HeadWay
Winter 2017

For diseases that are chronic or can recur, such as human papilloma virus (HPV)-related head and neck cancers, doctors not only have to develop a plan for the present—how to treat a patient’s current condition—but also for the future. If only they could accurately predict whether a patient’s disease will be cured or if it might return, says otolaryngologist–head and neck surgeon Carole Fakhry, they could help patients make better decisions in the moment about how aggressively to treat or to monitor.

That’s why she and her colleagues are working on a variety of different methods to predict recurrence and long-term survival.

Fakhry explains that these cancers tend to strike those who are relatively young and otherwise healthy. Researchers have long known that those with HPV-related cancers tend to respond better to treatments compared with patients whose cancers aren’t linked to this virus. However, many cases may not warrant therapy as intense as the present standard of care, which can leave patients with life-long side effects.

Initial work by Fakhry and multidisciplinary colleagues suggests that measuring blood levels of antibody against HPV could help doctors risk-stratify patients. “It might eventually help us decide who needs more aggressive treatment and who will do just as well with a less intense approach,” she says.

Fakhry and her colleagues are also developing a nomogram, a risk calculator that can accurately predict a patient’s survival using a variety of variables. Having a good idea of a patient’s chance of survival could affect the type of treatment they opt for in the future, Fakhry says.

The researchers are also interested in earlier identification of recurrent disease. “Even at the time of recurrence, which we thought was a dismal event, patients tend to have a better prognosis if they’re HPV-positive,” Fakhry says.

That prognosis likely improves even more if doctors are able to catch recurrences early when surgery can be performed, she adds. In the current system, however, patients who are HPV-positive and -negative receive the same limited surveillance protocol: basic clinical exams.

To improve their ability to catch recurrences in the HPV-positive population, Fakhry and her colleagues are developing a blood- or saliva-based test that has the potential to discover the presence of returning disease before it’s clinically apparent. Their early work shows that after a patient’s initial cancer is treated, markers of HPV decrease. If this measure begins to increase again, their findings suggest that the cancer could be on its way back, which could potentially give doctors an early alert to search for recurrent disease.

“We’re in a very different place than we were even three years ago, when all we knew was that an HPV-positive patient did better than an HPV-negative one,” Fakhry says. “Now we can make predictions within the HPV-positive population, opening new doors for our patients’ care.”