Liquid biopsy may aid in diagnosis, surveillance of HPV-associated oropharyngeal cancer
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Key takeaways:
- Tumor tissue-modified viral-HPV DNA demonstrated 91.5% sensitivity among patients in the diagnostic cohort and 88.4% in the surveillance cohort.
- Further study is needed to validate the performance of the test.
Tumor tissue-modified viral-HPV DNA testing demonstrated 100% specificity in both diagnosis and surveillance of HPV-associated oropharyngeal squamous cell carcinoma in a clinical setting, according to a study.
However, results published in JAMA Otolaryngology-Head & Neck Surgery showed nearly 10% of negative tumor tissue-modified viral (TTMV)-HPV DNA tests appeared to be false negatives after review of sensitivity data, researchers wrote. They noted the need for additional study to validate the test’s performance.
Background and methodology
Despite growing interest in the use of circulating plasma tumor HPV DNA for diagnosis and surveillance of patients with HPV-associated oropharyngeal squamous cell carcinoma, few data exist on newer testing techniques.
Researchers conducted a retrospective, observational cohort study that included 399 patients with oropharyngeal squamous cell carcinoma in an effort to establish the clinical efficacy of plasma TTMV-HPV DNA testing in the diagnosis and surveillance of HPV-associated oropharyngeal squamous cell carcinoma.
Eligible patients included individuals who underwent TTMV-HPV DNA testing between April 2020 and September 2022 and had at least one TTMV-HPV DNA measurement prior to initiation of primary therapy.
Researchers assigned 163 patients (median age, 63 years; 87.1% male) to the diagnostic cohort and 290 (median age, 63 years; 81.7% male) to the surveillance cohort.
Results
In the diagnostic cohort, 152 patients (93.3%) had HPV-associated oropharyngeal squamous cell carcinoma and 11 (6.7%) had HPV-negative disease. Results showed TTMV-HPV DNA testing had a pretreatment diagnosis sensitivity of 91.5% (95% CI, 85.8-95.4) and specificity of 100% (95% CI, 71.5-100).
Of the 290 patients in the surveillance cohort, 23 had molecularly confirmed pathologic recurrences. TTMV-HPV DNA testing showed a sensitivity of 88.4% (95% CI, 74.9-96.1) and sensitivity of 100% (95% CI, 99.3-100) in detecting these recurrences.
Researchers reported a positive predictive value of 100% (95% CI, 90.7-100) and a negative predictive value of 99.1% (95% CI, 97.9-99.7), and a median lead time from positive TTMV-HPV DNA testing to pathologic confirmation of 47 days (range, 0-507).
Implications
TTMV-HPV DNA testing can serve as a valuable tool for diagnosis and surveillance; however, additional studies are needed to refine its effectiveness, according to researchers.
“Surveillance testing for TTMV-HPV DNA may be useful in resolving cases of clinically or radiographically indeterminate results,” they wrote. “However, with careful consideration and appropriate integration into clinical practice guidelines, TTMV-HPV DNA testing may augment aspects of current diagnostic and surveillance algorithms.
“There are already several efforts in place to determine if liquid biopsy can be used during treatment to de-escalate therapy safely; however, efforts to determine if it can improve oncologic outcomes through efficiencies in diagnosis of new tumors or treatment of recurrences should also be pursued,” they added.
Use of this technology shows “remarkable promise” to identify and track patients who have HPV-related disease, Miriam N. Lango, MD, professor in the department of head and neck surgery at The University of Texas MD Anderson Cancer Center, wrote in an accompanying editorial.
“Testing is likely to be increasingly used in routine clinical care, as it is commercially available,” Lango wrote. “It is incumbent on us to establish evidence for strong and detailed surveillance guidelines to share among the cancer community.”
References:
- Ferrandino RM, et al. JAMA Otolaryngol Head Neck Surg. 2023;doi:10.1001/jamaoto.2023.1937.
- Lango MN. JAMA Otolaryngol Head Neck Surg. 2023;doi:10.1001/jamaoto.2023.1938.
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