Treatment Paradigms Are Shifting for Locally Advanced HPV-Positive Head and Neck Cancers

Date: November 18th, 2021 Authors: Kaveh Zakeri, MD, MAS, Nancy Y. Lee, MD Source: OncLive The standard of care for patients with locally advanced head and neck squamous cell carcinomas does not substantially differ according to human papillomavirus (HPV) status in the National Comprehensive Cancer Network guidelines.1 Resectable tumors can be treated with surgery followed by adjuvant therapy. Alternatively, definitive chemoradiation therapy with cisplatin is the other dominant treatment paradigm. Incidence of HPV-associated oropharyngeal squamous cell carcinoma has increased rapidly and is associated with higher overall survival (OS) compared with cancers caused by smoking and alcohol.2,3 Given the unique biology of HPV-associated oropharyngeal disease, a separate staging system was developed for these tumors.4 HPV-associated oropharyngeal cancers are more radiosensitive and chemosensitive than cancers caused by smoking and alcohol, yet the traditional treatment paradigms—including high doses of radiation and chemotherapy—were developed prior to the epidemic of HPV-associated disease. De-escalation of therapy has been proposed for HPV-associated oropharyngeal cancer based on data demonstrating high OS and progression-free survival (PFS).5 De-escalation of therapy has been investigated for both definitive surgical and chemoradiation therapy paradigms. Most de-escalated approaches focus on selecting patients according to clinical features, such as disease stage and smoking status, whereas personalized de-escalation reduces treatment intensity for patients according to treatment response. Transoral Robotic Surgery Followed by Adjuvant Radiotherapy Transoral robotic surgery (TORS) is a minimally invasive approach that reduces morbidity compared with traditional, open surgery for patients with oropharyngeal cancers. TORS is a standard of care option for patients with [...]

2021-12-06T11:00:39-07:00December, 2021|Oral Cancer News|

Two new studies show how to enhance effectiveness of cancer immunotherapy

Source: www.news-medical.net Author: Reviewed by Emily Henderson, B.Sc. Two new studies revealed that anti-PD-1 immunotherapy given before surgery was safe and effective for patients with oral-cavity squamous cell carcinoma (OCSCC) and identified potential molecular biomarkers in the blood and tumors of patients that would show how likely it is that someone would respond to immunotherapy. The studies, recently published in Cell Reports Medicine, were a collaborative effort between MUSC Hollings Cancer Center, UCLA Jonsson Comprehensive Cancer Center and Winship Cancer Institute of Emory University. Due to the highly invasive and resistant nature of OCSCC, researchers looked to anti-PD-1 immune checkpoint inhibitors to improve outcomes as this type of immunotherapy has revolutionized the way patients with advanced malignancies are treated. OCSCC, a subset of head and neck cancer, is prevalent in South Carolina due to the history of tobacco use. These cancers oftentimes require complicated surgeries that may be disfiguring, as treatment may involve removing all or a portion of the jawbone and tongue. David Neskey, M.D., a Hollings head and neck cancer specialist and co-senior author of the studies, said 50% of these patients will have a recurrence, and only 60% of patients are alive five years later. "This cancer can impact a patient's ability to talk and breathe," Neskey said. "It can impact a patient's ability to go out to a restaurant or socialize with friends and family. It's one of the reasons so many head and neck cancer doctors are seeking ways to improve outcomes for these patients." [...]

Combination of drugs causes tumours to vanish in some terminally ill patients, study finds

Source: www.theguardian.com Author: Andrew Gregory, Health editor In a landmark trial, a cocktail of immunotherapy medications harnessed patients’ immune systems to kill their own cancer cells and prompted “a positive trend in survival”, according to researchers at the Institute of Cancer Research (ICR), London, and the Royal Marsden NHS foundation trust. One patient, who was expected to die four years ago, told the Guardian of the “amazing” moment nurses called him weeks after he joined the study to say his tumour had “completely disappeared”. The 77-year-old grandfather is now cancer-free and spent last week on a cruise with his wife. Scientists found the combination of nivolumab and ipilimumab medications led to a reduction in the size of tumours in terminally ill head and neck cancer patients. In some, their cancer vanished altogether, with doctors stunned to find no detectable sign of disease. Combining the two immunotherapy drugs could prove an effective new weapon against several forms of advanced cancer, experts believe. Results from other trials of the drug combination have previously suggested similar benefits for terminally ill kidney, skin and bowel cancer patients. As well as boosting the long-term survival chances of patients, scientists said, the immunotherapy treatment also triggered far fewer side-effects compared with the often gruelling nature of “extreme” chemotherapy, which is the standard treatment offered to many patients with advanced cancer. The results from the phase 3 trial, involving almost 1,000 dying head and neck cancer patients, were early and not statistically significant but were still “clinically [...]

