Breaking News
March 22, 2019 - TMJ disorders could be treated with tissue-engineered implants after successful animal study
March 22, 2019 - Team-based approach is key to successful care of pregnant women with heart failure
March 22, 2019 - Study identifies gene variant associated with accelerated cellular aging
March 21, 2019 - Salk scientists show how background noise from neurons can interrupt focused attention
March 21, 2019 - New class of drugs could help treat patients diagnosed with ovarian cancer
March 21, 2019 - Tecentriq Approved for Small Cell Lung Cancer
March 21, 2019 - Adipocyte glucocorticoid receptors play a role in developing steroid diabetes
March 21, 2019 - Climate change can affect nutrient content of crops, harming human health
March 21, 2019 - Podcast: KHN’s ‘What The Health’ Surprise! Fixing Surprise Medical Bills Is Harder Than it Looks
March 21, 2019 - Chemistry researchers patent new method for making anti-leukemia compounds
March 21, 2019 - UIC scientists identify hidden proteins in bacteria
March 21, 2019 - New Australian drug trial achieves remarkable results in patients with acute myeloid leukemia
March 21, 2019 - Females live longer when they have help raising offspring
March 21, 2019 - How did orthodontists sell orthodontics?
March 21, 2019 - In the Spotlight: From dietitian to physician assistant student
March 21, 2019 - The CRISPR Revolution: What You Need to Know
March 21, 2019 - FDA Chief Calls For Stricter Scrutiny Of Electronic Health Records
March 21, 2019 - Combined glucocorticoid and antioxidant therapy could benefit premature babies
March 21, 2019 - Low levels of certain eye proteins could serve as predictor for Alzheimer’s
March 21, 2019 - Post-traumatic holocaust survivors transmit negative views on aging to offspring
March 21, 2019 - City of Hope receives $7.5 million in grant awards to study cutaneous T cell lymphoma
March 21, 2019 - New video game-led training device helps stroke survivors regain arm mobility
March 21, 2019 - Compounds in coffee could slow prostate cancer growth
March 21, 2019 - New mobile DNA element in Wolbachia may contribute to improved disease control strategies
March 21, 2019 - Phase 2 Clinical Trial of Bermekimab Shows Potential New Standard of Care for Treatment of Hidradenitis Suppurativa, Including Significant Pain Reduction without Antibiotics
March 21, 2019 - More than one-third of patients risk major bleeding by doubling up on blood thinners
March 21, 2019 - A skeptical look at popular diets: Thumbs up for Mediterranean
March 21, 2019 - PTSD After Cardiac Arrest Predicts More Heart Trouble
March 21, 2019 - Role of immunological imprinting in elicitation of new antibodies
March 21, 2019 - Breast cancer relapse predictor tool may soon be a reality
March 21, 2019 - New computer program developed by TGen lights up cancer-causing genetic mutations
March 21, 2019 - FDA warns two breast implant makers for failure to comply with post-approval study requirements
March 21, 2019 - Butler Hospital receives COBRE grant to enhance research on neuropsychiatric illnesses
March 21, 2019 - Majority of osteoporosis clinical practice guidelines ignore patients’ voices
March 21, 2019 - Generic messages don’t help patients to lose weight
March 21, 2019 - Eisai and Imbrium Therapeutics Announce U.S. FDA Filing Acceptance of New Drug Application for Lemborexant for the Treatment of Insomnia
March 21, 2019 - Two-drug combos using popular calcium channel blocker show superiority in lowering BP
March 21, 2019 - First-in-human pilot study shows positive results for ‘bacteria-phobic’ catheter
March 21, 2019 - Itamar Medical launches next-generation WatchPAT system for home sleep apnea testing
March 21, 2019 - Study estimates health and economic impacts of healthy food prescriptions
March 21, 2019 - Detecting fungal disease in crops with multispectral imaging system
March 21, 2019 - MIT announces creation of the Alana Down Syndrome Center
March 21, 2019 - Next-generation LVAD device clinically superior, safer for heart failure patients
March 21, 2019 - Allergan Announces FDA Approval of Avycaz (ceftazidime and avibactam) for Pediatric Patients
March 21, 2019 - Mutations in noncoding genes could play big role in regulating cancer, study finds
March 21, 2019 - A medical student’s thoughts on Match Day
March 21, 2019 - Are eggs good or bad for you?
March 21, 2019 - New analysis reveals precision oncology insights for colorectal cancer
March 21, 2019 - Pollutants appear to weaken immune system and increase pathogen virulence
March 21, 2019 - Researchers develop and validate scale for rating severity of mononucleosis
March 21, 2019 - Scientists identify generation of key immune response in mice on introducing solid food
March 21, 2019 - New nanomaterial could restore internal structure of damaged bones
March 21, 2019 - Selective destruction of prostate tumor as effective as complete prostate removal
March 21, 2019 - 2011 to 2015 Saw Increase in Psychiatric ED Visits for Youth
March 21, 2019 - Tapeworm drug targets common vulnerability in tumor cells
March 21, 2019 - WVU researcher discovers higher suicide rate among Medicaid-insured youth
March 21, 2019 - Off the beaten path for global health residency
March 21, 2019 - European Parliament’s report calls on EU to develop policies to regulate endocrine-disrupting chemicals
March 21, 2019 - Women with undiagnosed diabetes in pregnancy more likely to experience stillbirths
March 21, 2019 - Fish consumption can help prevent asthma, study reveals
March 21, 2019 - Royal Holloway professors to lead new to research into curing Neurofibromatosis type 1
March 21, 2019 - NSF offers grant to improve treatment approaches for pelvic organ prolapse
March 21, 2019 - Your Apple Watch Might Help Spot a Dangerous Irregular Heartbeat
March 21, 2019 - Research team uncovers critical new clues about what goes awry in autistic brains
March 21, 2019 - From March Madness to medicine with help from mentors
March 21, 2019 - Mental health disorders among young adults may be on the increase
March 21, 2019 - New study examines smarter automatic defibrillator
March 21, 2019 - UC Riverside research shows how natural selection favors cheaters
March 21, 2019 - Mother’s diet during pregnancy can impact lung-specific genes of her offspring
March 21, 2019 - AeroForm Tissue Expanders makes breast reconstruction after mastectomy more comfortable
March 21, 2019 - New project focuses on creating more responsive, intuitive prosthetics
March 21, 2019 - New case study describes adolescent patient with rapid-onset schizophrenia and Bartonella infection
March 21, 2019 - Umass Amherst food scientist honored with 2019 Young Scientist Research Award
March 21, 2019 - Smell of skin could lead to early diagnosis for Parkinson’s
March 21, 2019 - Difference in brain connectivity may explain autism spectrum disorder
March 21, 2019 - Untangling the microbiome — with statistics
March 21, 2019 - Human microbiome metabolites enhance colon injury by enterohemorrhagic E. coli, study shows
March 21, 2019 - Written media can improve citizens’ understanding of palliative care
March 21, 2019 - New research aims to find how asthma symptoms are aggravated
March 21, 2019 - New $9.7 million NIH grant project seeks to improve hearing restoration
New liquid biopsy test confirms remission in patients with HPV-associated oropharyngeal cancer

