American Head & Neck Society

Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.

American Head & Neck Society | AHNS


The mission of the AHNS is to advance Education, Research, and Quality of Care for the head and neck oncology patient.

  • About
    • Mission Statement and Purpose
    • Divisions & Services of the Society
      • Education
        • Scientific Program/Resident Courses
        • Surgical Videos
        • Journal Club
        • Journals
        • Global Outreach
        • Awards
          • Margaret F. Butler Award
      • Diversity, Equity and Inclusion Division
      • Patient Care
        • Cancer Survivorship
          • Patient Education on Post-Treatment Care
          • Interviews with Cancer Survivors
        • Cancer Prevention
          • SLIDE DECK: HPV-Related Oropharyngeal Cancer
        • Guidelines/Position Statements
        • Find-A-Physician
      • Research
        • Grant Information
        • Clinical Trial
        • Tissue Banks
      • Administrative Divison
        • Development Service Process for Evaluating Projects Requiring Funding
    • Leadership
    • History
      • Society Background
      • AHNS History Interviews
      • Past Presidents
      • In Memory
    • AHNS Newsletter
    • Professionalism & Ethics
    • AHNS Policies and Procedures (P&P) Manual
    • AHNS Foundation
    • AHNS Bylaws
    • AHNS Staff
    • AHNS News and Announcements
    • COVID-19 Bulletin Board
  • Heads Up!
  • Post a Job
  • Meetings
    • AHNS Virtual Education Series
      • TORS Webinar Series
    • AHNS Meetings Info
    • AHNS Call For Abstracts
    • AHNS Call For Late Breaking Abstracts
    • Exhibitor and Support Opportunities
    • Past Meetings
    • Related Meetings
  • For Patients
  • For Trainees
    • Accredited Fellowships
      • Fellowship Match
      • Directory of Fellowships
      • Fellowship Curriculum
      • Certificate of Completion Request
      • Fellowship Graduates
      • For Program Directors
      • For Current AHNS Fellows
    • AHNS Surgical Videos
    • Fellows’ Virtual Tumor Boards
    • Cutaneous Cancer
  • Sections
    • Endocrine Surgery
    • Skull Base Surgery Section
    • Reconstructive Head & Neck Surgery
    • Mucosal Malignancy Section
      • Mucosal Malignancy Section Patient Information
    • Salivary Gland
    • Cutaneous Cancer
  • Member Central
    • Join AHNS
    • Find-A-Physician
    • Mailing List Order
  • Log In
  • Donate

Published on September 15, 2020 by Theresa Guo

AHNS Basic Science/Translational Newsletter Vol 4 – American Head & Neck Society

Association of Oral Human Papillomavirus DNA Persistence With Cancer Progression After Primary Treatment for Oral Cavity and Oropharyngeal Squamous Cell Carcinoma

Carole Fakhry, Amanda L Blackford, Geoff Neuner, Weihong Xiao, Bo Jiang, Amit Agrawal, Maura L Gillison

From JAMA Oncology, July 2019; 5(7):985-992.

Article Review by Theresa Guo, MD

Background / Hypothesis
Recent retrospective studies have shown that detection of HPV-16 DNA in oral rinse of HPV+ oropharyngeal cancer patients may predict increased risk for
recurrence. Therefore, a prospective study was designed to evaluate whether detection of HPV
DNA in oral rinses was able to predict clinical disease course.

Design
Multi-institutional prospective study enrolling patients diagnosed with oropharyngeal or oral cavity cancer. Oral rinses were collected at the time of diagnosis, after primary therapy, weekly during radiotherapy and at the completion of therapy. Rinses were tested for DNA of 37 HPV types by PCR.

Summary of Results
396 patients were enrolled including 217 oropharyngeal and 170 oral cavity patients, with 202 HPV-positive and 194 HPV-negative patients. At the time of diagnosis, oral HPV-16 DNA was 81% sensitive and 100% sensitive for HPV-16 positive tumors, and higher T stage was associated with oral HPV detection. In HPV-negative patients, oral HPV DNA was detected in 12.4% of patients. During treatment, tumor specific HPV type or “tumor-type HPV” decreased significantly during treatment, but non tumor-type HPV did not change. Tumor-type HPV was present in 14.3% of HPV-positive patients after completion of primary therapy, and recurrence rates were significantly higher than those without detectable DNA (45.3% vs. 12.2%). Persistent tumor-type DNA in oral rinses was significantly associated with increased risk of death (adjusted HR 6.61, p=0.003) as well as local (adjusted HR 9.81, p<0.001) and regional (adjusted HR 5.75, p=0.002) recurrence, but not distant recurrence.

