Researchers from the University of Pittsburgh and Washington University School of Medicine in St. Louis have made a groundbreaking discovery in the treatment of head and neck cancer caused by human papillomavirus (HPV).
Their study, published in Clinical Cancer Research, reveals that lymphatic fluid, usually discarded after surgery, holds critical information for tailoring patient treatments.
This research is a game-changer. It shows, for the first time, that DNA from HPV in lymphatic fluid collected post-surgery is a strong biomarker.
It can predict the risk of cancer coming back, helping doctors decide on the intensity of follow-up treatments for patients with HPV-positive head and neck cancer.
Dr. José P. Zevallos, the study’s senior author, explains that liquid biopsies (testing blood, urine, or other body fluids for cancer markers) are becoming popular for detecting cancer recurrences.
The goal here was to use this concept in a novel way – to inform treatment decisions for head and neck cancer.
The study is crucial because HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) is now more common than cervical cancer as an HPV-related disease, with rising cases worldwide.
Recurrences in head and neck cancer patients are often due to elusive cancer cells that survive initial treatments. The researchers were curious whether lymphatic fluid, drained post-surgery, could be more telling than blood in these cases.
The findings were remarkable. The study included over 100 patients with HPV-positive OPSCC. The team collected lymphatic fluid and blood samples after tumor removal surgery.
They found that cell-free DNA from HPV was present in 78% of the lymphatic fluid samples but only 12% of blood samples. The levels were much higher in lymph, indicating that it’s a more sensitive detector of cancerous DNA than blood.
This finding aligns with the standard clinical practice where doctors inspect lymph nodes and surgical margins for malignant cells.
The presence of HPV DNA in lymphatic fluid was closely related to the number and aggressiveness of cancer in lymph nodes. For patients with no metastatic lymph nodes, there was no detectable HPV DNA in the lymph fluid.
This new test is more informative than traditional methods. In two cases, patients considered low-risk based on pathology relapsed within a year.
Their blood samples showed no cf-HPV, but their lymphatic fluid was positive for it, suggesting that the new test can identify high-risk patients who might be overlooked otherwise.
Moreover, this test could help in reducing treatment intensity safely. For example, three patients who underwent chemoradiation didn’t have detectable cf-HPV in their lymph fluid, indicating a lower recurrence risk.
This suggests that they might have been eligible for less aggressive treatment.
The researchers didn’t stop there. They developed a machine learning model to predict which patients would remain disease-free and which would experience a relapse.
This model includes data from blood and lymphatic fluid, along with pathology and other patient information. The cf-HPV from lymphatic fluid was a key part of this model.
Dr. Zevallos highlights the potential impact of this discovery: being able to predict, just 24 hours after surgery, which patients will have a recurrence and which will remain cancer-free. This information is invaluable for making clinical treatment decisions.
The team is now working on validating their findings and developing a similar test for HPV-negative head and neck cancers.
Their work is transforming how we approach cancer treatment, moving towards more personalized and effective strategies.
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The research findings can be found in Clinical Cancer Research.
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