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Invited Commentary
October 2015

Persistent Salivary Human Papillomavirus DNA as a Surveillance Biomarker: Not Just Spitting in the Wind

Author Affiliations
  • 1Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 2Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Oncol. 2015;1(7):915-917. doi:10.1001/jamaoncol.2015.2606

Although patients with human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC) have a much better prognosis than HPV-negative patients, up to 25% still experience recurrence. Furthermore, efforts to reduce toxic therapy are controversial due to the potential risk for increasing recurrence; thus, early detection of residual or recurrent disease is important to institute salvage therapy.

In this issue of JAMA Oncology, Rettig and colleagues1 show that persistent oral HPV type 16 (HPV16) DNA, measured in pre- and posttreatment rinses of patients undergoing curative-intent therapy for HPV-positive OPSCC, is a harbinger of poor recurrence-free survival. Whereas their data are intriguing, an important clinical question is raised: Does the oral rinse, a noninvasive surveillance tool, identify subclinical local or locoregional recurrence (LRR) at a time amenable to surgical salvage?

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