Blood-based test could personalize treatment for patients with HPV-associated throat cancer

Researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) are advancing the understanding of a promising blood test that could personalize treatment and surveillance for patients with human papillomavirus (HPV)-associated throat cancer.

The research, published in JAMA Otolaryngology – Head and Neck Surgery, explores how a blood-based test, circulating tumor HPV DNA (ctDNA), changes before and after surgery. The study explores how tumor biology and patient factors influence ctDNA levels. The findings provide important new insight into how this ctDNA test can be used along with pathology reports to improve risk assessment and personalize treatment plans.

We know that more than 90% of throat cancer cases are caused by HPV. While this type of cancer responds well to treatment, patient quality of life is impacted by radiation and chemotherapy. Improved biomarkers could help us better tailor treatment to reduce unnecessary side effects while ensuring patients receive the therapy they need."

Catherine Haring, MD, otolaryngologist specializing in head and neck cancers and assistant professor in the Department of Otolaryngology - Head and Neck Surgery, The Ohio State University College of Medicine

The study followed 104 adult patients who were treated for HPV-associated throat cancer between September 2021 – April 2025. Twenty patients were female and 84 were male, and most had early stage tumors located in the tonsils. All patients underwent surgery to remove the cancer, with additional therapy (radiation and/or chemotherapy) recommended based on pathologic risk factors.

Circulating tumor HPV DNA was tested before surgery in all patients, and after surgery (prior to radiation) in 74 patients.

"We found that the pretreatment ctDNA levels are influenced by tumor biology and kidney function," Haring said. "Postoperative ctDNA reflects both residual cancer and baseline tumor DNA levels. This means the test needs to be interpreted in context. A positive result after surgery may indicate higher risk, but a negative result does not always mean a patient is in the clear." In practical terms, this means the blood test can provide an additional layer of insight after surgery, helping doctors better understand a patient's risk when combined with standard pathology.

More than 22,000 people are diagnosed with HPV-associated throat cancer each year, according to the Centers for Disease Control and Prevention. Rates of disease are higher in men than in women.

Following surgery and radiation, patients may experience long-term side effects such as difficulty swallowing, dry mouth, taste changes, sleep apnea and hypothyroidism.

Future research will focus on improving the sensitivity of ctDNA testing and integrating it into multifactorial risk models that combine biomarker data with traditional clinical and pathologic risk factors to better personalize care.

Additional Ohio State researcher coauthors include: Jack Birkenbeuel, MD; Christopher Noel, MD, PhD; Lauren Miller, MD; Enver Ozer, MD; Amit Agrawal, MD; Kyle VanKoevering, MD; Stephen Kang, MD; Nolan Seim, MD; and James Rocco, MD, PhD.