New liquid biopsy test confirms remission in patients with HPV-associated oropharyngeal cancer

image_pdfDownload PDFimage_print

A highly sensitive blood test that detects minute traces of cancer-specific DNA has been shown to accurately determine whether patients with HPV-related oropharyngeal squamous cell carcinoma (OPSCC) are free from cancer following radiation therapy. Findings will be presented today at the 60th Annual Meeting of the American Society for Radiation Oncology (ASTRO).

The sophisticated, new liquid biopsy test – which measures fragments of DNA shed by cancers cells in the blood – could save thousands of dollars per patient by reducing the need for costly radiological studies such as PET/CT scans following radiation therapy and greatly increase patients’ peace of mind.

“We’ve developed a highly specific, sensitive liquid biopsy blood test for people with HPV-associated OPSCC,” said Bhisham Chera, MD, an associate professor of radiation oncology at the University of North Carolina at Chapel Hill and a member of the UNC Lineberger Comprehensive Cancer Center. “This blood test had exceptional performance in monitoring patients for cancer recurrence after radiation therapy. If the circulating tumor HPV DNA is undetectable, there is a high likelihood that the patient is in remission and cancer-free.”

The number of oral cancer cases associated with HPV has been climbing over the past several decades, even as head and neck cancers have generally been declining. Oropharyngeal SCC is the most common HPV-related cancer, and it is five times more common among men than women. This type of cancer affects the back of the throat, including the base of the tongue and tonsils, and it is most prevalent in younger, non-smoking men (median age of diagnosis in the 50s). Radiation therapy has been shown to be a highly effective treatment, but patients must be monitored for recurrence for up to five years to ensure their cancer doesn’t return.

