1
|
Carsuzaa F, Chabrillac E, Marcy PY, Mehanna H, Thariat J. Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary. Strahlenther Onkol 2024; 200:553-567. [PMID: 38600366 DOI: 10.1007/s00066-024-02228-4] [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: 11/29/2023] [Accepted: 03/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Substantial changes have been made in the neck management of patients with head and neck squamous cell carcinomas (HNSCC) in the past century. These have been fostered by changes in cancer epidemiology and technological progress in imaging, surgery, or radiotherapy, as well as disruptive concepts in oncology. We aimed to review changes in nodal management, with a focus on HNSCC patients with nodal involvement (cN+) undergoing (chemo)radiotherapy. METHODS A narrative review was conducted to review current advances and address knowledge gaps in the multidisciplinary management of the cN+ neck in the context of (chemo)radiotherapy. RESULTS Metastatic neck nodes are associated with poorer prognosis and poorer response to radiotherapy, and have therefore been systematically treated by surgery. Radical neck dissection (ND) has gradually evolved toward more personalized and less morbid approaches, i.e., from functional to selective ND. Omission of ND has been made feasible by use of positron-emission tomography/computed tomography to monitor the radiation response in cN+ patients. Human papillomavirus-driven oropharyngeal cancers and their cystic nodes have shown dramatically better prognosis than tobacco-related cancers, justifying a specific prognostic classification (AJCC) creation. Finally, considering the role of lymph nodes in anti-tumor immunity, de-escalation of ND and prophylactic nodal irradiation in combination are intense areas of investigation. However, the management of bulky cN3 disease remains an issue, as aggressive multidisciplinary strategies or innovative combined treatments have not yet significantly improved their prognosis. CONCLUSION Personalized neck management is an increasingly important aspect of the overall therapeutic strategies in cN+ HNSCC.
Collapse
Affiliation(s)
- Florent Carsuzaa
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, Poitiers University Hospital, Poitiers, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Pierre Yves Marcy
- Department of Radiology, Clinique du Cap d'Or, La Seyne-sur-mer, France
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Juliette Thariat
- Department of radiotherapy, Centre François Baclesse, Caen, France.
- Laboratoire de physique Corpusculaire, IN2P3/ENSICAEN/CNRS, UMR 6534, Normandie Université, Caen, France.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Hanna GJ, Chang SSW, Siddiqui F, Bain PA, Takiar V, Ward MC, Shukla ME, Hu KS, Robbins J, Witek ME, Bakst R, Chandra RA, Galloway T, Margalit DN. Imaging and Biomarker Surveillance for Head and Neck Squamous Cell Carcinoma: A Systematic Review and American Radium Society Appropriate Use Criteria Statement. Int J Radiat Oncol Biol Phys 2024; 119:786-802. [PMID: 38168554 DOI: 10.1016/j.ijrobp.2023.12.024] [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: 04/18/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
Surveillance for survivors of head and neck cancer (HNC) is focused on early detection of recurrent or second primary malignancies. After initial restaging confirms disease-free status, the use of surveillance imaging for asymptomatic patients with HNC is controversial. Our objective was to comprehensively review literature pertaining to imaging and biomarker surveillance of asymptomatic patients treated for head and neck squamous cell carcinoma and to convene a multidisciplinary expert panel to provide appropriate use criteria for surveillance in representative clinical scenarios. The evidence base for the appropriate use criteria was gathered through a librarian-mediated search of literature published from 1990 to 2022 focused on surveillance imaging and circulating tumor-specific DNA for nonmetastatic head and neck squamous cell carcinoma using MEDLINE (Ovid), Embase, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials. The systematic review was reported according to PRISMA guidelines. Using the modified Delphi process, the expert panel voted on appropriate use criteria, providing recommendations for appropriate use of surveillance imaging and human papillomavirus (HPV) circulating tumor DNA. Of 5178 studies identified, 80 met inclusion criteria (5 meta-analyses/systematic reviews, 1 randomized control trial, 1 post hoc analysis, 25 prospective, and 48 retrospective cohort studies [with ≥50 patients]), reporting on 27,525 patients. No large, randomized, prospective trials examined whether asymptomatic patients who receive surveillance imaging or HPV circulating tumor DNA monitoring benefit from earlier detection of recurrence or second primary tumors in terms of disease-specific or quality-of-life outcomes. In the absence of prospective data, surveillance imaging for HNC survivors should rely on individualized recurrence-risk assessment accounting for initial disease staging, HPV disease status, and tobacco use history. There is an emerging surveillance role for circulating tumor biomarkers.
Collapse
Affiliation(s)
- Glenn J Hanna
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Steven Shih-Wei Chang
- Department of Otolaryngology Head and Neck Surgery, Henry Ford Cancer Institute and Hospital, Detroit, Michigan
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute and Hospital, Detroit, Michigan
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Matthew C Ward
- Atrium Health Levine Cancer Institute Radiation Therapy Center, Charlotte, North Carolina
| | - Monica E Shukla
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kenneth S Hu
- New York University Langone Hospitals, New York, New York
| | - Jared Robbins
- Radiation Oncology, College of Medicine Tucson, University of Arizona, Tucson, Arizona
| | - Matthew E Witek
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard Bakst
- Mount Sinai Icahn School of Medicine, New York, New York
| | - Ravi A Chandra
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Health, Rockville, Maryland
| | - Thomas Galloway
- Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | - Danielle N Margalit
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
Eguchi H, Takenaka Y, Tanaka H, Suzuki M, Horie M, Kanai H, Seo Y, Ogawa K, Yachida S, Inohara H. Survival of Metastatic Human Papillomavirus (HPV)-Related Head and Neck Cancer Receiving Platinum-Based Triplet Induction Chemotherapy and Relevance of Circulating Tumor HPV DNA. Cureus 2024; 16:e60547. [PMID: 38887331 PMCID: PMC11181740 DOI: 10.7759/cureus.60547] [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] [Accepted: 05/18/2024] [Indexed: 06/20/2024] Open
Abstract
Objectives We aimed to examine the effectiveness of platinum-based triplet induction chemotherapy in metastatic squamous cell carcinoma of the head and neck (HNSCC) at diagnosis in terms of tumor human papillomavirus (HPV) status and the clinical relevance of circulating tumor HPV DNA (ctHPVDNA) during induction chemotherapy. Methods Twenty-one patients were included. ctHPVDNA was longitudinally quantified using optimized digital PCR in a subset of patients. Results HPV-related HNSCC patients (N=7) had a significantly better response to induction chemotherapy than HPV-unrelated HNSCC patients (N=14) (complete or partial response rate, 100% vs. 36%, P = 0.007). Following induction chemotherapy, more HPV-related HNSCC patients than HPV-unrelated patients received radiotherapy (86% vs. 36%, P = 0.06). With a median follow-up of 26 months in surviving patients, the two-year overall survival was 86% in HPV-related HNSCC patients and 43% in HPV-unrelated HNSCC patients (P = 0.04). In two patients, ctHPVDNA levels drastically decreased after the first cycle of induction chemotherapy but turned to continuous increase after the second cycle, suggesting the acquisition of drug resistance by the end of the second cycle. Radiographic imaging after induction chemotherapy failed to identify the drug resistance. In one patient, ctHPVDNA decreased gradually but remained detectable after induction chemotherapy despite no radiographic residual disease. ctHPVDNA became undetectable during radiotherapy. Conclusion HPV-related HNSCC patients with distant metastasis at diagnosis should be treated definitively. The ctHPVDNA level reflects real-time disease activity. ctHPVDNA monitoring during induction chemotherapy could help the decision-making of the therapeutic strategy.
Collapse
Affiliation(s)
| | | | | | | | | | - Haruka Kanai
- Head and Neck Surgery, Osaka University, Suita, JPN
| | - Yuji Seo
- Radiation Oncology, Osaka University, Suita, JPN
| | | | | | - Hidenori Inohara
- Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, JPN
| |
Collapse
|
5
|
Bønløkke S, Steiniche T, Sorensen BS, Nyvang G, Lindegaard JC, Blaakær J, Bertelsen J, Fuglsang K, Strube ML, Lenz S, Stougaard M. Circulating cell-free HPV DNA is a strong marker for disease severity in cervical cancer. Mol Oncol 2024; 18:1231-1244. [PMID: 37853962 PMCID: PMC11076984 DOI: 10.1002/1878-0261.13538] [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: 01/31/2023] [Revised: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 10/20/2023] Open
Abstract
For cervical cancer (CC), circulating cell-free HPV DNA (ccfHPV) may establish disease severity. Furthermore, HPV integration has been correlated to viral load and survival. In this study, pre-treatment plasma from 139 CC cases (50 primary surgery patients, 22 primary surgery + adjuvant oncological therapy patients, and 67 primary oncological therapy patients) was collected (2018-2020). Furthermore, plasma from 25 cervical intraepithelial neoplasia grade 3 patients and 15 healthy women (negative controls) were collected. Two next-generation sequencing (NGS) panels were used to establish ccfHPV presence and human papillomavirus type 16 (HPV16) integration status. ccfHPV was detected in four primary surgery (8.0%), eight primary surgery + adjuvant oncology (36.4%), and 54 primary oncology (80.6%) patients. For primary oncology patients with HPV16-related cancer (n = 37), more ccfHPVneg than ccfHPVpos patients had HPV16 integration (P = 0.04), and in patients with HPV16 integration (n = 13), ccfHPVpos patients had higher disease stages than ccfHPVneg patients (P = 0.05). In summary, ccfHPV presence is related to disease severity and may add to the debated Sedlis criteria used for identifying patients for adjuvant oncological therapy. However, ccfHPV detection is influenced by HPV integration status and disease stage, and these factors need to be considered in ccfHPVneg patients.
Collapse
Affiliation(s)
- Sara Bønløkke
- Department of Clinical MedicineAarhus UniversityDenmark
- Department of PathologyAarhus University HospitalDenmark
| | - Torben Steiniche
- Department of Clinical MedicineAarhus UniversityDenmark
- Department of PathologyAarhus University HospitalDenmark
| | - Boe Sandahl Sorensen
- Department of Clinical MedicineAarhus UniversityDenmark
- Department of Clinical BiochemistryAarhus University HospitalDenmark
| | | | | | - Jan Blaakær
- Department of Obstetrics and GynecologyOdense University HospitalDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdense MDenmark
| | | | - Katrine Fuglsang
- Department of Clinical MedicineAarhus UniversityDenmark
- Department of Obstetrics and GynecologyAarhus University HospitalDenmark
| | | | - Suzan Lenz
- Private Gynecological Clinic “Suzan Lenz Gynækolog”CopenhagenDenmark
| | - Magnus Stougaard
- Department of Clinical MedicineAarhus UniversityDenmark
- Department of PathologyAarhus University HospitalDenmark
| |
Collapse
|
6
|
Lam D, Sangal NR, Aggarwal A, Rajasekaran K, Cannady SB, Basu D, Chalian A, Weinstein G, Brody RM. Preoperative Circulating Tumor HPV DNA and Oropharyngeal Squamous Cell Disease. JAMA Otolaryngol Head Neck Surg 2024; 150:444-450. [PMID: 38573644 PMCID: PMC11082685 DOI: 10.1001/jamaoto.2024.0350] [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: 11/03/2023] [Accepted: 02/10/2024] [Indexed: 04/05/2024]
Abstract
Importance The utility of preoperative circulating tumor tissue-modified viral human papillomavirus DNA (TTMV-HPV DNA) levels in predicting human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) disease burden is unknown. Objective To determine if preoperative circulating tumor HPV DNA (ctHPVDNA) is associated with disease burden in patients with HPV+ OPSCC who have undergone transoral robotic surgery (TORS). Design, Setting, and Participants This cross-sectional study comprised patients with HPV+ OPSCC who underwent primary TORS between September 2021 and April 2023 at one tertiary academic institution. Patients with treatment-naive HPV+ OPSCC (p16-positive) and preoperative ctHPVDNA levels were included, and those who underwent neck mass excision before ctHPVDNA collection were excluded. Main Outcomes and Measures The main outcome was the association of increasing preoperative ctHPVDNA levels with tumor size and lymph node involvement in surgical pathology. The secondary outcome was the association between preoperative ctHPVDNA levels and adverse pathology, which included lymphovascular invasion, perineural invasion, or extranodal extension. Results A total of 70 patients were included in the study (65 men [93%]; mean [SD] age, 61 [8] years). Baseline ctHPVDNA levels ranged from 0 fragments/milliliter of plasma (frag/mL) to 49 452 frag/mL (median [IQR], 272 [30-811] frag/mL). Overall, 58 patients (83%) had positive results for ctHPVDNA, 1 (1.4%) had indeterminate results, and 11 (15.6%) had negative results. The sensitivity of detectable ctHPVDNA for identifying patients with pathology-confirmed HPV+ OPSCC was 84%. Twenty-seven patients (39%) had pathologic tumor (pT) staging of pT0 or pT1, 34 (49%) had pT2 staging, and 9 patients (13%) had pT3 or pT4 staging. No clinically meaningful difference between detectable and undetectable preoperative ctHPVDNA cohorts was found for tumor size or adverse pathology. Although the median preoperative ctHPVDNA appeared to be higher in pT2 through pT4 stages and pN1 or pN2 stages, effect sizes were small (pT stage: η2, 0.002 [95% CI, -1.188 to 0.827]; pN stage: η2, 0.043 [95% CI, -0.188 to 2.600]). Median preoperative log(TTMV-HPV DNA) was higher in active smokers (8.79 [95% CI, 3.55-5.76]), compared with never smokers (5.92 [95% CI, -0.97 to 1.81]) and former smokers (4.99 [95% CI, 0.92-6.23]). Regression analysis did not show an association between tumor dimension or metastatic lymph node deposit size and preoperative log(TTMV-HPV DNA). After univariate analysis, no association was found between higher log(TTMV-HPV DNA) levels and adverse pathology. Conclusions and Relevance In this cross-sectional study, preoperative ctHPVDNA levels were not associated with disease burden in patients with HPV+ OPSCC who underwent TORS.
