ctHPVDNA detection and recurrence risk in HPV-positive OPSCC: secondary analysis of the phase 3 DART trial

Patients who undergo surgery for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) who have postoperative minimal residual disease (MRD) based on detection of circulating tumor HPV DNA (ctHPVDNA) may have higher rates of cancer recurrence. A secondary analysis including 140 participants from the De-escalated Adjuvant Radiation Therapy (DART) phase 3 randomized trial found that patients with postoperative MRD had a 5.3 times higher risk of cancer recurrence at 24 months compared with those who were MRD negative. The DART group showed a 24% difference in 24-month progression-free survival based on MRD status, and patients with fewer than 5 involved lymph nodes (ie, pN1; including extranodal extension) who were MRD negative had a 24-month PFS of 97% with DART compared to 100% with standard of care. The authors conclude that MRD status based on ctHPVDNA detection may be useful in selecting candidates for de-escalation.