Strengths

  • Large prospectively collected cohort including nearly 400 patients with half of the
    cohort being HPV-positive and half being HPV-negative, including both oral cavity and
    oropharynx primary tumors (which are most likely to shed DNA into saliva).
  • Rigorous testing of 37 HPV subtypes within tumor as well as saliva samples.
  • Robust data on dynamics of tumor-type HPV DNA throughout treatment including
    before and after surgery, as well as weekly during radiation treatment.

 Weaknesses

  • Lack data on plasma sampling to supplement oral rinses. The authors found that while
    oral rinse HPV DNA could predict locoregional recurrence, it was not associated with
    distant recurrence. Predicting distant recurrence may require plasma sampling for
    detection.
  • Follow up time was limited to a median of 2.6 years. While most recurrences in
    oropharyngeal cancer occur within 2 years, some data has shown late recurrences from HPV-positive tumors. The authors hypothesize that persistent HPV DNA likely represents subclinical disease that results in recurrence, thus it is unknown whether persistent HPV infection would be able to predict late recurrences.

Key Points

  • Oral HPV is detectable in 80% of patients with HPV-positive oropharyngeal cancer at the time of diagnosis.
  • Unlike EBV viral load in nasopharyngeal cancer, viral load or presence of HPV DNA at the time of diagnosis was not associated with clinical outcomes.
  • Detection of HPV is complicated by prevalence of non-tumor related HPV infections. This study highlights some of the nuances of using oral HPV as a surveillance biomarker, as only tumor-type HPV reflected the clinical disease course. There were no changes during treatment for viral load of non-tumor-type HPV. Furthermore, HPV-negative patients also demonstrated 12.4% prevalence of HPV DNA, and risk of infection in these patients was associated with the same risk factors for HPV infection in the general population, including male sex and number of lifetime sexual partners.
  • Active smoking was associated with persistent tumor-type DNA.
  • Persistent tumor-type HPV DNA is associated with both worse survival and locoregional recurrence. Future trial designs may consider additional therapy such as immunotherapy for patients with persistent HPV DNA after treatment completion.

From the Basic Science/Translational Service
Jeffrey C. Liu MD Vice Chair
Richard Wong MD Chair

  • Bio
  • Latest Posts
Theresa Guo

Theresa Guo

I am from Cleveland, Ohio where I received my medical degree from the Cleveland Clinic Lerner College of Medicine. I completed my Otolaryngology residency training at Johns Hopkins Hospital, and will be pursuing advanced fellowship training in Head & Neck Cancer at MD Anderson in Houston, Texas. My clinical and research interests are in advancing the treatment of head and neck cancer. In particular, I am interested in genetic profiling of head and neck tumors with poor prognosis and predicting treatment response.
Theresa Guo

Latest posts by Theresa Guo (see all)

  • AHNS Basic Science/Translational Newsletter Vol 4 – American Head & Neck Society - September 15, 2020

Views: 0

Share:

  • Facebook
  • Twitter
  • LinkedIn

Related

Subscribe to Heads Up!

Enter your email address to subscribe to Heads Up! and receive notifications of new posts by email.

Join 205 other subscribers

AHNS Meetings

WEBINAR CALENDAR

AHNS Call For Abstracts

News and Announcements

  • AHNS 2023 Meeting – Late Breaking Call For Abstracts – Final Day To Submit Abstracts March 22, 2023
  • ARS NASBS AHNS Sinonasal Cancer Collaborative – Sinonasal Malignancy Virtual Tumor Board March 20, 2023
  • AHNS 2023 Meeting – Late Breaking Call For Abstracts – 1 Week Left To Submit Abstracts March 16, 2023
  • Registration for the AHNS 2023 is now open! March 10, 2023
  • What’s New on the AHNS Website March 9, 2023

AHNS on Facebook

AHNS on Facebook

Contact Us

AHNS, 11300 W. Olympic Blvd, Suite 600
Los Angeles, CA 90064
ph: (310) 437-0559 / fx: (310) 437-0585
[email protected]

Search this website

Follow the AHNS

  • Email
  • Facebook
  • Twitter
  • YouTube

Recent Heads Up! Posts

AHNS 2023 Meeting – Late Breaking Call For Abstracts – Final Day To Submit Abstracts

ARS NASBS AHNS Sinonasal Cancer Collaborative – Sinonasal Malignancy Virtual Tumor Board

AHNS 2023 Meeting – Late Breaking Call For Abstracts – 1 Week Left To Submit Abstracts

More News and Announcements

© 2002–2023 American Head and Neck Society · Privacy and Return Policy
· Managed by BSC Management, Inc