Collapse
Affiliation(s)
- Doreen Lam
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia
| | - Neel R. Sangal
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia
| | - Ashna Aggarwal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia
| | - Steven B. Cannady
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia
| | - Devraj Basu
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia
| | - Ara Chalian
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia
| | - Gregory Weinstein
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia
| | - Robert M. Brody
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia
| |
Collapse
|
7
|
Sanz-Garcia E, Zou J, Avery L, Spreafico A, Waldron J, Goldstein D, Hansen A, Cho BCJ, de Almeida J, Hope A, Hosni A, Hahn E, Perez-Ordonez B, Zhao Z, Smith C, Zheng Y, Singaravelan N, Bratman SV, Siu LL. Multimodal detection of molecular residual disease in high-risk locally advanced squamous cell carcinoma of the head and neck. Cell Death Differ 2024; 31:460-468. [PMID: 38409276 PMCID: PMC11043441 DOI: 10.1038/s41418-024-01272-y] [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: 12/03/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
Up to 30% of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) relapse. Molecular residual disease (MRD) detection using multiple assays after definitive therapy has not been reported. In this study, we included patients with LA-HNSCC (stage III Human Papilloma virus (HPV)-positive, III-IVB HPV-negative) treated with curative intent. Plasma was collected pre-treatment, at 4-6 weeks (FU1) and 8-12 weeks (FU2) post-treatment. Circulating tumor DNA (ctDNA) was analyzed using a tumor-informed (RaDaR®) and a tumor-naïve (CAPP-seq) assay. HPV DNA was measured using HPV-sequencing (HPV-seq) and digital PCR (dPCR). A total of 86 plasma samples from 32 patients were analyzed; all patients with at least 1 follow-up sample. Most patients were stage III HPV-positive (50%) and received chemoradiation (78%). No patients had radiological residual disease at FU2. With a median follow-up of 25 months, there were 7 clinical relapses. ctDNA at baseline was detected in 15/17 (88%) by RaDaR and was not associated with recurrence free survival (RFS). Two patients relapsed within a year after definitive therapy and showed MRD at FU2 using RaDaR; detection of ctDNA during follow-up was associated with shorter RFS (p < 0.001). ctDNA detection by CAPP-seq pre-treatment and during follow-up was not associated with RFS (p = 0.09). HPV DNA using HPV-seq or dPCR during follow-up was associated with shorter RFS (p < 0.001). Sensitivity and specificity for MRD at FU2 using RaDaR was 40% and 100% versus 20 and 90.5% using CAPP-seq. Sensitivity and specificity for MRD during follow-up using HPV-seq was 100% and 91.7% versus 50% and 100% using dPCR. In conclusion, HPV DNA and ctDNA can be detected in LA-HNSCC before definitive therapy. The RaDaR assay but not CAPP-seq may detect MRD in patients who relapse within 1 year. HPV-seq may be more sensitive than dPCR for MRD detection.
Collapse
Affiliation(s)
- Enrique Sanz-Garcia
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jinfeng Zou
- Princess Margaret Cancer Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lisa Avery
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Goldstein
- Department of Surgical Oncology, Division of ENT, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aaron Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - B C John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John de Almeida
- Department of Surgical Oncology, Division of ENT, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bayardo Perez-Ordonez
- Department of Pathology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zhen Zhao
- Princess Margaret Cancer Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Yangqiao Zheng
- Princess Margaret Cancer Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nitthusha Singaravelan
- Cancer Genomics Program, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Scott V Bratman
- Princess Margaret Cancer Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Iseas S, Mariano G, Gros L, Baba-Hamed N, De Parades V, Adam J, Raymond E, Abba MC. Unraveling Emerging Anal Cancer Clinical Biomarkers from Current Immuno-Oncogenomics Advances. Mol Diagn Ther 2024; 28:201-214. [PMID: 38267771 PMCID: PMC10925578 DOI: 10.1007/s40291-023-00692-9] [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: 12/26/2023] [Indexed: 01/26/2024]
Abstract
Anal squamous cell carcinoma (ASCC) is a rare gastrointestinal malignancy associated with high-risk human papillomavirus (HPV) and is currently one of the fastest-growing causes of cancer incidence and mortality in developed countries. Although next-generation sequencing technologies (NGS) have revolutionized cancer and immuno-genomic research in various tumor types, a limited amount of clinical research has been developed to investigate the expression and the functional characterization of genomic data in ASCC. Herein, we comprehensively assess recent advancements in "omics" research, including a systematic analysis of genome-based studies, aiming to identify the most relevant ASCC cancer driver gene expressions and their associated signaling pathways. We also highlight the most significant biomarkers associated with anal cancer progression, gene expression of potential diagnostic biomarkers, expression of therapeutic drug targets, and emerging treatment opportunities. This review stresses the urgent need for developing target-specific therapies in ASCC. By illuminating the molecular characteristics and drug-target expression in ASCC, this study aims to provide insights for the development of precision medicine in anal cancer.
Collapse
Affiliation(s)
- Soledad Iseas
- Medical Oncology Department, Paris-St Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France.
| | - Golubicki Mariano
- Oncology Unit, Gastroenterology Hospital "Dr. Carlos Bonorino Udaondo", Av. Caseros 2061, C1264, Ciudad Autónoma de Buenos Aires, Argentina
| | - Louis Gros
- Medical Oncology Department, Paris-St Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France
| | - Nabil Baba-Hamed
- Medical Oncology Department, Paris-St Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France
| | - Vincent De Parades
- Proctology Unit, Paris-St Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France
| | - Julien Adam
- Pathology Department, Paris-St Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France
| | - Eric Raymond
- Medical Oncology Department, Paris-St Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France
| | - Martin Carlos Abba
- Basic and Applied Immunological Research Center (CINIBA), School of Medical Sciences, NationalUniversity of La Plata, Calle 60 y 120, C1900, La Plata, Argentina.
| |
Collapse
|
10
|
Naegele S, Ruiz-Torres DA, Zhao Y, Goss D, Faden DL. Comparing the Diagnostic Performance of Quantitative PCR, Digital Droplet PCR, and Next-Generation Sequencing Liquid Biopsies for Human Papillomavirus-Associated Cancers. J Mol Diagn 2024; 26:179-190. [PMID: 38103593 PMCID: PMC10918646 DOI: 10.1016/j.jmoldx.2023.11.007] [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: 04/28/2023] [Revised: 08/29/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Human papillomavirus (HPV)-associated cancers, including oropharyngeal squamous cell carcinoma (HPV + OPSCC), cervical cancer, and squamous cell carcinoma of the anus (HPV + SCCA), release circulating tumor HPV DNA (ctHPVDNA) into the blood. The diagnostic performance of ctHPVDNA detection depends on the approaches used and the individual assay metrics. A comparison of these approaches has not been systematically performed to inform expected performance, which in turn affects clinical interpretation. A meta-analysis was performed using Ovid MEDLINE, Embase, and Web of Science Core Collection databases to assess the diagnostic accuracy of ctHPVDNA detection across cancer anatomic sites, detection platforms, and blood components. The population included patients with HPV + OPSCC, HPV-associated cervical cancer, and HPV + SCCA with pretreatment samples analyzed by quantitative PCR (qPCR), digital droplet PCR (ddPCR), or next-generation sequencing (NGS). Thirty-six studies involving 2986 patients met the inclusion criteria. The sensitivity, specificity, and quality of each study were assessed and pooled for each analysis. The sensitivity of ctHPVDNA detection was greatest with NGS, followed by ddPCR and then qPCR when pooling all studies, whereas specificity was similar (sensitivity: ddPCR > qPCR, P < 0.001; NGS > ddPCR, P = 0.014). ctHPVDNA from OPSCC was more easily detected compared with cervical cancer and SCCA, overall (P = 0.044). In conclusion, detection platform, anatomic site of the cancer, and blood component used affects ctHPVDNA detection and must be considered when interpreting results. Plasma NGS-based testing may be the most sensitive approach for ctHPVDNA overall.
Collapse
Affiliation(s)
- Saskia Naegele
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Daniel A Ruiz-Torres
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Yan Zhao
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Deborah Goss
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
| |
Collapse
|
11
|
Tatsumi M, Tanaka H, Takenaka Y, Suzuki M, Fukusumi T, Eguchi H, Watabe T, Kato H, Yachida S, Inohara H, Tomiyama N. Association of circulating tumor HPV16DNA levels and quantitative PET parameters in patients with HPV-positive head and neck squamous cell carcinoma. Sci Rep 2024; 14:3278. [PMID: 38332246 PMCID: PMC10853198 DOI: 10.1038/s41598-024-53894-4] [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: 10/06/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024] Open
Abstract
Circulating tumor DNA (ctDNA), which circulates in the blood after being shed from cancer cells in the body, has recently gained attention as an excellent tumor marker. The purpose of this study was to evaluate whether ct human papillomavirus (HPV) 16 DNA (ctHPV16DNA) levels were associated with quantitative PET parameters in patients with HPV-positive head and neck (HN) squamous cell carcinoma (SCC). Fifty patients with oropharyngeal SCC (OPSCC) and 5 with SCC of unknown primary (SCCUP) before treatment were included. They all underwent blood sampling to test ctHPV16DNA levels and FDG PET-CT examinations. Quantitative PET parameters included SUVmax, metabolic tumor volume (MTV), MTV of whole-body lesions (wbMTV), and 56 texture features. ctHPV16DNA levels were compared to texture features of primary tumors in OPSCC patients (Group A) or the largest primary or metastatic lymph node lesions in OPSCC and SCCUP patients (Group B) and to other PET parameters. Spearman rank correlation test and multiple regression analysis were used to confirm the associations between ctHPV16DNA levels and PET parameters. ctHPV16DNA levels moderately correlated with wbMTV, but not with SUVmax or MTV in Groups A and B. ctHPV16DNA levels exhibited a weak negative correlation with low gray-level zone emphasis in Groups A and B. Multiple regression analysis revealed that wbMTV and high gray-level zone emphasis were the significant factors for ctHPV16DNA levels in Group B. These results were not observed in Group A. This study demonstrated that ctHPV16DNA levels correlated with the whole-body tumor burden and tumor heterogeneity visualized on FDG PET-CT in patients with HPV-positive HNSCC.
