101
|
Human Papillomavirus (HPV): A Criterion for Therapeutic Decision in Squamous Cell Carcinoma of the Head and Neck? Recent Results Cancer Res 2017. [PMID: 27699535 DOI: 10.1007/978-3-319-43580-0_10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
When deciding how to treat patients with squamous cell carcinoma of the head and neck (SCCHN), several factors have to be taken into account: disease factors, patient factors, treatment factors, and the wish of the patient. This symposium article is summarizing the information on HPV (p16) in the context of decision making in SCCHN patients with locoregionally advanced disease and those with recurrent/metastatic disease. The literature data suggest that HPV(p16) has prognostic significance, both in locoregionally advanced disease (in particular, in oropharynx cancer) and in recurrent/metastatic disease, while there are only limited data on its predictive significance. Results of HPV (p16) testing should not change management outside clinical trials.
Collapse
|
102
|
Rieke DT, Keilholz U. Systemic Treatment in HPV-Induced Recurrent or Metastatic HNSCC. Recent Results Cancer Res 2017; 206:149-160. [PMID: 27699536 DOI: 10.1007/978-3-319-43580-0_11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Recurrent or metastatic head and neck cancer describes tumor deposits that arise locally, regionally, or at distant sites after treatment or distant metastases at the time of primary diagnosis. Prognosis for R/M squamous cell carcinomas of the head and neck (HNSCC) is poor and treatment options are limited in this situation. Human papillomavirus (HPV) is an important risk factor for HNSCC. About 40 % of all HNSCC have been attributed to HPV in Europe. HPV positivity at initial diagnosis is the single best prognostic factor for survival. However, data for the prognostic and predictive value of HPV in the R/M situation are still scarce. Due to the rising incidence of HPV-associated cancers, the number of R/M HPV+ carcinomas is also expected to rise. This chapter therefore aims to give an overview of the current knowledge concerning the role of HPV as a prognostic and predictive marker in recurrent or metastatic HNSCC.
Collapse
Affiliation(s)
- Damian T Rieke
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Keilholz
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
103
|
Yom SS. Is Induction Chemotherapy Needed to Select Patients for Deintensified Treatment of Human Papillomavirus-Associated Oropharyngeal Cancer? J Clin Oncol 2017; 35:479-481. [DOI: 10.1200/jco.2016.71.0681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sue S. Yom
- Sue S. Yom, University of California, San Francisco, CA
| |
Collapse
|
104
|
Juergens RA, Bratman SV, Tsao MS, Laurie SA, Sara Kuruvilla M, Razak ARA, Hansen AR. Biology and patterns of response to EGFR-inhibition in squamous cell cancers of the lung and head & neck. Cancer Treat Rev 2017; 54:43-57. [PMID: 28192747 DOI: 10.1016/j.ctrv.2017.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/20/2016] [Accepted: 01/08/2017] [Indexed: 02/07/2023]
Abstract
The identification of common molecular aberrations that drive cancer progression has led to targeted therapies that improve treatment efficacy in many tumor types. Epidermal growth factor receptor (EGFR) inhibitors have been used to treat both lung and head and neck cancers with squamous cell histology. These tumors often show high EGFR expression and/or increased gene copy number, but low incidence of the activating kinase domain mutations common to adenocarcinomas of the lung. In this manuscript, we review clinical trial data on EGFR-inhibitors in the treatment of squamous cell carcinoma (SqCC) of the lung and head and neck (SCCHN), including both efficacy and biomarker analyses. Although some efficacy with use of EGFR inhibitors is observed, the level of benefit varies within and across tumor types, and the predictive capacity of high EGFR protein expression and/or gene amplification, if any, is limited. Due to the lack of candidate biomarkers that consistently predict response to EGFR-inhibitor therapy across treatment setting and class of agent in SqCC of the lung and SCCHN, we explore the biology, genomics and patterns of response to EGFR-inhibitors to inform identification of potential biomarkers, highlighting several key molecules that have shown promise in preclinical studies and clinical trials across multiple cancer sites.
