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Head and Neck Surgery

(451) Site-Agnostic Recurrence Monitoring with CtHPVDNA

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • BZ

    Brian Y. Zhao, BS

    Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear
    Rego Park, NY, USA

    • Co-Author(s)

  • SN

    Saskia Naegele, MD

    Resident
    Northwell Health
    New York, New York, United States

  • VE

    Vasileios Efthymiou, MD

    Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, USA

  • SH

    Shun Hirayama, MD

    Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, USA

  • DL

    Derrick T. Lin, MD

    Chief, Division of Head and Neck Oncology
    Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear
    Boston, MA, United States

  • DD

    Dipon Das, PhD

    Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, USA

    • Senior Author(s)

  • Daniel L. Faden, MD

    Assistant Professor
    Department of Otolaryngology–Head and Neck Surgery Harvard Medical School
    Boston, MA, United States

Introduction: In recent years, numerous studies have highlighted the utility of circulating tumor HPV DNA (ctHPVDNA) as a real-time biomarker that can be used throughout a patient’s cancer course. ctHPVDNA provides a global picture of tumor status and is agnostic of metastatic site, making it suited to the challenge of atypical “out-of-field” metastases detection in post-treatment monitoring. Here, we present one such case as a discussion point for the potential of ctHPVDNA to change current post-treatment monitoring strategies for HPV+OPSCC.

Methods: Blood samples were collected before, during, and following treatment according to our lab’s published ctHPVDNA protocol and run on our custom digital droplet PCR ctHPVDNA assay.

Results: A 66-year-old male presented with cT2N3M0 HPV16+OPSCC. A pretreatment PET/CT scan showed FDG uptake in the left palatine tonsil and level II-III nodal conglomerate without evidence of distant metastatic disease. Pretreatment ctHPVDNA level was 46,502 copies/mL. The patient underwent definitive chemoradiation (CRT). Weekly ctHPVDNA monitoring showed a steady downtrend during treatment with a nadir of six copies/mL at the end of treatment, suggesting low level residual disease. Routine follow-up exams every 3 months over the next 15 months found no evidence of disease on clinical exam and endoscopy, nor on neck and chest CTs repeated at 2 month, 6 month, and 12 month intervals. However ctHPVDNA levels steadily climbed to 4,979 copies/mL during this period. On day 630 since his initial treatment, 19 months after completion of CRT, the patient presented to an outside emergency room following a fall. Imaging revealed a pathologic fracture of his right femoral neck and multifocal lytic osseous lesions in his pelvis and spine A biopsy confirmed metastatic HPV16+OPSCC.

Conclusions: Current monitoring paradigms using physical exam and neck/chest imaging are focused on local and pulmonary recurrence detection despite known atypical metastatic patterns seen in a subset of HPV+OPSCC patients. ctHPVDNA is agnostic to metastatic site and thus overcomes such limitations.