Collapse
Affiliation(s)
- Mitsuaki Tatsumi
- Department of Radiology, Osaka University Hospital, 2-2-D1 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hidenori Tanaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motoyuki Suzuki
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takahito Fukusumi
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hirotaka Eguchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tadashi Watabe
- Department of Nuclear Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroki Kato
- Department of Nuclear Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shinichi Yachida
- Department of Cancer Genome Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Hospital, 2-2-D1 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| |
Collapse
|
12
|
Nenclares P, Larkeryd A, Manodoro F, Lee JY, Lalondrelle S, Gilbert DC, Punta M, O’Leary B, Rullan A, Sadanandam A, Chain B, Melcher A, Harrington KJ, Bhide SA. T-cell receptor determinants of response to chemoradiation in locally-advanced HPV16-driven malignancies. Front Oncol 2024; 13:1296948. [PMID: 38234396 PMCID: PMC10791873 DOI: 10.3389/fonc.2023.1296948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024] Open
Abstract
Background The effect of chemoradiation on the anti-cancer immune response is being increasingly acknowledged; however, its clinical implications in treatment responses are yet to be fully understood. Human papillomavirus (HPV)-driven malignancies express viral oncogenic proteins which may serve as tumor-specific antigens and represent ideal candidates for monitoring the peripheral T-cell receptor (TCR) changes secondary to chemoradiotherapy (CRT). Methods We performed intra-tumoral and pre- and post-treatment peripheral TCR sequencing in a cohort of patients with locally-advanced HPV16-positive cancers treated with CRT. An in silico computational pipeline was used to cluster TCR repertoire based on epitope-specificity and to predict affinity between these clusters and HPV16-derived epitopes. Results Intra-tumoral repertoire diversity, intra-tumoral and post-treatment peripheral CDR3β similarity clustering were predictive of response. In responders, CRT triggered an increase peripheral TCR clonality and clonal relatedness. Post-treatment expansion of baseline peripheral dominant TCRs was associated with response. Responders showed more baseline clustered structures of TCRs maintained post-treatment and displayed significantly more maintained clustered structures. When applying clustering by TCR-specificity methods, responders displayed a higher proportion of intra-tumoral TCRs predicted to recognise HPV16 peptides. Conclusions Baseline TCR characteristics and changes in the peripheral T-cell clones triggered by CRT are associated with treatment outcome. Maintenance and boosting of pre-existing clonotypes are key elements of an effective anti-cancer immune response driven by CRT, supporting a paradigm in which the immune system plays a central role in the success of CRT in current standard-of-care protocols.
Collapse
Affiliation(s)
- Pablo Nenclares
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, United Kingdom
- Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Adrian Larkeryd
- Bioinformatics Unit, The Centre for Translational Immunotherapy, The Institute of Cancer Research, London, United Kingdom
| | - Floriana Manodoro
- Genomics Facility, The Institute of Cancer Research, London, United Kingdom
| | - Jen Y. Lee
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, United Kingdom
| | - Susan Lalondrelle
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, United Kingdom
| | - Duncan C. Gilbert
- Sussex Cancer Centre, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - Marco Punta
- Unit of Immunogenetic, Leukemia Genomics and Immunobiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ben O’Leary
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, United Kingdom
- Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Antonio Rullan
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, United Kingdom
- Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Anguraj Sadanandam
- Systems and Precision Cancer Medicine Team, The Institute of Cancer Research, London, United Kingdom
| | - Benny Chain
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Alan Melcher
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, United Kingdom
| | - Kevin J. Harrington
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, United Kingdom
- Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Shreerang A. Bhide
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, United Kingdom
- Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom
| |
Collapse
|
13
|
Radaic A, Kamarajan P, Cho A, Wang S, Hung GC, Najarzadegan F, Wong DT, Ton-That H, Wang CY, Kapila YL. Biological biomarkers of oral cancer. Periodontol 2000 2023:10.1111/prd.12542. [PMID: 38073011 PMCID: PMC11163022 DOI: 10.1111/prd.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/09/2023] [Indexed: 06/12/2024]
Abstract
The oral squamous cell carcinoma (OSCC) 5 year survival rate of 41% has marginally improved in the last few years, with less than a 1% improvement per year from 2005 to 2017, with higher survival rates when detected at early stages. Based on histopathological grading of oral dysplasia, it is estimated that severe dysplasia has a malignant transformation rate of 7%-50%. Despite these numbers, oral dysplasia grading does not reliably predict its clinical behavior. Thus, more accurate markers predicting oral dysplasia progression to cancer would enable better targeting of these lesions for closer follow-up, especially in the early stages of the disease. In this context, molecular biomarkers derived from genetics, proteins, and metabolites play key roles in clinical oncology. These molecular signatures can help predict the likelihood of OSCC development and/or progression and have the potential to detect the disease at an early stage and, support treatment decision-making and predict treatment responsiveness. Also, identifying reliable biomarkers for OSCC detection that can be obtained non-invasively would enhance management of OSCC. This review will discuss biomarkers for OSCC that have emerged from different biological areas, including genomics, transcriptomics, proteomics, metabolomics, immunomics, and microbiomics.
Collapse
Affiliation(s)
- Allan Radaic
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Pachiyappan Kamarajan
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Alex Cho
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Sandy Wang
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Guo-Chin Hung
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Fereshteh Najarzadegan
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - David T Wong
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Hung Ton-That
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Cun-Yu Wang
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Yvonne L Kapila
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| |
Collapse
|
14
|
Zhou S, Chan C, Lau YC, Rulach R, Dyab H, Hendry F, Wilson C, Schipani S, Lamb C, Grose D, James A, Maxfield C, Dempsey MF, Paterson C. The Effects of Human Papillomavirus Status and Treatment on the Positive Predictive Value of Post-radiotherapy 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Advanced Head and Neck Squamous Cell Carcinoma. Clin Oncol (R Coll Radiol) 2023; 35:e699-e707. [PMID: 37798198 DOI: 10.1016/j.clon.2023.09.006] [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: 04/03/2023] [Revised: 07/03/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
AIMS The high negative predictive value of post-chemoradiation (CRT) positron emission tomography-computed tomography (PET-CT) is well established in head and neck squamous cell cancers (HNSCC). The positive predictive value (PPV) remains under scrutiny, with increasing evidence that it is affected by several factors. The aim of this study was to assess the PPV of post-treatment PET-CT for residual nodal disease when stratified by treatment modality and tumour human papillomavirus (HPV) status. MATERIALS AND METHODS This was a retrospective cohort study in a tertiary oncology centre carried out between January 2013 and December 2019. Patients were radically treated with radiotherapy only/CRT for node-positive HNSCC. PET-CT nodal responses were categorised as complete, equivocal (EQR) or incomplete (ICR), and outcomes extracted from electronic records. RESULTS In total, 480 patients were evaluated, all had a minimum potential follow-up of 2 years, with a median of 39.2 months. The PPV of 12-week PET-CT was significantly different between HPV-positive (22.5%) and HPV-unrelated (52.7%) disease, P < 0.001. It was also significantly different between the CRT (24.8%) and radiotherapy-only (51.1%) groups, P = 0.001. The PPV of an EQR was significantly less than an ICR, irrespective of HPV status and primary treatment modality. In HPV-positive disease, the PPV of an EQR was 9.0% for the CRT group compared with 21.4% for radiotherapy only, P = 0.278. The PPV in those who achieved an ICR was 34.2% in the CRT group, significantly lower than 70.0% in the radiotherapy-only group, P = 0.03. CONCLUSION The PPV of 12-week PET-CT is significantly lower for HPV-positive compared with HPV-unrelated HNSCC. It is poorer in patients with HPV-positive disease treated with CRT compared with radiotherapy alone.
Collapse
Affiliation(s)
- S Zhou
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Chan
- University Hospital Ayr, Ayr, UK
| | - Y C Lau
- Royal Alexandra Hospital, Glasgow, UK
| | - R Rulach
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - H Dyab
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - F Hendry
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - C Wilson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Schipani
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Lamb
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D Grose
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A James
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Maxfield
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - M-F Dempsey
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - C Paterson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK.
| |
Collapse
|
15
|
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 DOI: 10.1001/jamaoncol.2023.4042] [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: 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.
Collapse
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
| |
Collapse
|
16
|
Thangarajah F, Busshoff J, Salamon J, Pruss MS, Lenz C, Morgenstern B, Hellmich M, Schlößer HA, Lenz M, Domröse C, Mallmann MR, Mallmann P, Weiß J, Franzen F, Merkelbach-Bruse S, Binot E, Eich ML, Büttner R, Schultheis AM, Alidousty C. Digital droplet PCR-based quantification of ccfHPV-DNA as liquid biopsy in HPV-driven cervical and vulvar cancer. J Cancer Res Clin Oncol 2023; 149:12597-12604. [PMID: 37452202 PMCID: PMC10587338 DOI: 10.1007/s00432-023-05077-3] [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: 05/23/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE More than 99% of cervical cancers and up to 40% of vulvar cancers are human papillomavirus (HPV) related. HPV 16 and 18 are the most relevant subtypes. Novel technologies allow the detection of minimal amounts of circulating cell-free HPV DNA (ccfHPV-DNA). The aim of this study was to evaluate ccfHPV-DNA assessed by droplet digital PCR (ddPCR) as a biomarker for molecular therapy monitoring in early, advanced, relapsed and metastatic HPV-driven cervical and vulvar cancer. METHODS Inclusion criteria of the study were histologically proven HPV 16/18-driven cervical and vulvar cancer with first diagnosed disease, newly diagnosed recurrence, or progression of disease. Blood samples were taken pre- and post-therapeutically. Circulating cell-free HPV DNA was quantified using ddPCR and the results were correlated with clinical data. RESULTS The mean copy number of ccfHPV-DNA was 838.6 (± 3089.1) in pretreatment and 2.3 (± 6.4) in post-treatment samples (p < 0.05). The copy number of ccfHPV-DNA increased with higher FIGO stages (p < 0.05), which are commonly used for clinical staging/assessment. Furthermore, we compared the distribution of copy numbers between T-stage 1 versus T-stage 2/3. We could show higher copy number level of ccfHPV-DNA in T-stage 2/3 (p < 0.05). CONCLUSIONS Therapy monitoring with determination of ccfHPV-DNA by ddPCR with a small amount of plasma reflects response to therapy and appears feasible for patients in advanced cancer stages of cervical and vulvar cancer. This promising tool should be examined as marker of therapy monitoring in particular in novel HPV-directed therapies.
Collapse
Affiliation(s)
- Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, University Hospital of Essen, University of Duisburg Essen, Faculty of Medicine, Essen, Germany.
- Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Jana Busshoff
- Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Janina Salamon
- Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Marie-Sandrine Pruss
- Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Caroline Lenz
- Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Bernd Morgenstern
- Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Hans Anton Schlößer
- Center for Molecular Medicine Cologne and Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Maximilian Lenz
- Department for Orthopaedic and Trauma Surgery, University Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Christian Domröse
- Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael R Mallmann
- Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jonathan Weiß
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Fabian Franzen
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Medical Faculty, Cologne, Germany
| | | | - Elke Binot
- Institute of Pathology, University Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Marie-Lisa Eich
- Institute of Pathology, University Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Reinhardt Büttner
- Institute of Pathology, University Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Anne Maria Schultheis
- Institute of Pathology, University Hospital of Cologne, Medical Faculty, Cologne, Germany.
| | - Christina Alidousty
- Institute of Pathology, University Hospital of Cologne, Medical Faculty, Cologne, Germany
| |
Collapse
|
17
|
Ferrandino RM, Chen S, Kappauf C, Barlow J, Gold BS, Berger MH, Westra WH, Teng MS, Khan MN, Posner MR, Misiukiewicz KJ, Bakst RL, Sindhu KK, Genden EM, Chai RL, Roof SA. Performance of Liquid Biopsy for Diagnosis and Surveillance of Human Papillomavirus-Associated Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:971-977. [PMID: 37422913 PMCID: PMC10331620 DOI: 10.1001/jamaoto.2023.1937] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Importance There is growing interest in the use of circulating plasma tumor human papillomavirus (HPV) DNA for diagnosis and surveillance of patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). Recent advances in the assays, combining the identification of circulating HPV tumor DNA and tumor DNA fragment analysis (tumor tissue-modified viral [TTMV]-HPV DNA), have been shown to be highly accurate. However, use of these newer techniques has been limited to small cohort studies and clinical trials. Objective To establish the clinical efficacy of plasma TTMV-HPV DNA testing in the diagnosis and surveillance of HPV-associated OPSCC in a contemporary clinical setting. Design, Setting, and Participants This retrospective observational cohort study included patients with OPSCC who underwent TTMV-HPV DNA testing between April 2020 and September 2022 during the course of routine clinical care. For the diagnosis cohort, patients with at least 1 TTMV-HPV DNA measurement prior to initiation of primary therapy were included. Patients were included in the surveillance cohort if they had at least 1 TTMV-HPV DNA test performed after completion of definitive or salvage therapy. Main Outcomes and Measures Per-test performance metrics, including sensitivity, specificity, positive predictive value, and negative predictive value, for TTMV-HPV DNA testing. Results Of 399 patients included in the analysis, 163 were in the diagnostic cohort (median [IQR] age, 63 [56-68.5] years; 142 [87.1%] male), and 290 were in the surveillance cohort (median [IQR] age, 63 [57-70] years; 237 [81.7%] male). Of the 163 patients in the diagnostic cohort, 152 (93.3%) had HPV-associated OPSCC while 11 (6.7%) had HPV-negative OPSCC. The TTMV-HPV DNA sensitivity in pretreatment diagnosis was 91.5% (95% CI, 85.8%-95.4% [139 of 152 tests]), and the specificity was 100% (95% CI, 71.5%-100% [11 of 11 tests]). In the surveillance cohort, 591 tests conducted in 290 patients were evaluated. A total of 23 patients had molecularly confirmed pathologic recurrences. The TTMV-HPV DNA test demonstrated sensitivity of 88.4% (95% CI, 74.9%-96.1% [38 of 43 tests]) and specificity of 100% (95% CI, 99.3%-100% [548 of 548 tests]) in detecting the recurrences. Positive predictive value was 100% (95% CI, 90.7%-100% [38 of 38 tests]), and negative predictive value was 99.1% (95% CI, 97.9%-99.7% [548 of 553 tests]). The median (range) lead time from positive TTMV-HPV DNA test to pathologic confirmation was 47 (0-507) days. Conclusions and Relevance This cohort study demonstrated that when evaluated in a clinical setting, the TTMV-HPV DNA assay demonstrated 100% specificity in both diagnosis and surveillance. However, the sensitivity was 91.5% for the diagnosis cohort and 88.4% for the surveillance cohort, signifying that nearly 1 in 10 negative tests among patients with HPV-associated OPSCC was a false negative. Additional research is required to validate the assay's performance and, if validated, then further research into the implementation of this assay into standard clinical practice guidelines will be required.