Collapse
Affiliation(s)
- Rosalyn A Juergens
- Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession Street, 3rd Floor Medical Oncology, Hamilton, ON L8V 5C2, Canada.
| | - Scott V Bratman
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
| | - Ming-Sound Tsao
- Department of Pathology, University Health Network, Department of Laboratory Medicine and Pathobiology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
| | - Scott A Laurie
- Division of Medical Oncology, University of Ottawa, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
| | - M Sara Kuruvilla
- Division of Medical Oncology, Western University, London Regional Cancer Program, 790 Commissioners Road East, London ON, Canada.
| | - Albiruni R A Razak
- Division of Medical Oncology and Hematology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
| |
Collapse
|
105
|
Faraji F, Eisele DW, Fakhry C. Emerging insights into recurrent and metastatic human papillomavirus-related oropharyngeal squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2017; 2:10-18. [PMID: 28894817 PMCID: PMC5510283 DOI: 10.1002/lio2.37] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022] Open
Abstract
Objective To review recent literature on human papillomavirus‐related (HPV‐positive) oropharyngeal squamous cell carcinoma (OPC) and focus on implications of recurrent and metastatic disease. Methods Primary articles from 1990 to 2016 indexed in MEDLINE (1) pertaining to the epidemiology of HPV‐positive OPC and (2) providing clinical insight into recurrent and metastatic OPC. Results The incidence of HPV‐positive OPC is increasing globally. HPV‐positive OPC is a subtype with distinct molecular and clinical features including enhanced treatment response and improved overall survival. While disease recurrence is less common in patients with HPV‐positive OPC, up to 36% of patients experience treatment failure within eight years. Recurrent and metastatic OPC has historically signified poor prognosis, however recent data are challenging this dogma. Here, we discuss recurrent and metastatic OPC in the context of HPV tumor status. Conclusion HPV‐positive OPC exhibits distinct genetic, cellular, epidemiological, and clinical features from HPV‐negative OPC. HPV tumor status is emerging as a marker indicative of improved prognosis after disease progression in both locoregionally recurrent and distant metastatic OPC. Level of Evidence N/A.
Collapse
Affiliation(s)
- Farhoud Faraji
- Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland
| |
Collapse
|
106
|
Wong SJ, Heron DE, Stenson K, Ling DC, Vargo JA. Locoregional Recurrent or Second Primary Head and Neck Cancer: Management Strategies and Challenges. Am Soc Clin Oncol Educ Book 2017; 35:e284-92. [PMID: 27249734 DOI: 10.1200/edbk_157804] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Treatment of patients with locoregional recurrent or second primary head and neck squamous cell cancer (HNSCC) has been guided by well-reasoned principles and informed by carefully tested chemotherapy and radiation regimens. However, clinical decision making for this population is complicated by many factors. Although surgery is generally considered the treatment of choice for patients with HNSCC with recurrent disease or new second primary disease in a previously irradiated field, operability of cases is not always straightforward. Postoperative treatment is frequently warranted but carries significant risk. In addition, the rapid rise in the incidence of HPV-associated HNSCC raises the question of whether established treatment paradigms should be re-examined in this population of patients with a much better prognosis than the non-HPV population. Furthermore, new radiation techniques and new systemic agents show early promising results in recent clinical studies, suggesting potential for practice-changing effects in the future management of this disease. This article examines each of the treatment modalities used in the care of patients with HNSCC with recurrent or new second primary disease and provides a perspective to aid clinicians in the management of this disease.
