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Plasma Circulating HPV DNA Surveillance in a Patient With Nasopharyngeal Cancer
Siddharth Sheth1, Tyler Walburn2, Jason Tasoulas3
1Department of Medicine, Division of Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Ear, Nose, & Throat Journal
|September 12, 2024
Summary
Serial circulating tumor HPV DNA (ctHPVDNA) monitoring effectively tracked disease activity in a patient with human papillomavirus (HPV)-positive nasopharyngeal carcinoma (NPC). This biomarker detected recurrence earlier than standard methods, enabling timely interventions.
Area of Science:
- Oncology
- Virology
- Biomarker Discovery
Background:
- Approximately one-third of US nasopharyngeal carcinomas (NPCs) are linked to human papillomavirus (HPV).
- Current surveillance for EBV-negative NPC relies on imaging and physical exams, potentially missing early disease recurrence.
- HPV-positive NPC represents a distinct subtype requiring tailored monitoring strategies.
Purpose of the Study:
- To investigate the utility of serial circulating tumor HPV DNA (ctHPVDNA) as a biomarker for disease status in HPV-positive NPC.
- To assess the correlation between ctHPVDNA levels and disease activity in a real-world clinical scenario.
- To evaluate the potential of ctHPVDNA for early detection of recurrence compared to standard surveillance.
Main Methods:
- A case study of a 58-year-old female with HPV-positive, EBV-negative NPC treated with chemoradiation.
- Serial monitoring of plasma ctHPVDNA using a commercial PCR-based assay.
- Correlation of ctHPVDNA trends with imaging (PET scans) and clinical outcomes during surveillance and treatment.
- Utilized salvage neck dissection, radiotherapy, pembrolizumab, chemoradiation with cetuximab, and systemic therapy based on disease status.
Main Results:
- Plasma ctHPVDNA levels correlated well with disease activity, reflecting tumor burden and treatment response.
- Rising ctHPVDNA levels preceded radiographically evident recurrence, prompting earlier diagnostic imaging (PET scans).
- Decreases in ctHPVDNA were observed following effective treatments, with subsequent increases indicating further recurrence.
Conclusions:
- Serial ctHPVDNA monitoring shows promise as an effective biomarker for tracking disease status in HPV-positive NPC.
- ctHPVDNA may enable earlier detection of recurrence than conventional surveillance methods, facilitating prompt intervention.
- Further large-scale studies are warranted to validate the clinical utility and impact of HPV biomarker surveillance in NPC management.
