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Researchers identify features associated with better results in HPV-related head and neck cancer


Using a new blood test, researchers at the University of North Carolina, the Lineberger Comprehensive Cancer Center, have identified features that could be used to personalize treatment for patients with HPV-related head and neck cancer types.

Researchers believe that the findings were published in the journal Clinical Cancer Research, can help identify those patients with characteristics associated with improved treatment responses. They hope to adapt their therapy to these patients in order to reduce their exposure to potential toxic side effects.

"Head and neck carcinoma caused by HPV infection have a better overall outcome of head and neck carcinoma related to other factors such as smoking and alcohol," said Dr.Sc. Department of Radiation Oncology, UNC School of Medicine. "There was a great interest in researching whether we can give less treatment to these patients and still achieve the same level of healing while reducing the treatment's toxicity. The aim of this study was to examine whether a blood test for the circulation of tumor HPV DNA can potentially be used for monitoring the patient's response to chemotherapy and radiation.

The researchers developed a test for the detection of DNA levels in the blood from the tumor of HPV-bound cell carcinoma. Studies are under way to determine whether the test can be used to monitor patients' responses to radiation treatment and chemotherapy. In addition, the test is licensed for commercial development by Naveris Inc.

In their most recent work, the researchers have identified the characteristics of patients who can be used to stratify and personalize treatments. Their findings were derived from a study on blood test results from 103 patients who underwent chemotherapy and radiation for HPV-bound carcinoma of plaque cells of the cornea.

"This means that in the future, dynamic, real-time monitoring of circulating tumor HPV DNA in blood during treatment can help us better personalize and choose treatment – especially the radiation level and chemotherapy we give to the patient," said the first author of the study, UNC Lineberger Bhishamjit S. Chera, dr. MD, associate professor at the Department of Radiation Oncology, UNC School of Medicine.

One feature derived from their study as a good outcome biomarker was the high level of circulating tumor HPV DNA in the blood prior to treatment. Since the findings seem counterintuitive, researchers plan to investigate why a high level of initial viral DNA in the blood would be associated with a better outcome.

"At first, it may seem confusing, but we think it reflects how tumor is dependent on HPV biology," Gupta said.

In addition, they found that patients who quickly removed the circulating tumor DNA from their blood probably improved their outcomes. Patients who were able to purify more than 95% of their DNA from their blood until the 28th day of treatment were considered to have a favorable clearance rate. For 19 out of 67 patients with these two favorable biomarkers, they found that none had a persistent or recurrent disease.

"When we put these two factors together, which means that someone had a lot of HPV DNA and quickly cleared up, we did not notice any failure in the treatment in our cohort," said Gupta.

On the contrary, they found that carcinoma with low circulating DNA from the tumor at the beginning – or less than 200 copies of HPV DNA per milliliter – and with unfavorable HPV DNA clearance after treatment had a higher risk of relapse. This risk was even worse when combined with other risk factors such as the long history of smoking.

Researchers at UNC Lineberger are planning to launch a clinical trial in which patients stratify different levels of therapy based on the tracking of circulating tumor HPV DNA in real time. The planned trial, which will be led by dr. Colette Shen, an assistant at the Department of Radiation Oncology at the UNC School of Medicine, will include patients with a history of smoking and who are not currently entitled to treatment of reduced intensity. By using circulating tumor HPV DNA monitoring during treatment, researchers hope to identify patients who can be safely spared additional full-intensity treatment toxicity.

A blood test for HPV can help predict the risk in patients with cancer

More information:
Bhishamjit S. Chera et al., The rapid release of plasma circulating tumor of the HPV type 16 DNA during chemotheradiotherapy correlates with the control of HPV-related diseases of the throat carcinoma, Clinical Cancer Research (2019). DOI: 10.1158 / 1078-0432.CCR-19-0211

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UNC Lineberger Comprehensive Cancer Center

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The researchers identify the properties associated with better results in HPV-related head and neck cancer (2019, June 14)
taken on June 14, 2019

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