Circulating DNA testing shows potential in HPV oropharyngeal cancer recurrence detection

  • Chera BS & al.
  • J Clin Oncol
  • 4 Feb 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • 2 consecutive positive tests for circulating tumor HPV DNA (ctHPVDNA) detect recurrence of HPV-associated oropharyngeal cancer with high sensitivity and specificity.

Why this matters

  • ctHPVDNA compares favorably to other surveillance technologies such as positron emission tomography (PET)/CT, which is prone to false positives.

Study design

  • Prospective analysis.
  • 115 patients who underwent curative-intent chemoradiotherapy (CRT) had a 3-month post-CRT PET/CT scan.
  • Patients were evaluated clinically every 2-4 months during years 1 and 2 and every 6 months in years 3-5.
  • Blood samples were analyzed every 6-9 months for ctHPVDNA.
  • Funding: University Cancer Research Fund; Burroughs Wellcome Fund; NIH; others.

Key results

  • Median follow-up, 23.7 months.
  • Recurrence rate, 13%.
  • 87 of 115 patients never had detectable ctHPVDNA at 2 consecutive tests throughout follow-up, and none developed recurrence:
    • Negative predictive value, 100% (95% CI, 96%-100%).
  • 16 patients had 2 consecutive positive ctHPVDNA tests, and 15 of them had a recurrence:
    • Positive-predictive value of 2 consecutive tests: 94% (95% CI, 70%-100%).
    • Sensitivity: 100%.
    • Specificity: 99%.
  • The median interval between ctHPVDNA positivity and recurrence, as confirmed by a biopsy, was 3.9 (range, 0.37-12.9) months.

Limitations

  • 2 consecutive tests were not tested prospectively.