HPV-related neck cancer treatment

Dental Tribune International

Wed. 9. October 2019

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WINSTON-SALEM, N.C., U.S.: Within the health sector, dentistry has been leading the way when it comes to personalizing treatment. In a recent study that has turned its focus to cancer treatment, researchers have identified certain characteristics in patients with head and neck cancer linked to the human papillomavirus (HPV) that may help personalize levels of radiation and chemotherapy.

“Head and neck cancers that are caused by HPV infection tend to have a better overall outcome than head and neck cancers related to other factors like smoking and alcohol,” said Dr. Gaorav Gupta, assistant professor in the Department of Radiation Oncology at the University of North Carolina School of Medicine, Chapel Hill. “There’s been a lot of interest in exploring whether we can give less treatment to these patients and still achieve the same level of cure, while reducing the toxicities of treatment.”

Using blood test results from a previous study of 103 patients who were undergoing chemotherapy and radiation for HPV-linked oropharyngeal squamous cell carcinoma, the team was able to identify specific traits that could help to stratify and personalize treatment. According to the study, there were a number of surprising factors to emerge from the results. A biomarker of a good outcome was a high level of circulating tumor HPV DNA in the blood before treatment. Conversely, they found that patients with low levels of circulating DNA from tumors at the outset—or less than 200 copies of HPV DNA per milliliter—and with unfavorable clearance of HPV DNA after treatment had a higher risk of recurrence.

Since the results seem counterintuitive, the team plans to undertake further investigation. “It may seem confusing at first, but we think it reflects how addicted the tumor is to HPV biology,” noted Gupta.

What also surprised the researchers was the finding that patients who then rapidly cleared the circulating tumor DNA from their blood were more likely to have improved outcomes. Patients who were able to clear 95% of the DNA from their blood in the first 28 days of treatment were considered to have a favorable clearance rate.

Speaking about the future possibilities of the study, lead author Dr. Bhishamjit S. Chera, Associate Chair of Clinical Operations and Improvement in the Department of Radiation Oncology, said: “What this means is that in the future, dynamic, real-time monitoring of circulating tumor HPV DNA in the blood during treatment may help us better personalize and select treatment—especially the level of radiation and chemotherapy we give the patient.”

The study, titled “Rapid clearance profile of plasma circulating tumor HPV Type 16 DNA during chemoradiotherapy correlates with disease control in HPV-associated oropharyngeal cancer,” was published on Aug. 1, 2019, in Clinical Cancer Research.

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