Squamous
cell
carcinoma
(SCC)
is
the
most
common
malignancy
of
head
and
neck.
Stagnating
survival
rates
in
recent
decades,
despite
advances
treatment
paradigms,
surveillance
technologies,
multidisciplinary
care,
leave
clinicians
with
a
need
for
better
options
screening,
risk-stratifying,
monitoring
patients.
A
growing
proportion
patients
HPV-associated
SCC
have
improved
outcomes
but
continue
to
heterogenous
response
treatment.
Advances
platforms
assays
measuring
circulating
tumor
DNA
offer
an
opportunity
monitor
disease
status
at
molecular
level
both
virally
mediated
traditional
risk-factor-driven
This
overview
will
discuss
experimental,
clinically
used,
commercially
available
liquid
biopsy
their
applications
neck
malignancies.
IMPORTANCE:
Early
detection
of
Head
and
Neck
Squamous
Cell
Carcinoma
(HNSCC)
recurrence
in
HPV-positive
patients
is
crucial
for
improving
survival
rates
reducing
treatment
costs.
Integrating
circulating
tumor
DNA
(ctDNA)
testing
as
part
post-treatment
surveillance
may
enhance
timely
cancer
detection,
reduce
false-positive
rates,
lower
overall
OBJECTIVE:
To
develop
evaluate
personalized,
cost-effective
strategies
that
integrate
ctDNA
with
established,
computed
tomography
(CT)
scans,
the
goal
minimizing
costs
delays
HNSCC
patients.
METHODS:
We
constructed
a
microsimulation
model
optimizes
timing
tests
generates
schedules
designed
to
achieve
below
specified
thresholds
at
minimum
cost.
The
was
fit
using
n=
840
training
data
validated
447
external
data.
Six
sub-populations
were
created
based
on
combination
stage
(AJCC
8th
edition
1,
2,
3)
smoking
status
(non-smoker
ever-smoker).
study
compared
proposed
ctDNA-based
strategy
established
clinical
guidelines,
well
from
literature.
RESULTS:
Our
optimization
generated
cost-effecive
scheduling
range
delay
tolerances
(i.e.,
3,
6,
9
months)
across
six
subpopulations.
optimal
demonstrated
substantial
cost
savings,
potentially
annual
USA
by
least
$200
million
imaging-based
while
matching
an
equal
patient
outcome
delay.
Additionally,
hypothetical
scenario
monthly
testing,
incurring
comparable
total
existing
guidelines’,
offers
32%
reduction
also
highlighted
growing
importance
surveillance,
incidence
projected
rise,
further
emphasizing
cost-saving
potential
integration.
CONCLUSION:
traditional
imaging
methods
minimizes
delays.
As
population
grows,
significance
savings
will
increase.
Future
research
should
focus
applicability
developed
their
impact
quality
life.
Current Oncology Reports,
Год журнала:
2025,
Номер
unknown
Опубликована: Фев. 26, 2025
Abstract
Purpose
of
Review
Although
it
is
now
firmly
established
that
the
presence
human
papillomavirus
(HPV)
expression
in
oropharyngeal
cancer
associated
with
a
favorable
prognosis,
implications
respect
to
treatment
remain
uncertain.
However,
recognition
HPV-positive
exquisitely
sensitive
radiation
and
chemotherapy
has
raised
questions
regarding
appropriateness
historical
paradigms,
clinical
trials
have
been
conducted
assess
whether
patients
can
be
treated
less
intensive
regimens.
The
fundamental
goal
de-escalation
preserve
high
rates
cure
survival
from
traditional
approaches
while
reducing
incidence
both
short-
long-term
side
effects.
data
reporting
on
relatively
limited.
Recent
Findings
While
evidence
date
promising,
heterogeneity
published
studies
particularly
trial
design,
approach,
inclusion
criteria,
selection
made
drawing
definitive
conclusions
difficult.
use
differing
endpoints
related
disease
control
quality
life
also
complicated
comparison
across
literature.
Summary
Multiple
uncertainties
continue
exist
current
state
for
cancer,
how
consider
growing
context
decision-making
future
subject
this
review.
Neoadjuvant
immunotherapy
in
human
papillomavirus
(HPV)-negative
locoregionally
advanced
(LA)
head
and
neck
squamous
cell
carcinoma
(HNSCC)
appears
promising,
yet
its
role
nonsurgical
treatment
for
cancer
remains
undefined.
nivolumab
plus
chemotherapy
followed
by
response-stratified
de-escalated
chemoradiation
therapy
(CRT)
HPV-negative
LA
stage
IVa/b
HNSCC
may
improve
efficacy
while
reducing
treatment-related
toxic
effects.
To
determine
the
deep
response
rate
tolerability
of
neoadjuvant
CRT
nonvirally
mediated
HNSCC.
In
this
investigator-initiated
phase
2
nonrandomized
clinical
trial
conducted
at
a
single
academic
center,
patients
with
(American
Joint
Committee
on
Cancer
Tumor
Classification,
8th
edition)
were
enrolled
between
2019
2022.
Data
analyzed
from
February
2023
to
January
2024.
The
DEPEND
evaluated
carboplatin
paclitaxel,
CRT.
Patients
50%
or
greater
reduction
per
Response
Evaluation
Criteria
Solid
Tumors
(RECIST)
version
1.1
received
66
Gy
elimination
elective
nodal
volumes;
less
than
standard
70
75
Gy.
Adjuvant
was
administered
9
cycles.
primary
end
point
(DRR;
shrinkage
RECIST
1.1)
following
chemotherapy.
Secondary
points
included
progression-free
survival
(PFS),
overall
(OS),
locoregional
control,
distant
control.
Exploratory
acute
effects
who
response-adapted
Of
36
patients,
28
(78%)
male,
median
(range)
age
58.9
(27-77)
years.
All
started
available
analysis.
follow-up
20
(13-40)
months.
met,
DRR
nivolumab/chemotherapy
53%
(95%
CI,
35-70).
objective
86%
71-95).
A
total
19
16
PFS
OS
years
66%
34-76)
73%
52-86),
respectively.
most
common
treatment-emergent
adverse
events
mucositis
(14
[74%]
15
[94%],
respectively),
radiation
dermatitis
(13
[68%]
14
[88%],
dry
mouth
(7
[37%]
10
[63%],
respectively).
trial,
led
responses
HNSCC,
favorable
lower
among
responders.
ClinicalTrials.gov
Identifier:
NCT03944915.
