Journal: Journal of medical virology
This publication reviews the current evidence on circulating tumor HPV DNA (ctHPVDNA) as a liquid biopsy tool in human papillomavirus–associated oropharyngeal squamous cell carcinoma (HPV-OPSCC).
Key points:
- Clinical context: HPV-OPSCC differs from HPV-negative disease in biology, prognosis, failure patterns, and patient demographics. Outcomes are generally favorable, but randomized trials have not yet validated treatment de-escalation.
- Technology: ctHPVDNA detection via droplet digital PCR and next-generation sequencing offers high sensitivity and specificity. These assays can quantify viral DNA and provide information about tumor burden and HPV integration.
- Baseline ctHPVDNA:
- • Levels correlate with tumor volume and disease burden.
- • Associations exist between baseline levels, HPV integration status, and clinical outcomes.
- During treatment:
- • Rapid clearance of ctHPVDNA during radiation correlates strongly with improved disease control.
- • Slow or incomplete clearance may indicate higher risk of treatment failure.
- Postoperative and surveillance use:
- • Detectable or persistent ctHPVDNA after surgery is linked to increased recurrence risk.
- • In surveillance, ctHPVDNA can identify recurrence earlier than imaging in some studies and shows high positive and negative predictive values, in some cases outperforming conventional imaging.
- Limitations and future directions:
- • Assay methodologies are heterogeneous and not yet standardized.
- • Larger prospective validation is needed before ctHPVDNA can be routinely integrated into risk-adapted treatment de-escalation or escalation strategies for HPV-OPSCC.