# Survival of Metastatic Human Papillomavirus (HPV)-Related Head and Neck Cancer Receiving Platinum-Based Triplet Induction Chemotherapy and Relevance of Circulating Tumor HPV DNA

## TL;DR

This study shows that HPV-related head and neck cancer patients respond better to a specific chemotherapy and that tracking HPV DNA in the blood can guide treatment decisions.

## Contribution

The study introduces the clinical relevance of monitoring circulating tumor HPV DNA during induction chemotherapy for metastatic HNSCC.

## Key findings

- HPV-related HNSCC patients had a 100% response rate to induction chemotherapy compared to 36% in HPV-unrelated patients.
- ctHPVDNA levels can detect drug resistance earlier than radiographic imaging during treatment.
- ctHPVDNA monitoring can inform treatment decisions and reflect real-time disease activity.

## Abstract

Objectives

We aimed to examine the effectiveness of platinum-based triplet induction chemotherapy in metastatic squamous cell carcinoma of the head and neck (HNSCC) at diagnosis in terms of tumor human papillomavirus (HPV) status and the clinical relevance of circulating tumor HPV DNA (ctHPVDNA) during induction chemotherapy.

Methods

Twenty-one patients were included. ctHPVDNA was longitudinally quantified using optimized digital PCR in a subset of patients.

Results

HPV-related HNSCC patients (N=7) had a significantly better response to induction chemotherapy than HPV-unrelated HNSCC patients (N=14) (complete or partial response rate, 100% vs. 36%, P = 0.007). Following induction chemotherapy, more HPV-related HNSCC patients than HPV-unrelated patients received radiotherapy (86% vs. 36%, P = 0.06). With a median follow-up of 26 months in surviving patients, the two-year overall survival was 86% in HPV-related HNSCC patients and 43% in HPV-unrelated HNSCC patients (P = 0.04). In two patients, ctHPVDNA levels drastically decreased after the first cycle of induction chemotherapy but turned to continuous increase after the second cycle, suggesting the acquisition of drug resistance by the end of the second cycle. Radiographic imaging after induction chemotherapy failed to identify the drug resistance. In one patient, ctHPVDNA decreased gradually but remained detectable after induction chemotherapy despite no radiographic residual disease. ctHPVDNA became undetectable during radiotherapy.

Conclusion

HPV-related HNSCC patients with distant metastasis at diagnosis should be treated definitively. The ctHPVDNA level reflects real-time disease activity. ctHPVDNA monitoring during induction chemotherapy could help the decision-making of the therapeutic strategy.