Collapse
Affiliation(s)
- Rocco M. Ferrandino
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sida Chen
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catharine Kappauf
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua Barlow
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brandon S. Gold
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael H. Berger
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - William H. Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marita S. Teng
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohemmed N. Khan
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall R. Posner
- Department of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Krzysztof J. Misiukiewicz
- Department of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L. Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric M. Genden
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raymond L. Chai
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott A. Roof
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
18
|
Jakobsen KK, Bendtsen SK, Pallisgaard N, Friborg J, Lelkaitis G, Grønhøj C, von Buchwald C. Liquid Biopsies with Circulating Plasma HPV-DNA Measurements-A Clinically Applicable Surveillance Tool for Patients with HPV-Positive Oropharyngeal Cancer. Clin Cancer Res 2023; 29:3914-3923. [PMID: 37477909 DOI: 10.1158/1078-0432.ccr-23-1064] [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: 04/11/2023] [Revised: 05/25/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To evaluate the accuracy of cell-free human papillomavirus-DNA (cfHPV-DNA) measurements in liquid biopsies in predicting disease in patients with HPV-positive/p16-positive (HPV+/p16+) oropharyngeal squamous cell carcinoma (OPSCC). EXPERIMENTAL DESIGN This was a prospective cohort study. Plasma samples were collected before treatment, serially after curative intended therapy at follow-up visits 2 weeks, and 6, 9, 12, 18, 24, and 30 months after treatment. A droplet digital PCR assay comprising eight HPV genotypes was used. HPV genotypes found in plasma and tumor tissue were compared. We correlated biopsy- or imaging-verified tumor progression to cfHPV-DNA in follow-up samples. RESULTS We enrolled 72 patients with HPV+/p16+ OPSCC. Baseline sensitivity for cfHPV-DNA detection was 97.2% (95% confidence interval, 90.3%-99.6%). CfHPV-DNA copy number/milliliter plasma correlated with tumor stage. We found a 100% concordance between HPV genotype in tumor tissue and plasma. Fifty-four patients were followed with serial blood samples for a median of 19.7 months (interquartile range, 13.5-25.5 months). Forty-one patients had undetectable plasma cfHPV-DNA in all follow-up samples, and none developed recurrences. Thirteen patients were classified as cfHPV-DNA-positive in a follow-up plasma sample. Of these, five patients developed a recurrence, and three had residual cancer. It was possible to detect cfHPV-DNA in plasma 97 to 166 days prior to the proven recurrence. CONCLUSIONS To our knowledge, to date, our study, comprising the largest study of patients with HPV+/p16+ OPSCC, using an ultrasensitive multiplex HPV gene panel, revealed a high sensitivity of cfHPV-DNA detection in the liquid biopsies. We recommend serial plasma HPV samples for clinical monitoring of patients with HPV+/p16+ OPSCC.
Collapse
Affiliation(s)
- Kathrine K Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Simone K Bendtsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jeppe Friborg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Giedrius Lelkaitis
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Dietrich D, Weider S, de Vos L, Vogt TJ, Färber M, Zarbl R, Hunecke A, Glosch AK, Gabrielpillai J, Bootz F, Bauernfeind FG, Kramer FJ, Kristiansen G, Brossart P, Strieth S, Franzen A. Circulating Cell-Free SEPT9 DNA Methylation in Blood Is a Biomarker for Minimal Residual Disease Detection in Head and Neck Squamous Cell Carcinoma Patients. Clin Chem 2023; 69:1050-1061. [PMID: 37477541 DOI: 10.1093/clinchem/hvad084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Tumorous SEPT9 (septin 9, SEPTIN9) circulating cell-free DNA (ccfDNA) methylation in blood plasma is a powerful biomarker for diagnosis, molecular staging, prognosis, and recurrence monitoring in head and neck squamous cell carcinoma (HNSCC) patients. The present study aimed to evaluate the clinical performance of SEPT9 ccfDNA methylation to detect post-surgical minimal residual disease (MRD) in patients with localized or locally advanced HNSCC treated with curative intent. METHODS We applied quasi-digital methylation-specific real-time PCR to quantify SEPT9 ccfDNA methylation levels 2 to 30 days post-surgically in plasma from n = 219 prospectively enrolled HNSCC patients. We tested the associations of SEPT9 ccfDNA methylation with clinicopathological parameters and used Kaplan-Meier and Cox proportional hazards analyses for univariate, pairwise bivariate, and multivariate analyses of disease-free survival. RESULTS Of 219 patients, 26.5% (58/219) were post-surgically SEPT9 ccfDNA methylation positive. SEPT9 ccfDNA methylation positivity was significantly associated with tumor site, American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC; 8th edition) tumor stage, nodal category and extracapsular extension, lymphatic and vascular invasion, and surgical margin. Bivariate Cox proportional hazards analysis proved post-surgical SEPT9 ccfDNA methylation positivity to be an independent prognostic factor tested together with AJCC/UICC tumor stage (SEPT9: hazard ratio [HR] = 2.43, 95% CI, 1.37-4.30, P = 0.002; AJCC/UICC stage: HR = 1.48, 95% CI, 1.11-1.98, P = 0.008). CONCLUSIONS Post-surgical SEPT9 ccfDNA methylation may aid to identify high-risk HNSCC patients who could benefit from an intensified adjuvant treatment and surveillance.
Collapse
Affiliation(s)
- Dimo Dietrich
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Simone Weider
- Department of Oral and Maxillofacial Surgery, University Medical Center Bonn (UKB), Bonn, Germany
| | - Luka de Vos
- Department of Dermatology and Allergology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Timo Jakob Vogt
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Moritz Färber
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Romina Zarbl
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Alina Hunecke
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Ann-Kathrin Glosch
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Jennis Gabrielpillai
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Friedrich Bootz
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Franz-Georg Bauernfeind
- Department of Oncology, Hematology and Rheumatology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Franz-Josef Kramer
- Department of Oral and Maxillofacial Surgery, University Medical Center Bonn (UKB), Bonn, Germany
| | - Glen Kristiansen
- Department of Pathology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Peter Brossart
- Department of Oncology, Hematology and Rheumatology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Sebastian Strieth
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Alina Franzen
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Califano J, Yousef A, Mostafa H, Valsamakis A, Zhang X, Batis N, Varghese C, Parish J, Forman M, Jarrett J, Messer K, Mehanna H. Lead Time to Recurrence After Posttreatment Plasma and Saliva HPV DNA Testing in Patients With Low-Risk HPV Oropharynx Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:812-819. [PMID: 37498566 PMCID: PMC10375388 DOI: 10.1001/jamaoto.2023.1730] [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: 02/23/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023]
Abstract
Importance Head and neck squamous cell carcinoma is a highly lethal cancer that is often associated with human papillomavirus (HPV). Recent studies have shown promise in the use of HPV DNA detection in salivary rinses and plasma as a factor associated with a future diagnosis of HPV-positive oropharynx cancer (HPVOPC). However, the use of plasma and salivary HPV DNA detection in defining risk for recurrence in the context of a prospective, phase 3, clinical trial coupled with standardized clinical surveillance has not been reported. Objective To identify patients with low-risk HPVOPC at risk for recurrence by detection of HPV16 DNA in plasma and salivary rinses. Design, Setting, and Participants In this cohort study, 233 low-risk patients were recruited from 32 head and neck treatment centers in Ireland (1 [3.1%]), the Netherlands (1 [3.1%]), and the UK (30 [93.8%]) as part of the DE-ESCALATE HPV trial, an open-label, phase 3 randomized clinical trial examining treatment with cetuximab vs cisplatin for HPVOPC. Patients were assayed for the presence of HPV16 DNA in plasma and salivary rinse via a quantitative polymerase chain reaction-based assay. Main Outcomes and Measures Assay results were associated with risk of recurrence and lead time from HPV16 DNA detection to recurrence. Results Of 233 patients, 45 (19.3%) were women, and the mean (SD) age was 57.01 (8.45) years. A total 1040 salivary or blood samples were collected during the course of the study. With a median follow-up of 760 days, the sensitivity and specificity of combined plasma and salivary rinse HPV DNA assays for detecting recurrence were 65% and 87%, respectively. There was a median lead time of positive test to event/recurrence date of 19 days (range, 0-536 days) and mean (SD) of 122 (169.8) days. Conclusion and Relevance The results of this cohort study suggest that in the setting of a randomized, prospective, phase 3 trial for low-risk patients with HPVOPC, posttreatment presence of HPV DNA in plasma and salivary rinses is associated with recurrence; a lead time between test positivity and clinical recurrence offers a potential opportunity for earlier detection of recurrence.
Collapse
Affiliation(s)
- Joseph Califano
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Diego, La Jolla
- Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Andrew Yousef
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Diego, La Jolla
| | - Heba Mostafa
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexandra Valsamakis
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Roche Diagnostic Solutions, Pleasanton, California
| | - Xinlian Zhang
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Nikolaos Batis
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, England
| | - Christy Varghese
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, England
| | - Joanna Parish
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, England
| | - Michael Forman
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Karen Messer
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, England
| |
Collapse
|
23
|
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.
Collapse
Affiliation(s)
- Samuel N Regan
- From the Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | |
Collapse
|
24
|
Scholte LL, Bethony JM, Xian RR. Diagnosis and monitoring of virus-associated cancer using cell-free DNA. Curr Opin Virol 2023; 60:101331. [PMID: 37187125 DOI: 10.1016/j.coviro.2023.101331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/14/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
Viral-associated cancers are a distinct group of malignancies with a unique pathogenesis and epidemiology. Liquid biopsy is a minimally invasive way to identify tumor-associated abnormalities in blood derivatives, such as plasma, to guide the diagnosis, prognosis, and treatment of patients with cancer. Liquid biopsy encompasses a multitude of circulating analytes with the most extensively studied being cell-free DNA (cfDNA). In recent decades, substantial advances have been made toward the study of circulating tumor DNA in nonviral-associated cancers. Many of these observations have been translated to the clinic to improve the outcomes of patients with cancer. The study of cfDNA in viral-associated cancers is rapidly evolving and reveals tremendous potential for clinical applications. This review provides an overview of the pathogenesis of viral-associated malignancies, the current state of cfDNA analysis in oncology, the current state of cfDNA analysis in viral-associated cancers, and perspectives for the future of liquid biopsies in viral-associated cancers.
