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A Closer Look at HPV-Associated Oropharyngeal Cancer Surveillance

Op-Med is a collection of original articles contributed by Doximity members.

Dr. Zhen Gooi is a 2020–2021 Doximity Research Review Fellow. Nothing in this article is intended nor implied to constitute professional medical advice or endorsement. The views expressed in this article are those of the author and do not necessarily reflect the views/position of Doximity. 

HPV-associated oropharyngeal cancer (HPV-associated OC) confers an overall favorable prognosis but still recurs in an estimated 10–25% of patients. Traditional surveillance strategies involving clinical exam and imaging studies may fail to detect recurrences early in a subset of high-risk patients, which can have an impact on the extent and nature of salvage therapy. In a recent prospective cohort study, researchers aimed to determine if monitoring plasma-circulating tumor HPV DNA (ctHPVDNA) could predict HPV-associated OC disease recurrence as compared to traditional surveillance.

The study results showed that detectable ctHPVDNA during surveillance after definitive treatment for HPV-associated OC has high utility in predicting subsequent cancer recurrence. That said, the study was limited by the heterogeneity of the treatment regimens in the sample population; the intensity of radiation therapy and the use of concurrent chemotherapy could have been confounding factors for disease recurrence. Further, there was also some amount of variation in the use of imaging studies for cancer surveillance among these patients.

Notwithstanding its limitations, however, the study provides some points of interest. For example, in several patients, the detection of ctHPVDNA predated biopsy-proven recurrence by a few months. This suggests that it may be possible to identify patients at higher risk for recurrence who warrant closer follow-up care. Given that the median time interval between abnormal ctHPVDNA and subsequent biopsy-proven recurrence was 3.9 months, future work to determine if a shorter frequency for ctHPVDNA monitoring (compared to the six to nine months used in the current study) would shorten the time interval for detection of disease recurrence. Additional avenues for future investigation also include the survival impact of interventions based on ctHPVDNA detection.

In sum, the study highlights the potential of a minimally invasive, blood-based assay strategy as a complement to in-office laryngoscopies and imaging studies. Potentially, it suggests the negation of these surveillance strategies in the absence of abnormal ctHPVDNA results.

Dr. Zhen Gooi is a head and neck oncologic surgeon in academic practice at the University of Chicago. He completed his residency and fellowship training at Johns Hopkins University.

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