The presence of human (HPV) type 16 DNA in oral rinses after treatment for HPV-related oropharyngeal cancer is rare. But because such presence appears to be linked to poor prognosis, it may have potential as a tool for long-term tumor surveillance, according to a new article in JAMA Oncology.
In the study, Gypsyamber D’Souza, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, and coauthors looked at 124 patients with new HPV-related oropharyngeal cancer. They investigated HPV DNA detection in oral rinses after treatment for HPV-related oropharyngeal cancer with disease recurrence and survival to understand prognosis implications.
Human papillomavirus infection is to blame for most of the oropharyngeal carcinomas in the United States.
The cancer will progress after treatment in 10 percent to 25 percent of patients with HPV-positive tumors, although earlier diagnoses of progressive or recurrent disease may result in earlier treatment and better outcomes. HPV16 DNA in oral exfoliated cells is detected in as many as two-thirds of HPV-positive cancers before treatment and persists in a small subset of patients after treatment.
The authors found that oral HPV16 DNA was common at diagnosis, being detected in 67 of the 124 participants. However, it was detected in only six patients after treatment, including five patients with persistent oral HPV16 DNA that was also detected at diagnosis.
All five patients with persistent oral HPV16 DNA later developed recurrent disease, and three died of the disease. By contrast, only 9 of 119 patients without persistent oral HPV16 DNA developed recurrent disease.
“Our data suggest that persistent HPV16 DNA detection in posttreatment oral rinses, although uncommon, is associated with poor prognosis and may be predictive of disease recurrence, in particular local recurrence. Therefore, HPV16 DNA detection in oral rinses is a potentially useful tool for long-term tumor surveillance for the growing population of HPV-OPC (human papillomavirus-related oropharyngeal carcinoma) survivors,” the study concludes.
Illustration: MRC NIMR, Wellcome Images