Collapse
Affiliation(s)
- Stuart J Wong
- From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA; Rush University Medical Center, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI
| | - Dwight E Heron
- From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA; Rush University Medical Center, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI
| | - Kerstin Stenson
- From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA; Rush University Medical Center, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI
| | - Diane C Ling
- From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA; Rush University Medical Center, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI
| | - John A Vargo
- From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA; Rush University Medical Center, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
107
|
Ham JC, Tops BBJ, Driessen CML, van Raaij AWM, Slootweg PJ, Melchers WJG, Ligtenberg MJL, van Herpen CML. Using a semi-conductor sequencing-based panel for genotyping of HPV-positive and HPV-negative oropharyngeal cancer: a retrospective pilot study. Clin Otolaryngol 2017; 42:681-686. [PMID: 27882657 DOI: 10.1111/coa.12800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess the feasibility of testing actionable mutations in small amounts of formalin-fixed paraffin-embedded material in multiple genes of the receptor tyrosine kinase pathway and to determine the frequency of these mutations in human papillomavirus (HPV)-positive and HPV-negative oropharyngeal cancer (OPC). DESIGN A retrospective pilot study was performed. SETTING In OPC, no predictive markers for response to epidermal growth factor receptor inhibition are known. Therefore, identifying predictive biomarkers is of utmost importance, but is often hampered by the small amount of tumour material available. PARTICIPANTS We included the archival material of 45 OPC, all treated with concomitant chemoradiotherapy between 2003 and 2010. MAIN OUTCOME MEASURES Besides the HPV status, we assessed mutations using a gene panel that targets 16 genes in the receptor tyrosine kinase pathway and six other genes. The polymerase chain reaction required only 10 ng DNA. RESULTS In total, 42 of the 45 biopsies have been successfully analysed. In total 20 of 42 samples were HPV-positive and 22 of 42 were HPV-negative. In the receptor tyrosine kinase pathway, mutations in PIK3CA were most frequently identified. A TP53 mutation was identified in one HPV-positive sample and in 13 HPV-negative samples. Additionally, three mutations in three different genes were found. CONCLUSIONS We evaluated an assay to identify mutations in the receptor tyrosine kinase pathway. As only small amounts of formalin-fixed paraffin-embedded material are sufficient for reliable analysis, this test opens up new possibilities for personalised medicine.
Collapse
Affiliation(s)
- J C Ham
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B B J Tops
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C M L Driessen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A W M van Raaij
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P J Slootweg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W J G Melchers
- Department of Medical Microbiology and Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M J L Ligtenberg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
108
|
Rieke DT, Klinghammer K, Keilholz U. Targeted Therapy of Head and Neck Cancer. Oncol Res Treat 2016; 39:780-786. [PMID: 27889751 DOI: 10.1159/000452432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/04/2016] [Indexed: 11/19/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is one of the most common solid cancers worldwide. It is mainly caused by exposure to tobacco smoke and alcohol as well as infection with the human papilloma virus (HPV). The prognosis is poor, especially once it recurs or metastasizes. Current therapeutic options include surgery, radio- and chemotherapy. Epidermal growth factor receptor (EGFR) inhibitors are so far the only targeted agents that have been approved in head and neck cancer. Primary or secondary resistance is frequent or will eventually develop. Several driver mutations and other genomic aberrations have been described in HNSCC including EGFR overexpression and amplification. Yet, no predictive biomarkers for the application of EGFR inhibitors have been identified. Further targeted agents are in development for HNSCC, of which inhibitors of the PI3K pathway are the closest to clinical application. In recent years, the incidence of HPV-driven HNSCC has risen in Western countries. HPV-positive and -negative HNSCC are distinct molecular tumor entities, and consequences for targeted therapies have been discussed. This review looks at approved and investigational targeted treatment strategies as well as potential predictive biomarkers such as the HPV status to guide treatment.
Collapse
Affiliation(s)
- Damian T Rieke
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | |
Collapse
|
109
|
Kelly JR, Husain ZA, Burtness B. Treatment de-intensification strategies for head and neck cancer. Eur J Cancer 2016; 68:125-133. [PMID: 27755996 PMCID: PMC5734050 DOI: 10.1016/j.ejca.2016.09.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 01/16/2023]
Abstract
Increasingly, squamous cell carcinoma of the oropharynx (OPSCC) is attributable to transformation resulting from high-risk human papillomavirus (HPV) infection. Such cancers are significantly more responsive to treatment than traditional tobacco- and alcohol-associated squamous cell cancers of the head and neck. Conventional management with definitive chemoradiation, surgery and adjuvant radiation, or radiation given with altered fractionation schemes, while effective, incurs long-term morbidity that escalates with treatment intensity and significantly impairs quality of life. Recent trials have suggested that less intensive treatment regimens may achieve similar efficacy with decreased toxicity. In this article, we review the primary strategies used for de-escalation of treatment, which include the reduction of radiation dose, substitution and/or elimination of concurrent radiosensitising chemotherapy, and the use of minimally invasive surgery. We discuss the rationale behind these approaches and the preliminary data demonstrating the success of de-escalation, as well as potential considerations raised by treatment de-intensification in HPV-associated OPSCC.