New cancer treatments may be on the horizon – thanks to success in mRNA vaccine trial

Source: www.goodnewsnetwork.org Author: Andy Corbley A personalized, mRNA vaccine, given to patients with particular kinds of aggressive cancers could leverage the immune system of the patient to kill the cancer on its own, and in doing so usher in a new epoch of cancer treatment. Messenger RNA (ribonucleic acid) vaccines were what sparked the COVID-19 vaccine drives, as Pfizer and Moderna adapted the technology to create an emergency treatment to train the body to fight off the viral spike protein. What most of us won’t know however, is that the mRNA vaccines were originally in development for aggressive cancer types. Molly Cassidy, a mother studying for the Arizona Bar exam, is living proof that while the approach isn’t a panacea, it can clear away some of the most dreadful and fast cancers we know of. After being diagnosed with head and neck cancer, she underwent surgery and chemotherapy. However it was only ten days after finishing chemo that she found a marble-like bump on her collarbone from the cancer’s swift return. Later examinations found it had spread from her ear all the way to her lungs, and she was told to get her affairs in order. Cassidy was told she was eligible to join a clinical trial at the University of Arizona, testing an mRNA vaccine personalized to the cancer mutations of the host. By 27 weeks, Cassidy had received nine vaccine doses paired with an immunotherapy drug, and her CT scans were clear: the cancer had left her body. [...]

2021-09-07T05:46:03-07:00September, 2021|Oral Cancer News|

‘On the rise:’ Immunotherapy options for head and neck cancer

Source: www.curetoday.com Author: Kristie L. Kahl On behalf of the Head and Neck Cancer Alliance, Dr. Michael Moore spoke with CURE® about emerging therapies that potentially offer exciting new options for the future. Although rates of head and neck cancer have risen, in part because of the human papillomavirus (HPV), emerging therapies such as targeted agents and immunotherapies are paving the way for future treatment of the disease, according to Dr. Michael Moore. “I would say (immunotherapy) is probably one of the more exciting parts of what we’ve learned about head and neck cancer in recent years,” he told CURE® as a part of its “Speaking Out” video series. On behalf of the Head and Neck Cancer Alliance, CURE® spoke with Moore, associate professor of otolaryngology-head and neck surgery and chief of head and neck surgery at Indiana University School of Medicine in Indianapolis, about targeted therapies, immunotherapy and how clinical trials are leading the way for future treatments. How have genomics and targeted therapies played a role in head and neck cancer treatment? Well, I would say it’s an emerging role. And it’s not used as commonly in head-neck cancer as it is in some other areas. So molecular testing or targeted therapies essentially are looking at a very specific part of the tumor to see if we can develop a specific drug that will target just that; (the goal is to) weaken the cancer’s defense — that is one way to say it — and try to very [...]

Henderson throat cancer patient rallies after cutting-edge treatment

Source: www.reviewjournal.com Author: Mary Hynes, Las Vegas Review-Journal In February, a cancerous tumor caused extreme swelling in Ruben Solis’ neck and face, blocking his airway. After an emergency tracheotomy, an incision to his windpipe that allowed him to breathe, Solis had to decide whether he wanted to enter a clinical trial to receive an experimental treatment. The 54-year-old Henderson resident was skeptical. But with stage 4 laryngeal cancer that had spread to his lungs, he was running out of options. Three months later, after three treatments, the tumors in his throat and lungs have dramatically shrunk and the swelling subsided. “I feel much better,” Solis said Monday. The father and grandfather, who worked in banquets and as a food and beverage manager on the Strip before falling ill, is the first person in the world to receive a combination of two experimental drugs, Enoblituzumab and Retifanlimab, as part of a new clinical trial for head and neck cancer, according to Comprehensive Cancer Centers of Nevada, the local site participating in the global study. Solis and his oncologist, Dr. Anthony Nguyen, spoke with reporters prior to the patient receiving his fourth infusion of the two drugs. The treatment is a new form of immunotherapy, which boosts the body’s immune system to combat the cancer. “So his immune system is actually being manipulated, turned on, to actually fight the cancer from inside,” Nguyen said. In this way it is different from traditional chemotherapy. “When we think of chemotherapy and cancer medicine, we [...]

Genetic changes in head and neck cancer, immunotherapy resistance identified

Source: MedicalXPress Date: April 26th, 2021 Author: University of San Diego-California A multi-institutional team of researchers has identified both the genetic abnormalities that drive pre-cancer cells into becoming an invasive type of head and neck cancer and patients who are least likely to respond to immunotherapy. "Through a series of surprises, we followed clues that focused more and more tightly on specific genetic imbalances and their role in the effects of specific immune components in tumor development," said co-principal investigator Webster Cavenee, Ph.D., Distinguished Professor Emeritus at University of California San Diego School of Medicine. "The genetic abnormalities we identified drive changes in the immune cell composition of the tumors that, in turn, dictates responsiveness to standard of care immune checkpoint inhibitors." Reporting in the April 26, 2021 online issue of the Proceedings of the National Academy of Sciences, researchers describe the role of somatic copy-number alterations—abnormalities that result in the loss or gain in a copy of a gene—and the loss of chromosome 9p in the development of human papillomavirus (HPV)-negative head and neck cancer. The loss of chromosome 9p and the deletion of JAK2 and PD-LI, two neighboring genes found on chromosome 9p, was associated with resistance to immune checkpoint inhibitors, a type of cancer immunotherapy that uses antibodies to make tumor cells visible to a patient's immune system. "Although programmed death-1 (PD-1) immune checkpoint inhibitors represent a major breakthrough in cancer treatment, only 15 percent of patients with HPV-negative head and neck cancer respond to treatment," said [...]

