Can Liquid Biopsy Predict Oropharyngeal Cancer Recurrence?

Liam Davenport

March 02, 2022

PHOENIX — A liquid biopsy test may accurately predict recurrence of human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) earlier than standard clinical and imaging assessments, a new analysis indicates.

Of 80 patients who tested positive for circulating tumor tissue-modified viral (TTMV)-HPV DNA during surveillance, 74% (n = 59) had no other evidence of disease or had indeterminate disease status.

And of those patients, 93% (n = 55) "later had proven recurrent, metastatic disease on imaging and/or biopsy," according to Glenn Hanna, MD, from the Dana-Farber Cancer Institute, Boston, who presented the results February 24 at the 2022 Multidisciplinary Head and Neck Cancers Symposium.

"This is the first study to demonstrate broad clinical utility and validity of the biomarker in HPV-driven oropharyngeal cancer," Hanna said in a press release.

Although patients with HPV-driven OPSCC generally have favorable outcomes, up to 25% will experience recurrence after treatment.

Posttreatment surveillance currently relies on physical examinations and imaging, but Hanna and colleagues wanted to determine whether a routine circulating cell-free TTMV-HPV DNA test could detect occult recurrence sooner.

Hanna and colleagues analyzed the records of 1076 patients with HPV-driven OPSCC at 118 sites in the US who had completed therapy more than 3 months previously and undergone an TTMV-HPV DNA test (NavDx, Naveris) between June 2020 and November 2021.

The results of the test, which used ultrasensitive digital droplet PCR to identify HPV subtypes 16, 18, 31, 33, and 35, were compared with subsequent clinical evidence of OPSCC via nasopharyngolaryngoscopy, radiologic evaluations, or tissue biopsy.

Approximately 7% of the patients tested positive (n = 80) for circulating TTMV-HPV DNA. Of those, 26.2% (n = 21) had known clinical recurrence, while 73.8% (n = 59) had no other evidence of disease or an intermediate disease status.

Among those with no clinical evidence of recurrence, 93.2% (n = 55) had their recurrence subsequently confirmed using imaging or biopsy. Of the 4 remaining patients, 2 had clinically suspicious lesions and 2 had no other evidence of disease.

Overall, the data indicate that the biomarker test demonstrated a 95% positive predictive value (76 of 80 patients) for recurrence or persistence of HPV-driven OPSCC.

According to Hanna, a positive TTMV-HPV DNA test was the first indicator of recurrence for 72% of patients, and almost half of recurrences were detected more than 12 months after completing therapy.

"Incorporating a test for TTMV-HPV DNA into routine posttreatment follow-up can enable physicians to detect recurrent cancers earlier and allow us to start recommended interventions more quickly to improve outcomes," Hanna said in the release.

The study was supported by Naveris, which developed the TTMV-HPV DNA test studied. Hanna declares relationships with Actuate Therapeutics, Altor BioScience, Bicara, BMS, GSK, Merck, Regeneron, Sanofi/Genzyme, and others.

2022 Multidisciplinary Head and Neck Cancers Symposium: Abstract 3. Presented February 24, 2022.

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