Collapse
Affiliation(s)
- Jacqueline R Kelly
- Yale University School of Medicine, Department of Therapeutic Radiology, 35 Park St, LL509, New Haven, CT 06519, USA
| | - Zain A Husain
- Yale University School of Medicine, Department of Therapeutic Radiology, 35 Park St, LL509, New Haven, CT 06519, USA
| | - Barbara Burtness
- Yale University School of Medicine, Department of Medicine (Medical Oncology), 333 Cedar St., PO Box 208028, New Haven, CT 06520-8028, USA.
| |
Collapse
|
110
|
Heaton CM, Yu K, Calkins S, George JR, Ryan WR, Wang SJ. Clinicopathologic characteristics and outcomes of recurrent oropharyngeal squamous cell carcinoma. Am J Otolaryngol 2016; 37:513-516. [PMID: 27522438 DOI: 10.1016/j.amjoto.2016.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Positive p16 immunohistochemical staining is predictive of improved survival and response to treatment. The purpose of this study is to determine the clinicopathologic characteristics and outcomes of patients with p16+ oropharynx cancer who fail initial treatment. MATERIALS AND METHODS Case series including all patients with recurrent oropharyngeal squamous cell carcinoma from 2002 to 2014. RESULTS Forty patients met inclusion criteria. Thirty-one (77.5%) tumors were p16+ and 9 (22.5%) were p16-. There was no difference in T/M stage at diagnosis; more patients with p16+ tumors presented initially with ≥N2 disease (p=0.04). Regional and/or metastatic recurrence was more common in the p16+ group as compared to the p16- group - 71% vs 22.2%, p=0.003. Outcomes for both groups were poor - 67.7% p16+ and 44.4% p16- patients died from disease. CONCLUSIONS Compared to p16- recurrent tumor patients, p16+ recurrent tumor patients were more likely to experience regional or distant metastatic recurrence. Overall outcomes for both p16+ and p16- recurrent oropharynx tumors were poor.
Collapse
|
111
|
Ausoni S, Boscolo-Rizzo P, Singh B, Da Mosto MC, Spinato G, Tirelli G, Spinato R, Azzarello G. Targeting cellular and molecular drivers of head and neck squamous cell carcinoma: current options and emerging perspectives. Cancer Metastasis Rev 2016; 35:413-26. [PMID: 27194534 PMCID: PMC5524458 DOI: 10.1007/s10555-016-9625-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite improvements in functional outcomes attributable to advances in radiotherapy, chemotherapy, surgical techniques, and imaging techniques, survival in head and neck squamous cell carcinoma (HNSCC) patients has improved only marginally during the last couple of decades, and optimal therapy has yet to be devised. Genomic complexity and intratumoral genetic heterogeneity may contribute to treatment resistance and the propensity for locoregional recurrence. Countering this, it demands a significant effort from both basic and clinical scientists in the search for more effective targeted therapies. Recent genomewide studies have provided valuable insights into the genetic basis of HNSCC, uncovering potential new therapeutic opportunities. In addition, several studies have elucidated how inflammatory, immune, and stromal cells contribute to the particular properties of these neoplasms. In the present review, we introduce recent findings on genomic aberrations resulting from whole-genome sequencing of HNSCC, we discuss how the particular microenvironment affects the pathogenesis of this disease, and we describe clinical trials exploring new perspectives on the use of combined genetic and cellular targeted therapies.