Collapse
Affiliation(s)
- Larissa Ls Scholte
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University, Washington DC, United States
| | - Jeffrey M Bethony
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University, Washington DC, United States
| | - Rena R Xian
- Department of Pathology and Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, United States.
| |
Collapse
|
25
|
Bryan SJ, Lee J, Gunu R, Jones A, Olaitan A, Rosenthal AN, Cutts RJ, Garcia-Murillas I, Turner N, Lalondrelle S, Bhide SA. Circulating HPV DNA as a Biomarker for Pre-Invasive and Early Invasive Cervical Cancer: A Feasibility Study. Cancers (Basel) 2023; 15:cancers15092590. [PMID: 37174056 PMCID: PMC10177194 DOI: 10.3390/cancers15092590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND High-risk HPV infection is responsible for >99% of cervix cancers (CC). In persistent infections that lead to cancer, the tumour breaches the basement membrane, releasing HPV-DNA into the bloodstream (cHPV-DNA). A next-generation sequencing assay (NGS) for detection of plasma HPV circulating DNA (cHPV-DNA) has demonstrated high sensitivity and specificity in patients with locally advanced cervix cancers. We hypothesised that cHPV-DNA is detectable in early invasive cervical cancers but not in pre-invasive lesions (CIN). METHODS Blood samples were collected from patients with CIN (n = 52) and FIGO stage 1A-1B CC (n = 12) prior to treatment and at follow-up. DNA extraction from plasma, followed by NGS, was used for the detection of cHPV-DNA. RESULTS None of the patients with pre-invasive lesions were positive for CHPV-DNA. In invasive tumours, plasma from one patient (10%) reached the threshold of positivity for cHPV-DNA in plasma. CONCLUSION Low detection of cHPV-DNA in early CC may be explained by small tumour size, poorer access to lymphatics and circulation, and therefore little shedding of cHPV-DNA in plasma at detectable levels. The detection rate of cHPV-DNA in patients with early invasive cervix cancer using even the most sensitive of currently available technologies lacks adequate sensitivity for clinical utility.
Collapse
Affiliation(s)
- Stacey J Bryan
- UCL Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London, Medical School Building, 74 Huntley Street, London WC1E 6AU, UK
| | - Jen Lee
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - Richard Gunu
- Translational Research Lab, Department of Women's Cancer, IfWH, Ground Floor POGB, 72 Huntley Street, London WC1E 6DD, UK
| | - Allison Jones
- Translational Research Lab, Department of Women's Cancer, IfWH, Ground Floor POGB, 72 Huntley Street, London WC1E 6DD, UK
| | - Adeola Olaitan
- UCL Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London, Medical School Building, 74 Huntley Street, London WC1E 6AU, UK
| | - Adam N Rosenthal
- UCL Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London, Medical School Building, 74 Huntley Street, London WC1E 6AU, UK
| | - Ros J Cutts
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - Isaac Garcia-Murillas
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - Nick Turner
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | | | - Shreerang A Bhide
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| |
Collapse
|
26
|
Ferrando-Díez A, Pavón MA, Cirauqui B, Alemany L, Mesía R. How to prevent human papillomavirus-related oropharyngeal cancer? Curr Opin Oncol 2023; 35:145-150. [PMID: 36966500 DOI: 10.1097/cco.0000000000000937] [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: 03/27/2023]
Abstract
PURPOSE OF REVIEW Human papillomavirus (HPV) is responsible of the increasing incidence rates of oropharyngeal squamous cell carcinoma (OPSCC) in high-income countries. This significant epidemiological change requires several and diverse prevention strategies. RECENT FINDINGS The cervical cancer prevention model is the paradigm of HPV-related cancer, and its success provides encouragement for the development of similar methods to prevent HPV-related OPSCC. However, there are some limitations that hinder its application in this disease. Here, we review the primary, secondary and tertiary prevention of HPV-related OPSCC and discuss some directions for future research. SUMMARY The development of new and targeted strategies to prevent HPV-related OPSCC is needed since they could definitely have a direct impact on the reduction of morbidity and mortality of this disease.
Collapse
Affiliation(s)
- Angelica Ferrando-Díez
- Medical Oncology Department, Catalan Institute of Oncology-Badalona (ICO), Applied Research Group in Oncology (B-ARGO), IGTP, 08916 Badalona
| | - Miguel Angel Pavón
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Beatriz Cirauqui
- Medical Oncology Department, Catalan Institute of Oncology-Badalona (ICO), Applied Research Group in Oncology (B-ARGO), IGTP, 08916 Badalona
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Ricard Mesía
- Medical Oncology Department, Catalan Institute of Oncology-Badalona (ICO), Applied Research Group in Oncology (B-ARGO), IGTP, 08916 Badalona
| |
Collapse
|
27
|
Mirghani H, Troux C, Leroy C, El Bedoui S, Aupérin A, Garic F, Bozec A, Schiappa R, Blanchard P, Gorphe P, Culié D. Post-therapeutic surveillance of HPV-driven oropharyngeal cancers: are we ready to change our practices? Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-07952-8. [PMID: 37010600 DOI: 10.1007/s00405-023-07952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Although HPV-positive and negative oropharyngeal cancers are two distinct diseases, Post-Therapeutic Surveillance (PTS) modalities are similar. Adjusting PTS strategies to HPV status will represent a massive practice change that raises the issue of its acceptability, by both physicians and patients. METHODS Two distinct surveys were designed and submitted, respectively, to HPV-positive patients and physicians (surgeons, radiation and medical oncologists) involved in head and neck cancer treatment. RESULTS 133 patients and 90 physicians have participated to the study. Most patients were reluctant to embrace new PTS options (remote consultations, nurse consultations and smart phone applications). However, 84% of patients would be favorable to use HPV Circulating DNA (HPV Ct DNA) measurement to guide surveillance modalities. 57% of physicians acknowledged that our current PTS strategy is improvable and most of them would accept the use of new monitoring options from the third year of follow-up. 87% of physicians would be interested to participate to a trial comparing the current PTS strategy to a new approach, where monitoring modalities (number of visits, imaging prescription) would depend on HPV Ct DNA level. CONCLUSIONS Patients and physicians are aware that PTS modalities should depend on HPV status. Their adhesion is a prerequisite to any potential changes. Strategies based on HPV Ct DNA measurement should be assessed within a randomized clinical trial.
Collapse
Affiliation(s)
- Haitham Mirghani
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Georges Pompidou European Hospital, Paris Cité University, 20 rue Leblanc, Paris, France.
| | - Camille Troux
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Georges Pompidou European Hospital, Paris Cité University, 20 rue Leblanc, Paris, France
| | - Charlotte Leroy
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Guy's Hospital, Great Maze Pond, London, England
| | - Sophie El Bedoui
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Centre Oscar Lambret, 3 Rue Frédéric Combemale, Lille, France
| | - Anne Aupérin
- Department of Epidemiology and Statistics, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif, France
| | - Florence Garic
- Unicancer, 67 avenue de Fonteainebleau 94270, Le Kremlin-Bicêtre, France
| | - Alexandre Bozec
- Department of Head and Neck Oncology, Antoine Lacassagne Cancer Campus, 33 avenue de Valombrose, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Cancer Campus, 33 avenue de Valombrose, Nice, France
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif, France
| | - Dorian Culié
- Department of Head and Neck Oncology, Antoine Lacassagne Cancer Campus, 33 avenue de Valombrose, Nice, France
| |
Collapse
|
28
|
Mittelstadt S, Kelemen O, Admard J, Gschwind A, Koch A, Wörz S, Oberlechner E, Engler T, Bonzheim I, Staebler A, Weidner N, Stubenrauch F, Iftner T, Riess O, Schroeder C, Kommoss S, Ossowski S. Detection of circulating cell-free HPV DNA of 13 HPV types for patients with cervical cancer as potential biomarker to monitor therapy response and to detect relapse. Br J Cancer 2023; 128:2097-2103. [PMID: 36973448 DOI: 10.1038/s41416-023-02233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND HPV-related cervical cancer (CC) is the fourth most frequent cancer in women worldwide. Cell-free tumour DNA is a potent biomarker to detect treatment response, residual disease, and relapse. We investigated the potential use of cell-free circulating HPV-DNA (cfHPV-DNA) in plasma of patients with CC. METHODS cfHPV-DNA levels were measured using a highly sensitive next-generation sequencing-based approach targeting a panel of 13 high-risk HPV types. RESULTS Sequencing was performed in 69 blood samples collected from 35 patients, of which 26 were treatment-naive when the first liquid biopsy sample was retrieved. cfHPV-DNA was successfully detected in 22/26 (85%) cases. A significant correlation between tumour burden and cfHPV-DNA levels was observed: cfHPV-DNA was detectable in all treatment-naive patients with advanced-stage disease (17/17, FIGO IB3-IVB) and in 5/9 patients with early-stage disease (FIGO IA-IB2). Sequential samples revealed a decrease of cfHPV-DNA levels in 7 patients corresponding treatment response and an increase in a patient with relapse. CONCLUSIONS In this proof-of-concept study we demonstrated the potential of cfHPV-DNA as a biomarker for therapy monitoring in patients with primary and recurrent CC. Our findings facilitate the development of a sensitive and precise, non-invasive, inexpensive, and easily accessible tool in CC diagnosis, therapy monitoring and follow-up.
Collapse
Affiliation(s)
- Suzana Mittelstadt
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.
| | - Olga Kelemen
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Jakob Admard
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- NGS Competence Center Tübingen (NCCT), University of Tübingen, Tübingen, Germany
| | - Axel Gschwind
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - André Koch
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Sarah Wörz
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Ernst Oberlechner
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Engler
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Irina Bonzheim
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Annette Staebler
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Nicola Weidner
- Department of Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | - Frank Stubenrauch
- Institute for Medical Virology and Epidemiology of Viral Disease, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Iftner
- Institute for Medical Virology and Epidemiology of Viral Disease, University Hospital Tübingen, Tübingen, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Christopher Schroeder
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Kommoss
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Ossowski
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- NGS Competence Center Tübingen (NCCT), University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Bioinformatics and Medical Informatics (IBMI), University of Tübingen, Tübingen, Germany
| |
Collapse
|
29
|
Dowthwaite S, Jackson J, Dzienis M, Khoo E, Cronin M, Guazzo E. Management of Recurrent HPV-Positive Oropharyngeal Squamous Cell Carcinoma: a Contemporary Review. Curr Oncol Rep 2023; 25:501-510. [PMID: 36881215 DOI: 10.1007/s11912-023-01386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE OF REVIEW To review the impact of contemporary treatment strategies on salvage outcomes in patients with recurrent human papilloma virus-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). RECENT FINDINGS Secondary to HPV, changes in disease biology have impacted primary treatments and subsequent approaches to patients with recurrence. With treatment strategies more inclusive of upfront surgery, the characteristics of patients with recurrence HPV + OPSCC have been further redefined. Less invasive endoscopic surgical approaches such as transoral robotic surgery (TORS), and the continued refinement of conformal radiotherapy techniques, have improved treatment options for patients with recurrent HPV + OPSCC. Systemic treatment options have continued to expand including potentially effective immune-based therapies. Effective surveillance with systemic and oral biomarkers offers hope of earlier detection of recurrence. Management of patients with recurrent OPSCC remains difficult. Modest improvements in salvage treatment have been observed within the HPV + OPSCC cohort largely reflecting disease biology and improved treatment techniques.
Collapse
Affiliation(s)
- Sam Dowthwaite
- Gold Coast University Hospital, Department of Otolaryngology/Head and Neck Surgery, Suite 2B, Ground Floor, AHC House, 14 Carrara St Benowa, Benowa, QLD, 4217, Australia.
| | - James Jackson
- Gold Coast University Hospital, Department of Radiation Oncology, Benowa, Australia.,Icon Cancer Centre, Benowa, Australia
| | - Marcin Dzienis
- Gold Coast University Hospital, Department of Medical Oncology, Benowa, Australia
| | - Eric Khoo
- Gold Coast University Hospital, Department of Radiation Oncology, Benowa, Australia.,Icon Cancer Centre, Benowa, Australia
| | - Mathew Cronin
- Gold Coast University Hospital, Department of Otolaryngology/Head and Neck Surgery, Suite 2B, Ground Floor, AHC House, 14 Carrara St Benowa, Benowa, QLD, 4217, Australia
| | - Emily Guazzo
- Gold Coast University Hospital, Department of Otolaryngology/Head and Neck Surgery, Suite 2B, Ground Floor, AHC House, 14 Carrara St Benowa, Benowa, QLD, 4217, Australia
| |
Collapse
|
30
|
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: 7] [Impact Index Per Article: 7.0] [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.
