ctDNA Testing for Oropharyngeal Cancer

Recruiting in Palo Alto (17 mi)

+6 other locations

Overseen by Linda Chen, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Memorial Sloan Kettering Cancer Center

Disqualifiers: Metastatic disease, Non-HPV16, Prior radiation, others

No Placebo Group

Prior Safety Data

Trial Summary

What is the purpose of this trial?

This trial is testing a blood test to detect tiny pieces of HPV DNA in people with throat cancer who have had surgery. The goal is to see if this test can help decide if and when they need more treatment like radiation or chemotherapy.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of this treatment for oropharyngeal cancer?

Research shows that circulating tumor DNA (ctDNA) is a promising biomarker for monitoring and predicting treatment response in HPV-related oropharyngeal cancer. It can help in early diagnosis, assess treatment effectiveness, and detect disease recurrence, potentially improving patient outcomes. ^{1 2 3 4 5}

Is ctDNA testing for oropharyngeal cancer safe for humans?

The research does not provide specific safety data for ctDNA testing in humans, but it is being actively studied as a promising tool for monitoring and diagnosing HPV-related oropharyngeal cancer. ^{1 2 3 4 5}

How is the ctDNA Testing for Oropharyngeal Cancer treatment different from other treatments?

This treatment is unique because it uses circulating tumor DNA (ctDNA) as a biomarker to monitor the response to therapy and detect disease recurrence in HPV-related oropharyngeal cancer. This approach allows for more personalized treatment adjustments, potentially improving outcomes and reducing unnecessary side effects compared to traditional methods. ^{1 2 3 4 5}

Research Team

Linda Chen, MD

Principal Investigator

Memorial Sloan Kettering Cancer Center

Eligibility Criteria

This trial is for adults with HPV-16 related oropharyngeal cancer who've had surgery to remove the tumor and show no signs of cancer in post-op imaging. They must have certain blood markers, good organ function, and be able to consent. People with metastatic disease, non-HPV16 cancers, prior chemo for this cancer, severe health issues like recent heart failure or infections can't join.

Inclusion Criteria

My post-surgery HPV cancer tests were negative twice.

My cancer has spread beyond its original location or has cells at the surgery margin.

Signed informed consent form by the participant or their legally authorized representative (LAR).

Exclusion Criteria

Severe, active co-morbidity defined as follows: - Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months - Transmural myocardial infarction within the last 6 months - Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration - Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization within 30 days of registration - Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects - Lack of ability to understand and willingness to sign a written informed consent and complete questionnaires.

My cancer has spread to other parts of my body.

I have cancer in areas other than the oropharynx.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Active Surveillance

Monitoring of HPV ctDNA levels to determine the need for radiation therapy

Up to 4 weeks

Regular monitoring visits

Treatment (Arm A)

Delayed standard of care adjuvant radiation based on HPV ctDNA levels

50-60 Gy administered in 1.8-2 Gy fractions

Multiple visits for radiation therapy

Treatment (Arm B)

De-escalated treatment with adjuvant radiation and concurrent chemotherapy

3 weeks

Multiple visits for radiation and chemotherapy

Follow-up

Participants are monitored for safety and effectiveness after treatment

2 years

Regular follow-up visits

Treatment Details

Interventions

• Chemoradiation (CombinationProduct)
• HPV ctDNA Assay (Diagnostic Test)
• Intensity-Modulated Radiation Therapy (Radiation)

Trial Overview The study tests if monitoring cell-free tumor DNA (ctDNA) levels can guide treatment timing after surgery. Arm A explores delaying radiation therapy until ctDNA is detectable again. Arm B checks if patients normally needing longer chemoradiation could receive a shorter 3-week course based on their ctDNA levels.

Participant Groups

Group I: Screening, active surveillance, and treatment (Arm A) Experimental Treatment 6 Interventions

Participants who meet criteria for the treatment phase (a post-operative HPV ctDNA which rose from initial undetectable to meet HPV16 ctDNA criteria and have no clinical or radiographic evidence of gross disease) will undergo delayed standard of care adjuvant radiation (50-60 Gy administered in 1.8-2 Gy fractions) based on the patient's initial pathology. Treatment will be initiated within 4 weeks of a NavDx result. Subjects will undergo FDG PET/CT simulation and standard radiation treatment planning and this FDG PET/CT will also be utilized to rule out distant metastases. Diagnostic FDG PET/CT fusion is also allowed for treatment planning and to rule out distant metastases. Non-therapeutic assessments will be completed.