Collapse
Affiliation(s)
- Simonetta Ausoni
- Department of Biomedical Sciences, University of Padua, Padova, Italy
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Regional Hospital, Treviso, Italy
| | - Bhuvanesh Singh
- Laboratory of Epithelial Cancer Biology, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Maria Cristina Da Mosto
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Regional Hospital, Treviso, Italy
| | - Giacomo Spinato
- Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, Trieste, Italy
| | - Giancarlo Tirelli
- Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, Trieste, Italy
| | - Roberto Spinato
- Department of Otorhinolaryngology, Head and Neck Surgery, Dell'Angelo Hospital, Mestre, Venezia, Italy
| | - Giuseppe Azzarello
- Department of Medical Oncology, Mirano Hospital, Local Health Unit 13, Mirano, Venezia, Italy.
| |
Collapse
|
112
|
Jimeno A, Machiels JP, Wirth L, Specenier P, Seiwert TY, Mardjuadi F, Wang X, Kapp AV, Royer-Joo S, Penuel E, McCall B, Pirzkall A, Clement PM. Phase Ib study of duligotuzumab (MEHD7945A) plus cisplatin/5-fluorouracil or carboplatin/paclitaxel for first-line treatment of recurrent/metastatic squamous cell carcinoma of the head and neck. Cancer 2016; 122:3803-3811. [DOI: 10.1002/cncr.30256] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/22/2016] [Accepted: 07/25/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Antonio Jimeno
- Division of Medical Oncology; University of Colorado School of Medicine; Aurora Colorado
| | - Jean-Pascal Machiels
- King Albert II Institute, Medical Oncology Service, Saint-Luc University Clinic and Clinical and Experimental Research Institute (Pole MIRO), Catholic University of Louvain; Brussels Belgium
| | - Lori Wirth
- Department of Hematology/Oncology; Massachusetts General Hospital; Boston Massachusetts
| | - Pol Specenier
- Department of Medical Oncology; Antwerp University Hospital; Edegem Belgium
| | - Tanguy Y. Seiwert
- Department of Hematology/Oncology; University of Chicago Medical Center; Chicago Illinois
| | - Feby Mardjuadi
- King Albert II Institute, Medical Oncology Service, Saint-Luc University Clinic and Clinical and Experimental Research Institute (Pole MIRO), Catholic University of Louvain; Brussels Belgium
| | | | | | | | | | | | | | - Paul M. Clement
- Department of General Medical Oncology; University Hospitals Leuven; Leuven Belgium
- Department of Oncology; KU Leuven; Leuven Belgium
| |
Collapse
|
113
|
Campbell NP, Hensing TA, Bhayani MK, Shaikh AY, Brockstein BE. Targeting pathways mediating resistance to anti-EGFR therapy in squamous cell carcinoma of the head and neck. Expert Rev Anticancer Ther 2016; 16:847-58. [PMID: 27400139 DOI: 10.1080/14737140.2016.1202116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION As epidermal growth factor receptor (EGFR) is overexpressed in approximately 90% of squamous cell carcinomas of the head and neck (SCCHN), several therapeutic agents that target EGFR have been evaluated for the treatment of SCCHN. Although patients with SCCHN derive clinical benefit from anti-EGFR agents, most notably the EGFR monoclonal antibody cetuximab, these patients eventually become resistant to EGFR-based therapies; preclinical studies have shown activation of secondary signaling pathways that lead to resistance to EGFR inhibition and, as such, serve as potential therapeutic targets to overcome resistance to EGFR inhibitors. AREAS COVERED This review summarizes the results of recently completed trials of anti-EGFR agents in SCCHN, highlights the various mechanisms that drive resistance to EGFR inhibitors in SCCHN, and focuses on several novel targeted agents that could potentially help overcome resistance to EGFR-based therapies in SCCHN. Expert commentary: Due to the development of resistance to EGFR-targeted therapies, novel treatment approaches to overcome resistance are a key unmet need for SCCHN.