Collapse
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.
| |
Collapse
|
31
|
Lalondrelle S, Lee J, Cutts RJ, Garcia Murillas I, Matthews N, Turner N, Harrington K, Vroobel K, Moretti E, Bhide SA. Predicting Response to Radical Chemoradiotherapy with Circulating HPV DNA (cHPV-DNA) in Locally Advanced Uterine Cervix Cancer. Cancers (Basel) 2023; 15:1387. [PMID: 36900180 PMCID: PMC10000151 DOI: 10.3390/cancers15051387] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The majority of locally advanced cervical cancers (LaCC) are causally related to HPV. We sought to investigate the utility of an ultra-sensitive HPV-DNA next generation sequencing (NGS) assay-panHPV-detect-in LaCC treated with chemoradiotherapy, as a marker of treatment response and persistent disease. METHOD Serial blood samples were collected from 22 patients with LaCC before, during and after chemoradiation. The presence of circulating HPV-DNA was correlated with clinical and radiological outcomes. RESULTS The panHPV-detect test demonstrated a sensitivity and specificity of 88% (95% CI-70-99%) and 100% (95% CI-30-100%), respectively, and correctly identified the HPV-subtype (16, 18, 45, 58). After a median follow up of 16 months, and three relapses all had detectable cHPV-DNA at 3 months post-CRT despite complete response on imaging. Another four patients with radiological partial or equivocal response and undetectable cHPV-DNA at the 3-month time point did not go on to develop relapse. All patients with radiological CR and undetectable cHPV-DNA at 3-months remained disease free. CONCLUSIONS These results demonstrate that the panHPV-detect test shows high sensitivity and specificity for detecting cHPV-DNA in plasma. The test has potential applications in assessment of the response to CRT and in monitoring for relapse, and these initial findings warrant validation in a larger cohort.
Collapse
Affiliation(s)
- Susan Lalondrelle
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- The Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
| | - Jen Lee
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
| | | | | | - Nik Matthews
- Imperial College London, South Kengsington Campus, SW7 2AZ, UK
| | - Nicholas Turner
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- The Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
| | - Kevin Harrington
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- The Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
| | - Katherine Vroobel
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- The Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
| | - Emily Moretti
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- The Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
| | - Shreerang A. Bhide
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- The Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
| |
Collapse
|
32
|
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: 12] [Impact Index Per Article: 12.0] [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.
Collapse
|
33
|
Practical Application of Circulating Tumor-Related DNA of Human Papillomavirus in Liquid Biopsy to Evaluate the Molecular Response in Patients with Oropharyngeal Cancer. Cancers (Basel) 2023; 15:cancers15041047. [PMID: 36831390 PMCID: PMC9953792 DOI: 10.3390/cancers15041047] [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: 01/09/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Recent findings have shown that human papillomavirus (HPV) DNA is present in the blood as a tumor-specific biomarker (circulating tumor-related HPV; ctHPV) in patients with HPV-related oropharyngeal cancer (HPV-related OPC). The molecular response (MR) in patients with HPV-related OPC can be defined as the change in the number of ctHPV copies in relation to its initial quantity. The optimal model for assessing the MR using a liquid biopsy (LB) should be based on the E6/E7 sequences of the viral genome. MR assessment can help to evaluate the intensity of ongoing treatments in relation to the tumor response. The evaluation of the residual disease at the end of therapy may also be performed by MR assessment. If a partial MR (pMR) is found, caution is indicated and a subsequent LB should be considered, due to the likelihood of disease progression. Complete radiological and clinical responses together with a complete MR (cMR) convincingly indicate a low risk of treatment failure. Moreover, molecular recurrence (Mrec) during a follow-up, confirmed in two consecutive assays, even despite the lack of any other clinical or radiological symptoms of progression, indicates patients at high risk of disease recurrence. In conclusion, MR by ctHPV assessment may hasten the early detection of disease progression, at any stage of the management of the patient with HPV-related OPC.
Collapse
|
34
|
Tanaka H, Uno A, Takenaka Y, Suzuki M, Seo Y, Takemoto N, Fukusumi T, Eguchi H, Kanai H, Horie M, Isohashi F, Ogawa K, Yachida S, Inohara H. Clearance Profile of Circulating Tumor Human Papillomavirus DNA During Radiotherapy Predicts Clinical Outcomes in Human Papillomavirus-Related Oropharyngeal Cancer. JCO Precis Oncol 2023; 7:e2200494. [PMID: 36787504 DOI: 10.1200/po.22.00494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
PURPOSE This study aimed to examine whether circulating tumor human papillomavirus type 16 (HPV16) DNA (ctHPV16DNA) can help identify patients with locally advanced HPV16-related oropharyngeal squamous cell carcinoma who may benefit from deintensified treatment. MATERIALS AND METHODS We serially collected blood samples before, during, and after treatment from 22 patients who received 70 Gy radiotherapy alone and longitudinally quantified ctHPV16DNA using droplet digital polymerase chain reaction. We correlated the clearance profile of ctHPV16DNA with clinical outcomes. RESULTS The percentage of patients with detectable ctHPV16DNA decreased after every 10 Gy of radiotherapy. By contrast, the percentage of patients who later developed treatment failure among patients with detectable ctHPV16DNA gradually increased as radiotherapy proceeded, reaching 100% after 60 Gy of radiotherapy. We defined patients with and without detectable ctHPV16DNA after receiving 40 Gy as having slow and rapid clearance profiles, respectively. All 12 patients with a rapid clearance profile remained disease-free after radiotherapy. Of the 10 patients with a slow clearance profile, three had persistent or progressive disease at response evaluation after radiotherapy and one developed distant metastasis during follow-up (ie, four patients experienced treatment failure). The median follow-up for surviving patients was 38.6 months, and the 3-year failure-free survival rates of patients with rapid and slow clearance profiles were 100% and 58%, respectively (P = .02). Neither baseline ctHPV16DNA levels nor metabolic tumor volume was an independent predictor of the pattern of the clearance profile. CONCLUSION In patients with HPV16-related oropharyngeal squamous cell carcinoma receiving radiotherapy, a slow ctHPV16DNA clearance profile could prelude unfavorable outcomes. Monitoring ctHPV16DNA is essential for determining the clearance profile, which might help optimize treatment intensity individually.
Collapse
Affiliation(s)
- Hidenori Tanaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Cancer Genome Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motoyuki Suzuki
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuji Seo
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Norihiko Takemoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takahito Fukusumi
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hirotaka Eguchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Haruka Kanai
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Cancer Genome Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masafumi Horie
- Department of Cancer Genome Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shinichi Yachida
- Department of Cancer Genome Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Osaka, Japan.,Division of Genomic Medicine, National Cancer Center Institute, Tokyo, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| |
Collapse
|
35
|
Fluid Biomarkers in HPV and Non-HPV Related Oropharyngeal Carcinomas: From Diagnosis and Monitoring to Prognostication-A Systematic Review. Int J Mol Sci 2022; 23:ijms232214336. [PMID: 36430813 PMCID: PMC9696529 DOI: 10.3390/ijms232214336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Biomarkers are crucial in oncology, from detection and monitoring to guiding management and predicting treatment outcomes. Histological assessment of tissue biopsies is currently the gold standard for oropharyngeal cancers, but is technically demanding, invasive, and expensive. This systematic review aims to review current markers that are detectable in biofluids, which offer promising non-invasive alternatives in oropharyngeal carcinomas (OPCs). A total of 174 clinical trials from the PubMed search engine in the last 5 years were identified and screened by 4 independent reviewers. From these, 38 eligible clinical trials were found and subsequently reviewed. The biomarkers involved, categorized by human papillomavirus (HPV)-status, were further divided according to molecular and cellular levels. Recent trials investigating biomarkers for both HPV-positive and HPV-negative OPCs have approaches from various levels and different biofluids including plasma, oropharyngeal swabs, and oral rinse. Promising candidates have been found to aid in detection, staging, and predicting prognosis, in addition to well-established factors including HPV-status, drinking and smoking status. These studies also emphasize the possibility of enhancing prediction results and increasing statistical significance by multivariate analyses. Liquid biopsies offer promising assistance in enhancing personalized medicine for cancer treatment, from lowering barriers towards early screening, to facilitating de-escalation of treatment. However, further research is needed, and the combination of liquid biopsies with pre-existing methods, including in vivo imaging and invasive techniques such as neck dissections, could also be explored in future trials.
Collapse
|
36
|
Berger BM, Hanna GJ, Posner MR, Genden EM, Lautersztain J, Naber SP, Del Vecchio Fitz C, Kuperwasser C. Detection of Occult Recurrence Using Circulating Tumor Tissue Modified Viral HPV DNA among Patients Treated for HPV-Driven Oropharyngeal Carcinoma. Clin Cancer Res 2022; 28:4292-4301. [PMID: 35576437 PMCID: PMC9527497 DOI: 10.1158/1078-0432.ccr-22-0562] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/24/2022] [Accepted: 05/11/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Despite generally favorable outcomes, 15% to 25% of patients with human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) will have recurrence. Current posttreatment surveillance practices rely on physical examinations and imaging and are inconsistently applied. We assessed circulating tumor tissue modified viral (TTMV)-HPV DNA obtained during routine posttreatment surveillance among a large population of real-world patients. EXPERIMENTAL DESIGN This retrospective clinical case series included 1,076 consecutive patients across 108 U.S. sites who were ≥ 3 months posttreatment for HPV-driven OPSCC and who had one or more TTMV-HPV DNA tests (NavDx, Naveris Laboratories) obtained during surveillance between February 6, 2020, and June 29, 2021. Test results were compared with subsequent clinical evaluations. RESULTS Circulating TTMV-HPV DNA was positive in 80 of 1,076 (7.4%) patients, with follow-up available on all. At first positive surveillance testing, 21 of 80 (26%) patients had known recurrence while 59 of 80 (74%) patients were not known to have recurrent disease. Among these 59 patients, 55 (93%) subsequently had a confirmed recurrence, 2 patients had clinically suspicious lesions, and 2 had clinically "no evidence of disease" (NED) at last follow-up. To date, the overall positive predictive value of TTMV-HPV DNA testing for recurrent disease is 95% (N = 76/80). In addition, the point-in-time negative predictive value is 95% (N = 1,198/1,256). CONCLUSIONS These findings highlight the clinical potential for circulating TTMV-HPV DNA testing in routine practice. As a surveillance tool, TTMV-HPV DNA positivity was the first indication of recurrence in the majority of cases, pre-dating identification by routine clinical and imaging exams. These data may inform future clinical and guideline-endorsed strategies for HPV-driven malignancy surveillance. See related commentary by Colevas, p. 4171.
Collapse
Affiliation(s)
| | - Glenn J. Hanna
- Center for Salivary and Rare Head and Neck Cancers, Head and Neck Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Marshall R. Posner
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Hematology/Oncology, 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.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Catherine Del Vecchio Fitz
- Naveris, Inc., Natick, Massachusetts.,Corresponding Author: Catherine Del Vecchio Fitz, Naveris, Inc., 22 Strathmore Road, Natick, MA 01760. 833-628-3747; E-mail:
| | | |
Collapse
|
37
|
Bhide S. Circulating Human Papillomavirus DNA as a Marker of Minimally Residual Disease After Surgery for Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2022; 113:539-541. [PMID: 35777398 DOI: 10.1016/j.ijrobp.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Shreerang Bhide
- Institute of Cancer Research and Royal Marsden Hospital, London, United Kingdom.
| |
Collapse
|
38
|
Aulakh SS, Silverman DA, Young K, Dennis SK, Birkeland AC. The Promise of Circulating Tumor DNA in Head and Neck Cancer. Cancers (Basel) 2022; 14:cancers14122968. [PMID: 35740633 PMCID: PMC9221491 DOI: 10.3390/cancers14122968] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 12/17/2022] Open
Abstract
As the seventh most common cancer globally, head and neck cancers (HNC) exert considerable disease burden, with an estimated 277,597 deaths worldwide in 2020 alone. Traditional risk factors for HNC include tobacco, alcohol, and betel nut; more recently, human papillomavirus has emerged as a distinct driver of disease. Currently, limitations of cancer screening and surveillance methods often lead to identifying HNC in more advanced stages, with associated poor outcomes. Liquid biopsies, in particular circulating tumor DNA (ctDNA), offer the potential for enhancing screening, early diagnosis, and surveillance in HNC patients, with potential improvements in HNC patient outcomes. In this review, we examine current methodologies for detecting ctDNA and highlight current research illustrating viral and non-viral ctDNA biomarker utilities in HNC screening, diagnosis, treatment response, and prognosis. We also summarize current challenges and future directions for ctDNA testing in HNC patients.