Group II: Screening and deescalated treatment (Arm B) Experimental Treatment 6 Interventions

Participants who meet criteria for the de-escalated treatment phase (Arm B) will undergo adjuvant radiation (30 Gy administered in 2 Gy fractions) with concurrent chemotherapy. They will undergo FDG PET/CT simulation and standard radiation treatment planning and this FDG PET/CT will also be utilized to rule out distant metastases. Diagnostic FDG PET/CT fusion is also allowed for treatment planning and to rule out distant metastases. Non-therapeutic assessments will be completed and the Study calendar.

Chemoradiation is already approved in China for the following indications:

Approved in China as Baizean for:

• Classical Hodgkin’s lymphoma (cHL)
• Locally advanced or metastatic urothelial carcinoma (UC)
• Locally advanced or metastatic non-small cell lung cancer (NSCLC)
• Advanced unresectable or metastatic microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) solid tumors
• Locally advanced or metastatic esophageal squamous cell carcinoma (ESCC)
• Recurrent or metastatic nasopharyngeal cancer (NPC)

Who Is Running the Clinical Trial?

Memorial Sloan Kettering Cancer Center

Lead Sponsor

Trials

1,998

Recruited

602,000+

Lisa M. DeAngelis

Memorial Sloan Kettering Cancer Center

Chief Medical Officer since 2021

MD from Columbia University

Selwyn M. Vickers

Memorial Sloan Kettering Cancer Center

Chief Executive Officer since 2022

MD from Johns Hopkins University

Findings from Research

Circulating tumor DNA (ctDNA) is a promising biomarker for diagnosing and monitoring human papillomavirus-related oropharyngeal squamous cell carcinoma, potentially improving patient management.

Changes in ctDNA levels during and after treatment may indicate disease response, which could inform decisions on whether to intensify or reduce treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Current Role of Human Papillomavirus Circulating Tumor DNA in Oropharynx Cancer. Regan, SN., Mierzwa, ML.[2023]

In a study of 34 patients with stage III oropharyngeal squamous cell carcinoma, low levels of circulating tumor DNA (ctDNA) before treatment and an early increase during treatment were linked to better outcomes, indicating that ctDNA can be a useful biomarker for predicting treatment response.

The study found that ctDNA levels correlated well with imaging biomarkers from MRI and FDG-PET scans, suggesting that ctDNA and imaging metrics are similarly effective in predicting freedom from progression after chemoradiation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early HPV ctDNA Kinetics and Imaging Biomarkers Predict Therapeutic Response in p16+ Oropharyngeal Squamous Cell Carcinoma. Cao, Y., Haring, CT., Brummel, C., et al.[2022]

HPV-related oropharyngeal squamous cell carcinoma (OPSCC) generally has better treatment outcomes compared to non-virally mediated cancers, prompting research into strategies that reduce treatment toxicity while maintaining survival rates.

Circulating tumor (ct) DNA is a promising biomarker for monitoring treatment response and disease recurrence in head and neck cancers, particularly in HPV-related OPSCC, suggesting potential for its integration into clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The future of circulating tumor DNA as a biomarker in HPV related oropharyngeal squamous cell carcinoma. Haring, CT., Dermody, SM., Yalamanchi, P., et al.[2022]

Circulating tumor DNA (ctDNA) is a promising biomarker in oropharyngeal squamous cell carcinoma, particularly for patients with human papillomavirus (HPV)-related cancers, as it may help in assessing prognosis and monitoring treatment response.

Current research highlights the importance of understanding ctDNA dynamics, especially in clinical trials aimed at treatment de-escalation, indicating its potential role in detecting minimal residual disease and guiding future therapeutic strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Circulating Tumor DNA in Human Papillomavirus-Mediated Oropharynx Cancer: Leveraging Early Data to Inform Future Directions. Heft Neal, ME., Walline, HM., Haring, CT.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

The Current Role of Human Papillomavirus Circulating Tumor DNA in Oropharynx Cancer. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Early HPV ctDNA Kinetics and Imaging Biomarkers Predict Therapeutic Response in p16+ Oropharyngeal Squamous Cell Carcinoma. [2022]

3. England pubmed.ncbi.nlm.nih.gov

The future of circulating tumor DNA as a biomarker in HPV related oropharyngeal squamous cell carcinoma. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Circulating Tumor DNA in Human Papillomavirus-Mediated Oropharynx Cancer: Leveraging Early Data to Inform Future Directions. [2023]

5. England pubmed.ncbi.nlm.nih.gov

Circulating tumor-tissue modified HPV DNA testing in the clinical evaluation of patients at risk for HPV-positive oropharynx cancer: The IDEA-HPV study. [2023]