Collapse
Affiliation(s)
- Nicholas P Campbell
- a Kellogg Cancer Center , NorthShore University HealthSystem , Evanston , IL , USA
| | - Thomas A Hensing
- a Kellogg Cancer Center , NorthShore University HealthSystem , Evanston , IL , USA
| | - Mihir K Bhayani
- a Kellogg Cancer Center , NorthShore University HealthSystem , Evanston , IL , USA
| | - Arif Y Shaikh
- a Kellogg Cancer Center , NorthShore University HealthSystem , Evanston , IL , USA
| | - Bruce E Brockstein
- a Kellogg Cancer Center , NorthShore University HealthSystem , Evanston , IL , USA
| |
Collapse
|
114
|
|
115
|
Abstract
INTRODUCTION Recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC) has a dismal prognosis. With the emergence of monoclonal antibodies and tyrosine kinase inhibitors (TKI) targeting the epidermal growth factor receptor (EGFR), several drugs were developed and tested in HNSCC. To date, the monoclonal antibody cetuximab is the only approved therapy for curative and recurrent/metastatic patients. Other EGFR-targeting drugs either failed in the clinical trials or are still in the early phases of drug development and research. AREAS COVERED In this article, previously published data and ongoing studies regarding dacomitinib, a second-generation irreversible TKI, for the treatment of HNSCC are presented and discussed. EXPERT OPINION The current body of evidence is not mature enough to indicate the use of dacomitinib for the treatment of HNSCC in curative or in recurrent/metastatic settings. Phase II data suggest the potential of improved outcome in selected recurrent/metastatic HNSCC based on several biomarkers, which need to be evaluated in randomized phase III trials. Meanwhile, an ongoing phase I study is investigating dacomitinib's optimal dosing combined with and without cisplatin in the curative concomitant chemoradiotherapy setting.
Collapse
Affiliation(s)
- Olgun Elicin
- a Department of Radiation Oncology, Inselspital , Bern University Hospital and University of Bern , Bern , Switzerland
| | - Mahmut Ozsahin
- b Department of Radiation Oncology , University of Lausanne, Centre Hospitalier Universitaire Vaudois (CHUV) , Lausanne , Switzerland
| |
Collapse
|
116
|
Wirth LJ. Cetuximab in Human Papillomavirus–Positive Oropharynx Carcinoma. J Clin Oncol 2016; 34:1289-91. [DOI: 10.1200/jco.2015.65.1414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
117
|
Truong Lam M, O'Sullivan B, Gullane P, Huang SH. Challenges in establishing the diagnosis of human papillomavirus-related oropharyngeal carcinoma. Laryngoscope 2016; 126:2270-5. [PMID: 27074870 DOI: 10.1002/lary.25985] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/18/2016] [Accepted: 02/25/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe initial presentations and idiosyncrasies in establishing the diagnosis for human papillomavirus-related (HPV(+) ) compared to HPV-unrelated (HPV(-) ) oropharyngeal carcinoma (OPC). STUDY DESIGN A single institution retrospective series derived from an institutional prospectively compiled database supplemented by chart review. METHODS We reviewed consecutive OPC patients referred to an academic tertiary cancer center from 2009 to 2011. HPV status was evaluated by p16 staining. Signs/symptoms and procedures to establish diagnosis were recorded independently by two abstractors blinded to the HPV status during data retrieval. Initial presentations (signs/symptoms), interval, and the procedures to establish the diagnosis were compared between HPV(+) and HPV(-) OPC. RESULTS The most common initial presentation was an asymptomatic nodal mass for HPV(+) patients (n = 208; 69% vs. 29%, P < .001) in contrast to dysphagia/odynophagia for HPV(-) (n = 96; 34% vs. 63%, P < .001). Protracted interval (>12 months) from onset of signs/symptoms to diagnosis was observed in 18 (9%) HPV(+) versus three (3%) HPV(-) patients (P = .058). More HPV(+) patients required repeated (≥2) biopsy procedures (56% vs. 10%, P < .001). Misattribution to other disease occurred in eight (4%) HPV(+) patients (seven were mistaken as having a "branchial cleft cyst" when there were cystic lymph nodes and one as having a "lymphoma") compared to none in HPV(-) . CONCLUSIONS About two-thirds of HPV(+) patients present with an asymptomatic neck mass and often require multiple biopsy procedures to establish the diagnosis. Idiosyncrasies in appreciating the diagnostic setting (cystic lymph node, misattribution to other entities, or submucosal location of the tumor) or patient-related factors could delay the diagnosis of HPV(+) OPC. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2270-2275, 2016.