2021-04-27T10:01:12-07:00April, 2021|Oral Cancer News|

Cancer vaccine shows early promise across tumor types

Source: www.webmd.com Author: Walter Alexander A personalized cancer vaccine proved possible to manufacture and was well tolerated in an early phase I clinical trial, researchers said. The vaccine, known as PGV-001, was given to 13 patients with solid tumors or multiple myeloma who had a high risk of recurrence after surgery or stem cell transplant. At last follow-up, four patients were still alive without evidence of disease and had not received subsequent therapy, four were alive and receiving therapy, three had died, and two could not be contacted for follow-up. Thomas Marron, MD, of Mount Sinai in New York presented these results at the American Association for Cancer Research Annual Meeting recently. “While cancer immunotherapy has revolutionized the treatment of cancer, we know that the majority of patients fail to achieve significant clinical response,” Marron said during his presentation. Personalized vaccines may help prime an improved immune response, he said. With this in mind, Marron and colleagues developed PGV-001, a vaccine consisting of customized peptides – a kind of amino acid -- given to patients along with initial treatment. Feasibility and safety Vaccines were given to 13 patients. Six had head and neck cancer, three had multiple myeloma – a cancer of the white blood cells -- two had lung cancer, one had breast cancer, and one had bladder cancer. Eleven patients received all 10 intended doses, and two patients received at least eight doses. “The vaccine was well tolerated, with only half of patients experiencing mild, grade 1 adverse [...]

Deactivating cancer cell gene boosts immunotherapy for head and neck cancers

Source: newsroom.ucla.edu Author: Brianna Aldrich By targeting an enzyme that plays a key role in head and neck cancer cells, researchers from the UCLA School of Dentistry were able to significantly slow the growth and spread of tumors in mice and enhance the effectiveness of an immunotherapy to which these types of cancers often become resistant. Their findings, published online in the journal Molecular Cell, could help researchers develop more refined approaches to combating highly invasive head and neck squamous cell cancers, which primarily affect the mouth, nose and throat. Immunotherapy, which is used as a clinical treatment for various cancers, harnesses the body’s natural defenses to combat disease. Yet some cancers, including head and neck squamous cell carcinomas, don’t respond as well to the therapy as others do. The prognosis for these head and neck cancers is poor, with a high five-year mortality rate, and there is an urgent need for effective treatments. The UCLA research team, led by distinguished professor Dr. Cun-Yu Wang, chair of oral biology at the dentistry school, demonstrated that by targeting a vulnerability in the cellular process of tumor duplication and immunity, they could affect tumor cells’ response to immunotherapy. The enzyme they focused on, KDM4A, is what is known as an epigenetic factor — a molecule that regulates gene expression, silencing some genes in cells and activating others. In squamous cell head and neck cancers, overexpression of KDM4A promotes gene expression associated with cancer cell replication and spread. It is well known that [...]

On treating advanced head and neck cancer without cisplatin – an oncology grand rounds discussion

Source: www.medpagetoday.com Author: Mark L. Fuerst An oncology grand rounds discussion with Sachin Jhawar, MD. Head and neck squamous cell carcinoma (HNSCC) represents a heterogeneous set of diseases with different features and treatment recommendations. Physicians face challenges in initial treatment decision-making and response assessments, including the changing role of surgery, the incorporation of human papilloma and Epstein Barr virus status, as well as the potential for treatment de-escalation using patient-related and tumor-related factors. A recent "Oncology Grand Rounds" article in the Journal of Clinical Oncology provides an overview of treating advanced HNSCC when cisplatin is not an option, including concurrent chemotherapy, cetuximab, targeted therapy, and immunotherapy. In the following interview, the paper's lead author, Sachin Jhawar, MD, of Ohio State University Comprehensive Cancer Center in Columbus, reviews the main issues. What is the focus of the article? Jhawar: We focused on patients with locally advanced disease who would be receiving definitive non-surgical treatment when possible treatment with concurrent cisplatin, delivered either every 3 weeks or weekly, is always the preferred treatment. We specifically wanted to delve into the subset of patients who we would not recommend to receive cisplatin because of age or comorbidities. This could be concurrent chemotherapy (carboplatin/paclitaxel), concurrent cetuximab, and altered or standard fractionation radiation schedules without systemic therapy, as well as when to consider immunotherapy and palliative radiation for those with recurrent or metastatic disease. There is also a great deal of institutional preference involved. At our institution, we prefer concurrent carboplatin/paclitaxel in patients who cannot [...]

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