Collapse
Affiliation(s)
| | - Dustin A. Silverman
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, CA 95817, USA; (D.A.S.); (S.K.D.)
| | - Kurtis Young
- John A. Burns School of Medicine, Honolulu, HI 96813, USA;
| | - Steven K. Dennis
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, CA 95817, USA; (D.A.S.); (S.K.D.)
| | - Andrew C. Birkeland
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, CA 95817, USA; (D.A.S.); (S.K.D.)
- Correspondence:
| |
Collapse
|
39
|
Warlow SJ, Adamowicz M, Thomson JP, Wescott RA, Robert C, Carey LM, Thain H, Cuschieri K, Li LQ, Conn B, Hay A, Nixon IJ, Aitman TJ. Longitudinal measurement of HPV copy number in cell-free DNA is associated with patient outcomes in HPV-positive oropharyngeal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1224-1234. [PMID: 35431082 DOI: 10.1016/j.ejso.2022.03.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/04/2022] [Accepted: 03/30/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Oropharyngeal squamous cell carcinoma (OPSCC) is increasing in global prevalence and is divided into two types dependent on association with human papillomavirus (HPV). Assay of HPV copy number in plasma cell-free DNA (cfDNA) provides a minimally invasive method for detecting and monitoring tumour-derived HPV, with potential for enhancing clinical care. MATERIALS AND METHODS In a prospectively recruited cohort of 104 OPSCC patients, we evaluate the utility of cfDNA droplet digital PCR (ddPCR) as a method for characterisation and longitudinal monitoring of patients with OPSCC. RESULTS ddPCR assay of pre-treatment plasma cfDNA for five HPV types showed overall 95% concordance with p16 immunohistochemistry and PCR analysis of tumour tissue. Longitudinal sampling in 48 HPV+ve patients, with median follow-up of 20 months, was strongly associated with patient outcomes. Persistently elevated cfDNA-HPV post-treatment was associated with treatment failure (2/2 patients) and an increase of cfDNA-HPV in patients whose HPV levels were initially undetectable post-treatment was associated with disease recurrence (5/6 patients). No recurrence was observed in patients in whom cfDNA-HPV was undetectable in all post-treatment samples. In two patients, sequential HPV measurement could have avoided surgical intervention which did not confirm recurrence. CONCLUSION The high concordance of pre-treatment plasma cfDNA-HPV analysis with tissue-based assays, together with the clinical associations of sequentially measured post-treatment cfDNA-HPV copy number add to a growing body of evidence that suggest utility of cfDNA-HPV ddPCR in management of OPSCC. Standardised clinical trials based on these data are now needed to assess the impact of such testing on overall patient outcomes.
Collapse
Affiliation(s)
- Sophie J Warlow
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Martyna Adamowicz
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - John P Thomson
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Robert A Wescott
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK; NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Christelle Robert
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Lara M Carey
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Helen Thain
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK; NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, NHS Lothian, EH16 4SA, UK
| | - Lucy Q Li
- NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Brendan Conn
- NHS Lothian, Department of Pathology, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Ashley Hay
- NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Iain J Nixon
- NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK; Department of Otolaryngology, University of Edinburgh, Lauriston Place, Edinburgh, EH3 9HX, UK.
| | - Timothy J Aitman
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK; NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK.
| |
Collapse
|
40
|
Wang Y, Li Y, Liang X, Xin S, Yang L, Cao P, Jiang M, Xin Y, Zhang S, Yang Y, Lu J. The implications of cell-free DNAs derived from tumor viruses as biomarkers of associated cancers. J Med Virol 2022; 94:4677-4688. [PMID: 35652186 DOI: 10.1002/jmv.27903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Abstract
Cancer is still ranked as a leading cause of death according to estimates from the World Health Organization (WHO) and the strong link between tumor viruses and human cancers have been proved for almost six decades. Cell-free DNA (cfDNA) has drawn enormous attention for its dynamic, instant, and noninvasive advantages as one popular type of cancer biomarker. cfDNAs are mainly released from apoptotic cells and exosomes released from cancer cells, including those infected with viruses. Although cfDNAs are present at low concentrations in peripheral blood, they can reflect tumor load with high sensitivity. Considering the relevance of the tumor viruses to the associated cancers, cfDNAs derived from viruses may serve as good biomarkers for the early screening, diagnosis, and treatment monitoring. In this review, we summarize the methods and newly developed analytic techniques for the detection of cfDNAs from different body fluids, and discuss the implications of cfDNAs derived from different tumor viruses in the detection and treatment monitoring of virus-associated cancers. A better understanding of cfDNAs derived from tumor viruses may help formulate novel anti-tumoral strategies to decrease the burden of cancers that attributed to viruses. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Yiwei Wang
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China.,NHC Key Laboratory of Carcinogenesis, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410078, Hunan, China.,Department of Hematology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410080, Hunan, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, 410013, Hunan, China
| | - Yanling Li
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China.,NHC Key Laboratory of Carcinogenesis, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410078, Hunan, China.,Department of Hematology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410080, Hunan, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, 410013, Hunan, China
| | - Xinyu Liang
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China
| | - Shuyu Xin
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China.,NHC Key Laboratory of Carcinogenesis, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410078, Hunan, China.,Department of Hematology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410080, Hunan, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, 410013, Hunan, China
| | - Li Yang
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China.,NHC Key Laboratory of Carcinogenesis, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410078, Hunan, China.,Department of Hematology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410080, Hunan, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, 410013, Hunan, China
| | - Pengfei Cao
- Department of Hematology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410080, Hunan, China
| | - Mingjuan Jiang
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China.,NHC Key Laboratory of Carcinogenesis, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410078, Hunan, China.,Department of Hematology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410080, Hunan, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, 410013, Hunan, China
| | - Yujie Xin
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China.,NHC Key Laboratory of Carcinogenesis, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410078, Hunan, China.,Department of Hematology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410080, Hunan, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, 410013, Hunan, China
| | - Senmiao Zhang
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China.,NHC Key Laboratory of Carcinogenesis, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410078, Hunan, China.,Department of Hematology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410080, Hunan, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, 410013, Hunan, China
| | - Yang Yang
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China.,NHC Key Laboratory of Carcinogenesis, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410078, Hunan, China.,Department of Hematology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410080, Hunan, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, 410013, Hunan, China
| | - Jianhong Lu
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China.,NHC Key Laboratory of Carcinogenesis, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410078, Hunan, China.,Department of Hematology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410080, Hunan, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, 410013, Hunan, China
| |
Collapse
|
41
|
Zhou S, Chan C, Rulach R, Dyab H, Hendry F, Maxfield C, Dempsey MF, James A, Grose D, Lamb C, Schipani S, Wilson C, Cheng Lau Y, Paterson C. Long term survival in patients with human papillomavirus-positive oropharyngeal cancer and equivocal response on 12-week PET-CT is not compromised by the omission of neck dissection. Oral Oncol 2022; 128:105870. [DOI: 10.1016/j.oraloncology.2022.105870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 12/14/2022]
|
42
|
Galati L, Combes JD, Le Calvez-Kelm F, McKay-Chopin S, Forey N, Ratel M, McKay J, Waterboer T, Schroeder L, Clifford G, Tommasino M, Gheit T. Detection of Circulating HPV16 DNA as a Biomarker for Cervical Cancer by a Bead-Based HPV Genotyping Assay. Microbiol Spectr 2022; 10:e0148021. [PMID: 35225653 PMCID: PMC9045285 DOI: 10.1128/spectrum.01480-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
Human papillomavirus (HPV) circulating tumor DNA (HPV ctDNA) was proposed as a biomarker for the detection and disease monitoring of HPV-related cancers. One hundred eighty plasma samples obtained from women diagnosed with HPV16-positive cervical cancer (CC) (n = 100), HPV16-positive premalignant lesions (cervical intraepithelial neoplasia grade 3 [CIN3]) (n = 20), and HPV DNA-negative controls (n = 60) were randomly selected from the archives for evaluating the performance of a bead-based HPV genotyping assay (E7 type-specific multiplex genotyping assay [E7-MPG]) in detecting HPV16 ctDNA. The performance of the E7-MPG was compared with those of DNA detection by droplet digital PCR (ddPCR) and detection of HPV16 E6 antibodies evaluated in an independent study. Internal controls to assess DNA quality were included in the molecular assays, i.e., beta-globin and ESR1, respectively. The sensitivity and specificity of E7-MPG and/or E6 antibodies to detect HPV16-positive CCs were evaluated. HPV16 ctDNA was detected using the E7-MPG in 42.3% of all plasma samples and in 74.7% of plasma samples from HPV16-positive CC cases. The validation of E7-MPG data by ddPCR showed that the sensitivity of the E7-MPG test for HPV16-positive CC detection was higher than that of ddPCR (74.7% versus 63.1%; P < 0.001). When both HPV16 ctDNA and E6 antibodies were considered, the sensitivity for HPV16-positive CC detection increased from 74.7% to 86.1%, while the specificity was unchanged at 97.8%. The performance of E7-MPG for the detection of HPV16 ctDNA appears to be at least as sensitive as that of ddPCR, offering an additional tool for ctDNA detection of HPV16-positive CC. The use of an additional blood marker of HPV infection, such as E6 antibodies, further improved the detection of CC. IMPORTANCE The validity of HPV ctDNA as a marker of HPV-driven cancers has been previously reported. Herein we validated an alternative to ddPCR for HPV16 ctDNA detection, using a bead-based HPV genotyping assay that offers the potential advantage of reducing the cost of clinical management due to the multiplex capability of the test, thus facilitating its use in clinical settings. In addition, we analyzed HPV ctDNA in the context of E6 antibodies as an additional HPV marker. The HPV16 ctDNA biomarker appeared to be highly specific and, to a lesser extent, sensitive for the detection of CC, mainly indicated for those at an advanced tumor stage. In this proof-of-principle study, E6 antibodies were mainly detected in early tumor stages of CC, while HPV ctDNA was mainly positive at advanced tumor stages.
Collapse
Affiliation(s)
- Luisa Galati
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Nathalie Forey
- International Agency for Research on Cancer, Lyon, France
| | - Mathis Ratel
- International Agency for Research on Cancer, Lyon, France
| | - James McKay
- International Agency for Research on Cancer, Lyon, France
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lea Schroeder
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gary Clifford
- International Agency for Research on Cancer, Lyon, France
| | | | - Tarik Gheit
- International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
43
|
Haring CT, Dermody SM, Yalamanchi P, Kang SY, Old MO, Chad Brenner J, Spector ME, Rocco JW. The future of circulating tumor DNA as a biomarker in HPV related oropharyngeal squamous cell carcinoma. Oral Oncol 2022; 126:105776. [DOI: 10.1016/j.oraloncology.2022.105776] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/02/2022] [Accepted: 02/13/2022] [Indexed: 12/30/2022]
|
44
|
PET/Computed Tomography. PET Clin 2022; 17:319-326. [DOI: 10.1016/j.cpet.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
45
|
Pilar A, O’Sullivan B, Huang SH. Risk Stratification of HPV-Associated Oropharyngeal Squamous Cell Carcinoma: Are All Tumors Created Equally? CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
46
|
Biomarker-Based Evaluation of Treatment Response and Surveillance of HPV-Associated Squamous Cell Carcinoma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00386-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
47
|
Siravegna G, O'Boyle CJ, Varmeh S, Queenan N, Michel A, Stein J, Thierauf J, Sadow PM, Faquin WC, Perry SK, Bard AZ, Wang W, Deschler DG, Emerick KS, Varvares MA, Park JC, Clark JR, Chan AW, Andreu Arasa VC, Sakai O, Lennerz J, Corcoran RB, Wirth LJ, Lin DT, Iafrate AJ, Richmon JD, Faden DL. Cell free HPV DNA provides an accurate and rapid diagnosis of HPV-associated head and neck cancer. Clin Cancer Res 2021; 28:719-727. [PMID: 34857594 DOI: 10.1158/1078-0432.ccr-21-3151] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE HPV-associated Head and Neck Squamous Cell Carcinoma(HPV+HNSCC) is the most common HPV-associated malignancy in the United States and continues to increase in incidence. Current diagnostic approaches for HPV+HNSCC rely on tissue biopsy followed by histomorphologic assessment and detection of HPV indirectly by p16 immunohistochemistry. Such approaches are invasive and have variable sensitivity. EXPERIMENTAL DESIGN We conducted a prospective observational study in 140 subjects (70 cases and 70 controls) to test the hypothesis that a non-invasive diagnostic approach for HPV+HNSCC would have improved diagnostic accuracy, lower cost, and shorter Diagnostic Interval compared to standard approaches. Blood was collected, processed for circulating tumor HPV DNA(ctHPVDNA) and analyzed with custom ddPCR assays for HPV genotypes 16,18, 33, 35 and 45. Diagnostic performance, cost and Diagnostic Interval were calculated for standard clinical work up and compared to a non-invasive approach using ctHPVDNA combined with cross-sectional imaging and physical exam findings. RESULTS Sensitivity and specificity of ctHPVDNA for detecting HPV+HNSCC was 98.4% and 98.6%. Sensitivity and specificity of a composite non-invasive diagnostic using ctHPVDNA and imaging/physical exam were 95.1% and 98.6%. Diagnostic accuracy of this non-invasive approach was significantly higher than standard of care (Youden index 0.937 vs 0.707, p=0.0006). Costs of non-invasive diagnostic were 36-38% less than standard clinical work up and the median Diagnostic Interval was 26 days less. CONCLUSIONS A non-invasive diagnostic approach for HPV+HNSCC demonstrated improved accuracy, reduced cost and a shorter time to diagnosis compared to standard clinical workup and could be a viable alternative in the future.