Collapse
Affiliation(s)
- Michelle Truong Lam
- Department of Radiation Therapy, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Gullane
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Therapy, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. .,Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
118
|
Nakano T, Yamamoto H, Nakashima T, Nishijima T, Satoh M, Hatanaka Y, Shiratsuchi H, Yasumatsu R, Toh S, Komune S, Oda Y. Molecular subclassification determined by human papillomavirus and epidermal growth factor receptor status is associated with the prognosis of oropharyngeal squamous cell carcinoma. Hum Pathol 2016; 50:51-61. [DOI: 10.1016/j.humpath.2015.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 01/04/2023]
|
119
|
Dok R, Nuyts S. HPV Positive Head and Neck Cancers: Molecular Pathogenesis and Evolving Treatment Strategies. Cancers (Basel) 2016; 8:cancers8040041. [PMID: 27043631 PMCID: PMC4846850 DOI: 10.3390/cancers8040041] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/09/2016] [Accepted: 03/23/2016] [Indexed: 01/02/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a highly heterogeneous disease that is the result of tobacco and/or alcohol abuse or infection with high-risk Human papillomaviruses. Despite the fact that HPV positive HNSCC cancers form a distinct clinical entity with better treatment outcome, all HNSCC are currently treated uniformly with the same treatment modality. At present, biologic basis of these different outcomes and their therapeutic influence are areas of intense investigation. In this review, we will summarize the molecular basis for this different outcome, novel treatment opportunities and possible biomarkers for HPV positive HNSCC. In particular, the focus will be on several molecular targeted strategies that can improve the chemoradiation response by influencing DNA repair mechanisms.
Collapse
Affiliation(s)
- Rüveyda Dok
- Laboratory of Experimental Radiotherapy, Department of Oncology, Katholieke Universiteit Leuven (KU Leuven), 3000 Leuven, Belgium.
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Katholieke Universiteit Leuven (KU Leuven), 3000 Leuven, Belgium.
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium.
| |
Collapse
|
120
|
p16 cutoff in head and neck squamous cell carcinoma: correlation between tumor and patient characteristics and outcome. Int J Biol Markers 2016; 31:e44-52. [PMID: 26481441 DOI: 10.5301/jbm.5000175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND p16 has been indicated as a suitable surrogate biomarker of HPV infection. The prognosis of p16-positive oropharynx tumors (OTs) of squamous cell carcinoma (SCC) histology is better than that of p16-negative tumors. METHODS We analyzed 209 samples of head and neck SCC to establish a predictive cutoff for p16 and determine the role of p16 positivity in OTs versus non-OTs. We compared the outcomes of tumors harboring any percentage of p16-positive cells (≥1%) with those of p16-negative OTs. We then considered 3 cutoffs (10%, 50% and 70% positive cells) to evaluate the outcome of OTs/non-OTs with similar p16 expression and p16-positive versus p16-negative tumors stratified by patient age. RESULTS p16-negative tumors among OTs and non-OTs were 29% and 49%, respectively (p = 0.0054). The cumulative distribution showed that the positive values were located around 2 focus points: 2% and 96%. Subgroup analysis showed that only OTs occurred in young patients (aged <65 years) and that there was a ≥70% gain in survival in cases with p16-positive cells. CONCLUSIONS p16 positivity influences outcome only in young patients and OTs (p = 0.048).
