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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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Das D, Hirayama S, Aye L, Bryan ME, Naegele S, Zhao B, Efthymiou V, Mendel J, Fisch AS, Kröller L, Michels BE, Waterboer T, Richmon JD, Adalsteinsson V, Lawrence MS, Crowson MG, Iafrate AJ, Faden DL. Blood-based screening for HPV-associated cancers. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.04.24300841. [PMID: 38328243 PMCID: PMC10849671 DOI: 10.1101/2024.01.04.24300841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Background HPV-associated oropharyngeal cancer (HPV+OPSCC) is the most common HPV-associated cancer in the United States yet unlike cervical cancer lacks a screening test. HPV+OPSCCs are presumed to start developing 10-15 years prior to clinical diagnosis. Circulating tumor HPV DNA (ctHPVDNA) is a sensitive and specific biomarker for HPV+OPSCC. Taken together, blood-based screening for HPV+OPSCC may be feasible years prior to diagnosis. Methods We developed an HPV whole genome sequencing assay, HPV-DeepSeek, with 99% sensitivity and specificity at clinical diagnosis. 28 plasma samples from HPV+OPSCC patients collected 1.3-10.8 years prior to diagnosis along with 1:1 age and gender-matched controls were run on HPV-DeepSeek and an HPV serology assay. Results 22/28 (79%) of cases and 0/28 controls screened positive for HPV+OPSCC with 100% detection within four years of diagnosis and a maximum lead time of 7.8 years. We next applied a machine learning model classifying 27/28 cases (96%) with 100% detection within 10 years. Plasma-based PIK3CA gene mutations, viral genome integration events and HPV serology were used to orthogonally validate cancer detection with 68% (19/28) of the cohort having multiple cancer signals detected. Molecular fingerprinting of HPV genomes was performed across patients demonstrating that each viral genome was unique, ruling out contamination. In patients with tumor blocks from diagnosis (15/28), molecular fingerprinting was performed within patients confirming the same viral genome across time. Conclusions We demonstrate accurate blood-based detection of HPV-associated cancers with lead times up to 10 years before clinical cancer diagnosis and in doing so, highlight the enormous potential of ctDNA-based cancer screening.
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Affiliation(s)
- Dipon Das
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Massachusetts Eye and Ear, Boston, Massachusetts
| | - Shun Hirayama
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ling Aye
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Michael E. Bryan
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Saskia Naegele
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Brian Zhao
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Vasileios Efthymiou
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Massachusetts Eye and Ear, Boston, Massachusetts
| | - Julia Mendel
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Adam S. Fisch
- Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lea Kröller
- Division of Infections and Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Birgitta E. Michels
- Division of Infections and Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Jeremy D. Richmon
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Massachusetts Eye and Ear, Boston, Massachusetts
| | | | - Michael S. Lawrence
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Krantz Family Center for Cancer Research, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Matthew G. Crowson
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Massachusetts Eye and Ear, Boston, Massachusetts
| | - A. John Iafrate
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel L. Faden
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Massachusetts Eye and Ear, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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Sichero L, Gonçalves MG, Bettoni F, Coser EM, Mota G, Nunes RAL, Mercante AMDC, Natalino R, Uno M, Ferreira Alves MJ, Matos LL, Kowalski LP, Kulcsar MAV, de Alvarenga GF, Höfler D, Schroeder L, Waterboer T, Tommasino M, Villa LL. Detection of serum biomarkers of HPV-16 driven oropharynx and oral cavity cancer in Brazil. Oral Oncol 2024; 149:106676. [PMID: 38150987 DOI: 10.1016/j.oraloncology.2023.106676] [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: 09/07/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND HPV-16 driven oropharynx/oral cavity squamous cell carcinomas prevalence varies globally. We evaluated the presence of HPV-16 ctDNA and HPV-16 E6 antibodies in samples obtained from participants treated at the Instituto do Cancer do Estado de Sao Paulo, ICESP, and from whom tumoral HPV DNA, HPV-16 E6*I mRNA, and p16INK4a status was also accessed. METHODS HPV was genotyped by PCR-hybridization. All HPV DNA positive and ∼10 % HPV DNA negative cases underwent p16INK4a immunohistochemistry and E6*I RNA testing using a multiplex bead based protocol. HPV-16 ctDNA and anti-E6 antibodies were assessed by ddPCR (digital droplet PCR) and multiplex serology, respectively. RESULTS The prevalence of HPV-16 in oropharynx carcinoma (OPC) cases was low (8.7 %) when considering solely HPV-16 DNA detection, and even lower (5.2 %) when taken into consideration the concomitant detection of HPV-16 E6*I RNA and/or p16INK4 (HPV-16 attributable fraction - AF). None of the oral cavity cancer (OCC) cases were detected with HPV-16 DNA. HPV-16 ctDNA was more commonly detected than HPV-16 E6 antibodies (29.8 % versus 10.6 %). Both serum biomarkers attained 100 % sensitivity of detecting HPV-16 AF OPC, however the specificity of the HPV-16 anti-E6 biomarker was higher compared to ctDNA (93.2 % versus 75.0 %). Finally, when both HPV-16 ctDNA and anti-E6 biomarkers were considered together, the sensitivity and specificity for HPV-16 OPC detection was 100 % and about 70 %, respectively, independently of analyzing HPV-16 DNA positive or HPV-16 AF tumors. CONCLUSIONS Our findings corroborate that serum biomarkers are highly sensitive and specific biomarkers for detection of HPV-associated OPC.
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Affiliation(s)
- Laura Sichero
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Milena Giulia Gonçalves
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Fabiana Bettoni
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Giana Mota
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Rafaella A L Nunes
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ana Maria da Cunha Mercante
- Department of Pathology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil
| | - Renato Natalino
- Department of Pathology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil
| | - Miyuki Uno
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Maria José Ferreira Alves
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Leandro Luongo Matos
- Department of Head and Neck Surgery, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | | | | | - Daniela Höfler
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lea Schroeder
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer (IARC), Lyon, France
| | - Luisa Lina Villa
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil; Department of Radiology and Oncology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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