Findings from a new study show how a mouthwash-based test may help predict head and neck cancer recurrence.
Head and neck cancers account for nearly 4 per cent of all cancers in the U.S. and are more commonly diagnosed in people over age 50, according to the National Cancer Institute.
Currently, primary treatment options include surgery and radiation, which can affect speech, swallowing and appearance, severely affecting a patient’s quality of life, and these effects can be even worse after recurrence.
Now, in order to predict recurrence, a team of researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, UC San Diego Health and collaborating cancer centres, have suggested in their new study that biomarkers could be detected from a mouthwash rinse.
Elizabeth Franzmann, MD, a head and neck surgeon at Sylvester, and co-corresponding author of the study, explained: “Our study suggests biomarker detection in saliva collected from an oral rinse after initial treatment offers potential to readily assess recurrence risk.
“Elevated levels of either of two biomarkers were associated with disease return.”
The findings have been published in JAMA Otolaryngology – Head & Neck Surgery.
Catching cancer recurrence
Catching a recurrence of head and neck cancer can be difficult.
Joseph Califano III, MD, director of UC San Diego’s Hanna and Mark Gleiberman Head and Neck Cancer Center and the study’s co-corresponding author, explained: “It can be very difficult to determine if what you’re observing is just post-treatment changes or a cancer recurrence.
“Good biomarkers could help remove some of the guesswork.”
Franzmann, whose research lab is focused on finding an inexpensive, non-invasive screening test for these cancers, emphasised the importance of early recurrence detection.
“These patients suffer terribly.
“The more we can minimise those effects by catching recurrence early, the better we can mitigate patient morbidity and mortality.”
Franzmann and her team have previously studied how biomarkers in oral rinses can assess a person’s risk for developing oral or oropharyngeal tumours, the most common types of head and neck cancers, finding a link with two key biomarkers – CD44, a tumour-initiating molecule, and total protein levels.
In this new study, the researchers studied whether those two biomarkers could predict recurrence in already-diagnosed patients.
Their clinical trial evaluated the effects of CD44 and total protein levels in 160-plus patients across multiple cancer centres.
Patients were provided oral-rinse samples for use up to 18 months after their initial treatment.
To measure biomarker presence, the researchers used laboratory tests and experimental lateral-flow tests, technology similar to stick-based pregnancy and COVID-19 tests.
“Our laboratory assays showed an association between biomarker levels and later recurrence,” Franzmann said.
“Compared to patients with normal protein levels three months after treatment, patients with about twice as much total protein had an estimated 65 per cent greater risk of recurrence.”
The results shoed that patients with CD44 levels that were triple the normal level had an estimated 62 per cent percent greater recurrence risk.
The study also generated early data on a rapid, point-of-care test to measure these biomarkers.
“It would be really useful if we had a test that was inexpensive and could be performed and resulted while the patient was in the office,” said Franzmann.
“That’s the area we are focusing on.”
Franzmann and her collaborators have noted that although additional research is needed, biomarkers show great promise for refining risk prediction in patients with head and neck cancers.
Better risk prediction, in turn, has the potential to save lives by reducing the need for harsh, invasive treatments.
