Double trouble: Synchronous and metachronous primaries confound ctHPVDNA monitoring

Head Neck. 2023 Jun;45(6):E25-E30. doi: 10.1002/hed.27378. Epub 2023 Apr 20.

Abstract

Background: Human papillomavirus-associated head and neck squamous cell carcinoma (HPV + HNSCC) occurs in the oropharynx (HPV + OPSCC), sinonasal cavity (HPV + SNSCC), and nasopharynx (HPV + NPC). Circulating tumor HPV DNA (ctHPVDNA) is an accurate tool for diagnosis, treatment monitoring, and recurrence detection. An emerging challenge with ctHPVDNA is that ~7.4% of HPV + HNSCC patients develop synchronous or metachronous HPV+ primaries, which could confound ctHPVDNA monitoring.

Methods: We describe a 65-year-old patient with T2N1M0 HPV16 + OPSCC and a 55-year-old patient with T2N2M0 HPV16 + OPSCC. Both patients were enrolled in our prospective observational ctHPVDNA study with longitudinal blood collections throughout treatment. Both patients developed multiple HPV+ primaries.

Results: Detailed discussion of the patients' treatment courses, the subsequent diagnoses of their second HPV+ primaries, and their ctHPVDNA monitoring is presented.

Conclusions: As ctHPVDNA use becomes more prevalent, it is important to recognize that an increase in ctHPVDNA can come not only from the primary tumor or metastatic clones, but also from synchronous or metachronous second primaries.

Keywords: cell-free DNA; circulating tumor DNA; human papillomavirus (HPV); oropharyngeal; sinonasal; squamous cell carcinoma.

Publication types

  • Observational Study
  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell* / diagnosis
  • Carcinoma, Squamous Cell* / pathology
  • Carcinoma, Squamous Cell* / therapy
  • Circulating Tumor DNA*
  • Head and Neck Neoplasms* / diagnosis
  • Head and Neck Neoplasms* / therapy
  • Humans
  • Middle Aged
  • Oropharyngeal Neoplasms* / pathology
  • Papillomavirus Infections* / pathology
  • Squamous Cell Carcinoma of Head and Neck

Substances

  • Circulating Tumor DNA