The liquid biopsy test developed by Dr. Chera and his colleagues to monitor patients following radiation therapy is a digital polymerase chain reaction assay for HPV DNA that is highly specific, in that it does not cross-detect other types of cellular DNA; precise, in that it can be consistently reproduced; and sensitive, in that it has the ability to detect as few as six molecules of HPV DNA in a blood sample.

The test was able to predict whether a patient was cancer-free with very high accuracy, indicated by a negative predictive value — the probability that patients with a negative screening test truly don’t have cancer — of 100 percent. That type of accuracy in a liquid biopsy test, said Dr. Chera, could potentially reduce the need for costly radiological studies during post-treatment surveillance, reserving them only for patients with detectable ctHPVDNA. The cost for a liquid biopsy test of this type is in the hundreds of dollars, compared to several thousand for radiological studies.

In other types of liquid biopsy tests, explained the researchers, it can be difficult to differentiate between DNA coming from normal cells and that coming from tumor cells, making it tough to get an accurate picture.

“Viruses circulating in the body can be derived either from tumors or from normal infections, and a key challenge for post-treatment care is distinguishing between these two very different sources,” said Gaorav P. Gupta, MD, PhD, an assistant professor of radiation oncology at UNC and also a member of the Lineberger Cancer Center. “Our approach makes it possible to distinguish between tumor-derived and non-tumor sources of HPV.”

Their multianalyte assay also tests the same piece of DNA twice, allowing for verification, said Dr. Gupta. “As a result, we can now detect minute amounts of cancer in patients from a simple blood draw. In our clinical study, every patient who developed a recurrence scored positively for the test – in some cases many months before their tumors would be clinically detectable. Not a single patient that was negative for our test developed a recurrence.”

The test also uses technology that allows for a more precise count of how many pieces of tumor DNA are in the blood at any given time, said Dr. Chera. “You can see the number of fragments growing or declining, and we can make comparisons over time. Older techniques gave you a relative quantification and had limited sensitivity. Our test is providing absolute quantification, so you can actually measure how much tumor-derived HPV DNA is there each time.”

This prospective biomarker trial included 89 patients with HPV-associated OPSCC whose cancer had not spread distantly to other organs. All patients received definitive chemoradiation therapy (CRT), with 78 receiving de-intensified CRT to 60 Gray (Gy) total radiation dose and 11 receiving standard CRT to 70 Gy.

Beginning three months after treatment completion, patients were monitored with a combination of PET/CT scans, CT scans and chest x-rays every six months. Additionally, patients underwent clinical exams every two to four months for two years, and every six months for the following three years. The average follow-up time for patients on the study was 19.8 months (range: 3.7-44.7).

Blood was drawn and tested for ctHPVDNA in all patients during each follow-up visit after treatment. If ctHPVDNA was detected, additional imaging tests were performed.

Following the three-month, post-CRT scans, 70 of the 89 patients in the surveillance cohort had undetectable levels of ctHPVDNA at every follow-up visit. None of these 70 patients showed any sign of cancer recurrence. The remaining 19 patients developed a positive ctHPVDNA test result with a median interval from CRT of 16.7 months (range: 7.8-30.4) and a median value of 75 copies/mL (range 9-28,369). Eight of the patients who developed a positive test result were diagnosed with cancer recurrence (0 local, 1 regional, 7 distant). The other 11 patients showed detectable levels of ctHPVDNA (range: 23-28,369 copies/ml) but no other evidence of cancer recurrence; they are being monitored with repeat blood tests and imaging.

The test could provide patients with much-needed peace of mind, said Dr. Chera. “We are showing in this abstract that the blood test performs very well. It detects cancer before the scan detects cancer. Using this test, I can walk into a patient’s room and say, ‘You are more than likely cancer-free at this point.'”

In the future, ctHPVDNA testing may also potentially be used to screen for cervical cancer or anal cancer, which are also frequently associated with HPV infection, the authors said. They recommend further research to see if it could improve early detection of cancer recurrence and reduce costs by targeting radiographic surveillance to the subset of patients who are at greatest risk of relapse.

Intellectual property related to the test and held by the University of North Carolina at Chapel Hill has been licensed to Naveris, a company in which Dr. Chera and Dr. Gupta hold equity stakes.

Tagged with:

About author

Related Articles