Collapse
Affiliation(s)
| | - Connor J O'Boyle
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear
| | | | - Natalia Queenan
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear
| | | | - Jarrod Stein
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear, Massachusetts General Hospital, Harvard Medical School, Broad Institute
| | - Julia Thierauf
- Department of Otolaryngology, Head and Neck Surgery, 1985
| | | | | | - Simon K Perry
- Department of Pathology, Massachusetts General Hospital
| | - Adam Z Bard
- Department of Pathology, Massachusetts General Hospital
| | - Wei Wang
- 6. Departments of Medicine and Neurology, Brigham and Women's Hospital
| | - Daniel G Deschler
- Otology and Laryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School
| | - Kevin S Emerick
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear, Massachusetts General Hospital, Harvard Medical School, Broad Institute
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary,, Harvard Medical School
| | - Jong C Park
- Hematology and Oncology, Massachusetts General Hospital
| | - John R Clark
- Hematology and Oncology, Massachusetts General Hospital/Harvard Medical School
| | - Annie W Chan
- Radiation Oncology, Massachusetts General Hospital
| | | | - Osamu Sakai
- Department or Radiology, Boston Medical Center
| | | | | | - Lori J Wirth
- Department of Medicine, Massachusetts General Hospital
| | | | | | - Jeremy D Richmon
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear, Massachusetts General Hospital, Harvard Medical School, Broad Institute
| | - Daniel L Faden
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear, Massachusetts General Hospital, Harvard Medical School, Broad Institute
| |
Collapse
|
48
|
Jeannot E, Latouche A, Bonneau C, Calméjane MA, Beaufort C, Ruigrok-Ritstier K, Bataillon G, Larbi Chérif L, Dupain C, Lecerf C, Popovic M, de la Rochefordière A, Lecuru F, Fourchotte V, Jordanova ES, von der Leyen H, Tran-Perennou C, Legrier ME, Dureau S, Raizonville L, Bello Roufai D, Le Tourneau C, Bièche I, Rouzier R, Berns EM, Kamal M, Scholl S. Circulating HPV DNA as a Marker for Early Detection of Relapse in Patients with Cervical Cancer. Clin Cancer Res 2021; 27:5869-5877. [PMID: 34210686 PMCID: PMC9401545 DOI: 10.1158/1078-0432.ccr-21-0625] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/22/2021] [Accepted: 06/28/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Almost all cervical cancers are caused by human papillomavirus (HPV) and patients with advanced stage are at high risk for relapse. Circulating HPV DNA (HPV ctDNA) may serve as a residual tumor marker at the end of chemoradiation or to predict relapse during the follow-up period. EXPERIMENTAL DESIGN We analyzed serum samples from 94 HPV16- or HPV18-related CCs from the BioRAIDs prospective cohort. Samples were collected before and after treatment and during an 18-month follow-up period. Using digital droplet PCR (ddPCR), we assessed the relevance of circulating HPV E7 gene as a marker for residual disease compared to HPV integration site and PIK3CA mutations. Finally, the prognostic impact of circulating HPV E7 gene was assessed with its prediction value of relapse. RESULTS HPV E7 gene was the most sensitive tumor marker, superior to both HPV integration sites and PIK3CA mutations in serum. Circulating HPV DNA (HPV ctDNA) was detected in 63% (59/94) of patients, before treatment. HPV ctDNA detection in serum sample was associated with high FIGO stage (P = 0.02) and para-aortic lymph node involvement (P = 0.01). The level of HPV ctDNA was positively correlated with HPV copy number in the tumor (R = 0.39, P < 0.001). Complete clearance of HPV ctDNA by the end of treatment was significantly associated with a longer PFS (P < 0.0001). Patients with persistent HPV ctDNA in serum relapsed with a median time of 10 months (range, 2-15) from HPV ctDNA detection. CONCLUSIONS HPV ctDNA detection is a useful marker to predict relapse in cervical cancer.See related commentary by Wentzensen and Clarke, p. 5733.
Collapse
Affiliation(s)
- Emmanuelle Jeannot
- Department of Pathology, Institut Curie, Paris and Saint Cloud, France.,Department of Genetics, Institut Curie, Paris and Saint Cloud, France
| | - Aurélien Latouche
- INSERM U900, Institut Curie, Saint-Cloud, France.,Conservatoire National des Arts et Métiers, Paris, France
| | - Claire Bonneau
- INSERM U900, Institut Curie, Saint-Cloud, France.,Department of Surgery, Institut Curie, PSL Research University, PSL Research University, Paris and Saint-Cloud, France
| | | | - Corine Beaufort
- Department Medical Oncology, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Linda Larbi Chérif
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, France
| | - Célia Dupain
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, France
| | - Charlotte Lecerf
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, France
| | - Marina Popovic
- Oncology Institute of Vojvodina, Put doktora Goldmana, Sremska Kamenica, Serbia
| | | | - Fabrice Lecuru
- Department of Surgery, Institut Curie, PSL Research University, PSL Research University, Paris and Saint-Cloud, France
| | - Virginie Fourchotte
- Department of Surgery, Institut Curie, PSL Research University, PSL Research University, Paris and Saint-Cloud, France
| | - Ekaterina S. Jordanova
- Department of Obstetrics and Gynecology, Center for Gynaecologic Oncology Amsterdam, location Vumc, Amsterdam UMC and The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | | | | | - Marie-Emmanuelle Legrier
- DREH, Institut Curie, Paris and Saint Cloud, France,Corresponding Author: Emmanuelle Jeannot, Department of Pathology, Institut Curie, 26 rue d'Ulm, Paris, 75248 Cedex 05, France. Phone: 331-5624-5992; Fax: 331-5310-4010; E-mail:
| | | | | | - Diana Bello Roufai
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, France
| | - Christophe Le Tourneau
- INSERM U900, Institut Curie, Saint-Cloud, France.,Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, France.,Paris-Saclay University, Paris, France
| | - Ivan Bièche
- Department of Genetics, Institut Curie, Paris and Saint Cloud, France
| | - Roman Rouzier
- INSERM U900, Institut Curie, Saint-Cloud, France.,Department of Surgery, Institut Curie, PSL Research University, PSL Research University, Paris and Saint-Cloud, France
| | - Els M.J.J. Berns
- Department Medical Oncology, Erasmus MC, Rotterdam, the Netherlands
| | - Maud Kamal
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, France
| | - Suzy Scholl
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, France
| |
Collapse
|
49
|
Sastre-Garau X, Diop M, Martin F, Dolivet G, Marchal F, Charra-Brunaud C, Peiffert D, Leufflen L, Dembélé B, Demange J, Tosti P, Thomas J, Leroux A, Merlin JL, Diop-Ndiaye H, Costa JM, Salleron J, Harlé A. A NGS-based Blood Test For the Diagnosis of Invasive HPV-associated Carcinomas with Extensive Viral Genomic Characterization. Clin Cancer Res 2021; 27:5307-5316. [PMID: 34108183 PMCID: PMC9401522 DOI: 10.1158/1078-0432.ccr-21-0293] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/29/2021] [Accepted: 06/04/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Use of circulating tumor DNA (ctDNA) for diagnosis is limited regarding the low number of target molecules in early-stage tumors. Human papillomavirus (HPV)-associated carcinomas represent a privileged model using circulating viral DNA (ctHPV DNA) as a tumor marker. However, the plurality of HPV genotypes represents a challenge. The next-generation sequencing (NGS)-based CaptHPV approach is able to characterize any HPV DNA sequence. To assess the ability of this method to establish the diagnosis of HPV-associated cancer via a blood sample, we analyzed ctHPV DNA in HPV-positive or HPV-negative carcinomas. EXPERIMENTAL DESIGN Patients (135) from France and Senegal with carcinoma developed in the uterine cervix (74), oropharynx (25), oral cavity (19), anus (12), and vulva (5) were prospectively registered. Matched tumor tissue and blood samples (10 mL) were taken before treatment and independently analyzed using the CaptHPV method. RESULTS HPV prevalence in tumors was 60.0% (81/135; 15 different genotypes). Viral analysis of plasmas compared with tumors was available for 134 patients. In the group of 80 patients with HPV-positive tumors, 77 were also positive in plasma (sensitivity 95.0%); in the group of 54 patients with HPV-negative tumors, one was positive in plasma (specificity 98.1%). In most cases, the complete HPV pattern observed in tumors could be established from the analysis of ctHPV DNA. CONCLUSIONS In patients with carcinoma associated with any HPV genotype, a complete viral genome characterization can be obtained via the analysis of a standard blood sample. This should favor the development of noninvasive diagnostic tests providing the identification of personalized tumor markers. See related commentary by Rostami et al., p. 5158.
Collapse
Affiliation(s)
- Xavier Sastre-Garau
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France.,Service de Pathologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Mamadou Diop
- Institut du Cancer Joliot Curie, CHU Aristide Le Dantec, Dakar, Sénégal
| | | | - Gilles Dolivet
- CNRS CRAN UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Frédéric Marchal
- CNRS CRAN UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Claire Charra-Brunaud
- Département de Radiothérapie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Didier Peiffert
- CNRS CRAN UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Département de Radiothérapie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Léa Leufflen
- Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Birama Dembélé
- Institut du Cancer Joliot Curie, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Jessica Demange
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Priscillia Tosti
- Unité de Recherche Clinique, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Jacques Thomas
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Agnès Leroux
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Jean-Louis Merlin
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France.,CNRS CRAN UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | | | | | - Julia Salleron
- Unité de Biostatistiques, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Alexandre Harlé
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France.,CNRS CRAN UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Corresponding Author: Alexandre Harlé, Service de Biopathologie, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France. Phone: 3 83–65 6–119; E-mail:
| |
Collapse
|
50
|
Salzillo TC, Taku N, Wahid KA, McDonald BA, Wang J, van Dijk LV, Rigert JM, Mohamed ASR, Wang J, Lai SY, Fuller CD. Advances in Imaging for HPV-Related Oropharyngeal Cancer: Applications to Radiation Oncology. Semin Radiat Oncol 2021; 31:371-388. [PMID: 34455992 DOI: 10.1016/j.semradonc.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
While there has been an overall decline of tobacco and alcohol-related head and neck cancer in recent decades, there has been an increased incidence of HPV-associated oropharyngeal cancer (OPC). Recent research studies and clinical trials have revealed that the cancer biology and clinical progression of HPV-positive OPC is unique relative to its HPV-negative counterparts. HPV-positive OPC is associated with higher rates of disease control following definitive treatment when compared to HPV-negative OPC. Thus, these conditions should be considered unique diseases with regards to treatment strategies and survival. In order to sufficiently characterize HPV-positive OPC and guide treatment strategies, there has been a considerable effort to diagnose, prognose, and track the treatment response of HPV-associated OPC through advanced imaging research. Furthermore, HPV-positive OPC patients are prime candidates for radiation de-escalation protocols, which will ideally reduce toxicities associated with radiation therapy and has prompted additional imaging research to detect radiation-induced changes in organs at risk. This manuscript reviews the various imaging modalities and current strategies for tackling these challenges as well as provides commentary on the potential successes and suggested improvements for the optimal treatment of these tumors.
Collapse
Affiliation(s)
- Travis C Salzillo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Nicolette Taku
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Kareem A Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Brigid A McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Jarey Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Lisanne V van Dijk
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Jillian M Rigert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|