Early post-therapy HPV clearance linked to improved survival in cervical cancer
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Early post-therapy clearance of HPV appeared associated with improved survival among women with cervical cancer, according to results of a prospective study published in Cancer.
Evaluation of HPV expression 6 weeks after treatment provided prognostic information beyond post-therapy PET imaging and may assist in risk stratification, as well as treatment escalation decisions, researchers noted.
“High-risk HPV is associated with greater than 95% of cases of cervical carcinoma,” Amar J. Srivastava, MD, MPH, radiation oncologist at Washington University Medical Center in St. Louis, and colleagues wrote. “Although this marker has been well integrated into the diagnostic paradigm for cervical cancer, much less is known about the natural history of HPV infection and the potential biological role of persistent HPV infection after definitive [chemoradiation].”
Concurrent chemoradiation remains the standard of care for locally advanced cervical cancer; however, one-third of women experience disease recurrence. Strategies for treatment escalation — including immunotherapy, dose escalation and adjuvant chemotherapy — are being investigated in clinical trials, but it is unknown which women may experience relapse and benefit from further treatment.
Srivastava and colleagues analyzed clinical responses of 97 women with cervical cancer (median age at diagnosis, 50 years; 69.1% white) who had high-risk HPV infection and underwent post-treatment testing with a messenger RNA-based genital swab after chemoradiation.
Researchers stratified post-therapy responses based on HPV messenger RNA detection into an early clearance group and a persistent expression group following evaluation at a median 6 weeks after therapy.
Results showed early clearance in 72 women (74.2%).
After mean follow-up of 25 months (range, 4-56), results showed superior 2-year pelvic control (76.9% vs. 50.2%; P = .01) and OS (80.9% vs. 52.2%; P < .01) among women with early HPV clearance vs. persistent expression.
Multivariable analysis showed predictors for improved survival included early HPV clearance (HR for mortality = 0.46; 95% CI, 0.21-0.96) and complete response on post-therapy PET (HR for less than a complete response on PET = 6.17; 95% CI, 2.58-14.72).
A subset analysis of women with post-therapy PET complete response showed OS remained higher at 2 years among women with early clearance vs. persistent expression (95.6% vs. 66.7%; P = .04). Women with persistent expression without a PET complete response had the lowest 2-year OS rate (35.9%).
All women received treatment at a single center, which served as a limitation to this study.
“Our study is the first to show that [persistent expression] of HPV within 6 weeks of definitive treatment with modern chemoradiation portends a poor prognosis independently of other known prognostic markers such as post-therapy [ fluorodeoxyglucose]-PET findings,” Srivastava and colleagues wrote. “Therefore, this 6-week window may represent a critical time point at which decisions could be made regarding treatment escalation.”
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