Researchers have examined whether a mouthwash-based test could detect biomarkers to help physicians predict disease recurrence in patients with head and neck cancer, according to a recent study published by Franzmann et al in JAMA Otolaryngology–Head & Neck Surgery.
Background
Head and neck cancers account for nearly 4% of all cancer cases in the United States and are more commonly diagnosed in patients over 50 years of age, according to the National Cancer Institute. Male patients may be over twice as likely to be diagnosed with the disease compared with female patients.
Primary treatment options for head and neck cancers currently include surgery and radiation, which can adversely affect speech, swallowing, and appearance. These side effects can severely impact a patient’s quality of life and can be worse after recurrence. Moreover, recurrence is not always easy to detect.
“It can be very difficult to determine if what you’re observing is just posttreatment changes or … cancer recurrence,” stressed senior study author Joseph Califano III, MD, Director of the Hanna and Mark Gleiberman Head and Neck Cancer Center at the University of California, San Diego. “Good biomarkers could help remove some of the guesswork,” he suggested.
For years, mouthwash has been marketed as an essential hygiene item to prevent poor breath, even though it offers minimal if any health benefits.
“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 [recurrence],” explained lead study author Elizabeth Franzmann, MD, a head and neck surgeon at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine. “These patients suffer terribly. The more we can minimize those effects by catching recurrence early, the better we can mitigate patient morbidity and mortality,” she added.
Previous studies assessing how biomarkers in oral rinses can determine a patient’s risk for developing oral or oropharyngeal tumors—the most common types of head and neck cancers—have found a link to two key biomarkers: the tumor-initiating molecule CD44 and total protein levels.
Study Methods and Results
In the recent study, the researchers analyzed whether CD44 and total protein levels could effectively predict head and neck cancer recurrence in over 160 patients who had already received a diagnosis. The 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. Compared to patients with normal protein levels 3 months after treatment, patients with about twice as much total protein had an estimated 65% greater risk of recurrence,” Dr. Franzmann revealed.
Further, the patients with CD44 levels that were triple the normal level had an estimated 62% greater risk of head and neck cancer recurrence.
Conclusions
The researchers generated early data on a rapid, point-of-care test to measure these biomarkers, with the findings expected to help hasten its development.
“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. That’s the area we are focusing on,” Dr. Franzmann underscored.
The researchers noted that although additional research is needed, biomarkers demonstrated the potential to refine risk prediction in patients with head and neck cancers. Improving risk prediction could improve survival by reducing the need for harsh, invasive treatments.
Disclosure: The research in this study was supported by the U.S. Department of Health and Human Services, the National Institutes of Health, and the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
