HPV DNA Blood Test for HPV-Associated Oropharyngeal Cancer Recurrence
Posted: Monday, March 23, 2020
Testing circulating tumor human papillomavirus (HPV) DNA levels in blood plasma appears to have high predictive value for detecting disease recurrence in patients with HPV-associated oropharyngeal cancer, according to a prospective biomarker study. Gaorav P. Gupta, MD, PhD, of the University of North Carolina, Chapel Hill, and colleagues suggest this method may enable earlier initiation of salvage therapy for those who may benefit from it.
“Circulating tumor HPV DNA monitoring has excellent sensitivity (100%) and specificity (99%) for identifying patients with clinical recurrence,” the authors wrote in the Journal of Clinical Oncology.
The clinical trial included 115 patients with nonmetastatic HPV-associated oropharyngeal squamous cell carcinoma. All patients received chemoradiotherapy, followed by a positron-emission tomography/computed tomography (PET/CT) scan 3 months later. Then patients underwent chest imaging every 6 months, provided a blood sample every 6 to 9 months, and received clinical evaluations every 2 to 4 months for the first 2 years and every 6 months during years 3 to 5. The authors used polymerase chain reaction to analyze circulating tumor HPV DNA levels in blood plasma.
The median follow-up time was 23 months. The negative predictive value of the test was 100%: 87 patients never had a positive circulating tumor HPV DNA test, and none of these patients experienced disease recurrence. A total of 28 patients had at least one positive test, and about half (15 patients) were diagnosed with biopsy-proven recurrence. The positive predictive value of two consecutively positive tests was 94%: 16 patients had 2 consecutive positive tests, and 15 of them experienced recurrence.
“The negative predictive value (100%) and positive predictive value (94%) of recurrence detection by circulating tumor HPV DNA compares favorably with alternative and emerging post-treatment surveillance strategies,” the authors wrote. This includes PET/CT scanning, which has been associated with more false-positive results, and oral HPV DNA testing.
Disclosure: The study authors’ disclosure information may be found at ascopubs.org.