-fold higher HPV16 signal on average. Finally, in a longitudinal analysis of samples from a patient with recurrent disease, the CHAMP-16 assay detected HPV16 ctDNA signal ∼ 20 months prior to the conventional SP assay. CONCLUSION Increased HPV16 signal detection using the CHAMP-16 assay suggests the potential for detection of recurrences significantly earlier than with conventional ddPCR assays in patients with HPV16+ OPSCC. Critically, this multi-probe approach maintains the cost-benefit advantage of ddPCR over next generation sequencing (NGS) approaches, supporting the cost-effectiveness of this assay for both large population screening and routine post-treatment surveillance.
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Affiliation(s)
- Chandan Bhambhani
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, USA
| | - Erin Sandford
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, USA
| | - Catherine T Haring
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan, USA
| | - Collin Brummel
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan, USA
| | - Kirsten L Tuck
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, USA
| | - Mary Olesnavich
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, USA
| | - Apurva D Bhangale
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan, USA
| | - Sarah M Dermody
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan, USA; Rogel Cancer Center, University of Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan, USA; Rogel Cancer Center, University of Michigan, USA
| | - Keith Casper
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan, USA
| | - Michelle Mierzwa
- Rogel Cancer Center, University of Michigan, USA; Department of Radiation Oncology, University of Michigan, USA
| | - Paul L Swiecicki
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, USA; Rogel Cancer Center, University of Michigan, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - J Chad Brenner
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan, USA; Rogel Cancer Center, University of Michigan, USA; Department of Pharmacology, University of Michigan, USA
| | - Muneesh Tewari
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, USA; Rogel Cancer Center, University of Michigan, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, USA; Center for Computational Medicine and Bioinformatics, University of Michigan, USA.
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5
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Haring CT, Bhambhani C, Brummel C, Jewell B, Bellile E, Heft Neal ME, Sandford E, Spengler RM, Bhangale A, Spector ME, McHugh J, Prince ME, Mierzwa M, Worden FP, Tewari M, Swiecicki PL, Brenner JC. Human papilloma virus circulating tumor DNA assay predicts treatment response in recurrent/metastatic head and neck squamous cell carcinoma. Oncotarget 2021; 12:1214-1229. [PMID: 34194620 PMCID: PMC8238244 DOI: 10.18632/oncotarget.27992] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022] Open
Abstract
Despite the rising incidence of human papillomavirus related (HPV+) oropharyngeal squamous cell carcinoma (OPSCC), treatment of metastatic disease remains palliative. Even with new treatments such as immunotherapy, response rates are low and can be delayed, while even mild tumor progression in the face of an ineffective therapy can lead to rapid death. Real-time biomarkers of response to therapy could improve outcomes by guiding early change of therapy in the metastatic setting. Herein, we developed and analytically validated a new droplet digital PCR (ddPCR)-based assay for HPV16 circulating tumor DNA (ctDNA) and evaluated plasma HPV16 ctDNA for predicting treatment response in metastatic HPV+ OPSCC. We found that longitudinal changes HPV16 ctDNA correlate with treatment response and that ctDNA responses are observed earlier than conventional imaging (average 70 days, range: 35-166). With additional validation in multi-site studies, this assay may enable early identification of treatment failure, allowing patients to be directed promptly toward clinical trials or alternative therapies.
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Affiliation(s)
- Catherine T. Haring
- University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, MI 48109, USA
- Co-First Authors
| | - Chandan Bhambhani
- University of Michigan, Department of Internal Medicine, Division of Hematology and Oncology, Ann Arbor, MI 48109, USA
- Co-First Authors
| | - Collin Brummel
- University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, MI 48109, USA
| | - Brittany Jewell
- University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, MI 48109, USA
| | - Emily Bellile
- University of Michigan, Department of Biostatistics, Ann Arbor, MI 48109, USA
| | - Molly E. Heft Neal
- University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, MI 48109, USA
| | - Erin Sandford
- University of Michigan, Department of Internal Medicine, Division of Hematology and Oncology, Ann Arbor, MI 48109, USA
| | - Ryan M. Spengler
- University of Michigan, Department of Internal Medicine, Division of Hematology and Oncology, Ann Arbor, MI 48109, USA
| | - Apurva Bhangale
- University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, MI 48109, USA
| | - Matthew E. Spector
- University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, MI 48109, USA
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI 48109, USA
| | - Jonathan McHugh
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI 48109, USA
- University of Michigan, Department of Pathology, Ann Arbor, MI 48109, USA
| | - Mark E. Prince
- University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, MI 48109, USA
| | - Michelle Mierzwa
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI 48109, USA
- University of Michigan, Department of Radiation Oncology, Ann Arbor, MI 48109, USA
| | - Francis P. Worden
- University of Michigan, Department of Internal Medicine, Division of Hematology and Oncology, Ann Arbor, MI 48109, USA
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI 48109, USA
| | - Muneesh Tewari
- University of Michigan, Department of Internal Medicine, Division of Hematology and Oncology, Ann Arbor, MI 48109, USA
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI 48109, USA
- University of Michigan, Department of Biomedical Engineering, Ann Arbor, MI 48109, USA
- University of Michigan, Center for Computational Medicine and Bioinformatics, Ann Arbor, MI 48109, USA
- Co-Senior Authors
| | - Paul L. Swiecicki
- University of Michigan, Department of Internal Medicine, Division of Hematology and Oncology, Ann Arbor, MI 48109, USA
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI 48109, USA
- Co-Senior Authors
| | - J. Chad Brenner
- University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, MI 48109, USA
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI 48109, USA
- University of Michigan, Department of Pharmacology, Ann Arbor, MI 48109, USA
- Co-Senior Authors
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