Collapse
|
121
|
Swiecicki PL, Malloy KM, Worden FP. Advanced oropharyngeal squamous cell carcinoma: Pathogenesis, treatment, and novel therapeutic approaches. World J Clin Oncol 2016; 7:15-26. [PMID: 26862488 PMCID: PMC4734935 DOI: 10.5306/wjco.v7.i1.15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/07/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Oropharyngeal cancer accounts for approximately 2.8% of newly cancer cases. Although classically a tobacco related disease, most cases today are related to infection with human papilloma virus (HPV) and present with locally advanced tumors. HPV related tumors have been recognized as a molecularly distinct entity with higher response rates to therapy, lower rates of relapse, and improved overall survival. Treatment of oropharyngeal cancer entails a multi-disciplinary approach with concomitant chemoradiation. The role of induction chemotherapy in locally advanced tumors continues to be controversial however large studies have demonstrated no difference in survival or time to treatment failure. Surgical approaches may be employed with low volume oropharyngeal cancers and with development new endoscopic tools, more tumors are able to be resected via an endoscopic approach. Given advances in the understanding of HPV related oropharyngeal cancer, ongoing research is looking at ways to minimize toxicities via de-intensification of therapy. Unfortunately, some patients develop recurrent or metastatic disease. Novel therapeutics are currently being investigated for this patient population including immunotherapeutics. This review discusses the current understanding of the pathogenesis of oropharyngeal cancer and treatment. We also discuss emerging areas of research as it pertains to de-intensification as well novel therapeutics for the management of metastatic disease.
Collapse
|
122
|
Rosenthal DI, Harari PM, Giralt J, Bell D, Raben D, Liu J, Schulten J, Ang KK, Bonner JA. Association of Human Papillomavirus and p16 Status With Outcomes in the IMCL-9815 Phase III Registration Trial for Patients With Locoregionally Advanced Oropharyngeal Squamous Cell Carcinoma of the Head and Neck Treated With Radiotherapy With or Without Cetuximab. J Clin Oncol 2015; 34:1300-8. [PMID: 26712222 DOI: 10.1200/jco.2015.62.5970] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We conducted a retrospective evaluation of the IMCL-9815 study to examine the association of human papillomavirus (HPV) and p16 protein expression status with outcomes in patients with oropharyngeal carcinoma (OPC) receiving radiotherapy (RT) plus cetuximab or RT alone. PATIENTS AND METHODS In the IMCL-9815 study, patients were randomly allocated to receive RT plus weekly cetuximab or RT alone. A subpopulation of patients with p16-evaluable OPC was retrospectively evaluated on the basis of locoregional control (LRC), overall survival (OS), and progression-free survival (PFS). Evaluable samples from patients with p16-positive OPC were also tested for HPV DNA. RESULTS Tumor p16 status was evaluable in 182 patients with OPC enrolled in the IMCL-9815 study; 41% were p16 positive. When treated with RT alone or RT plus cetuximab, p16-positive patients had a longer OS than p16-negative patients (hazard ratio, 0.40; 95% CI, 0.21 to 0.74 and hazard ratio, 0.16; 95% CI, 0.07 to 0.36, respectively). The addition of cetuximab to RT increased LRC, OS, and PFS in both patients with p16-positive OPC and those with p16-negative disease. Interaction tests for LRC, OS, and PFS did not demonstrate any significant interaction between p16 status and treatment effect (P = .087, .085, and .253, respectively). Similar trends were observed when patients with p16-positive/HPV-positive OPC (n = 49) and those with p16-positive/HPV-negative OPC (n = 14) were compared. CONCLUSION p16 status was strongly prognostic for patients with OPC. The data suggest that the addition of cetuximab to RT improved clinical outcomes regardless of p16 or HPV status versus RT alone.
Collapse
Affiliation(s)
- David I Rosenthal
- David I. Rosenthal, Diana Bell, and Kian K. Ang, The University of Texas MD Anderson Cancer Center, Houston, TX; Paul M. Harari, University of Wisconsin, Madison, WI; Jordi Giralt, Hospital Vall d'Hebron, Barcelona, Spain; David Raben, University of Colorado School of Medicine, Aurora, CO; Joyce Liu, Merck Serono, Beijing, People's Republic of China; Jeltje Schulten, Merck KGaA, Darmstadt, Germany; and James A. Bonner, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Paul M Harari
- David I. Rosenthal, Diana Bell, and Kian K. Ang, The University of Texas MD Anderson Cancer Center, Houston, TX; Paul M. Harari, University of Wisconsin, Madison, WI; Jordi Giralt, Hospital Vall d'Hebron, Barcelona, Spain; David Raben, University of Colorado School of Medicine, Aurora, CO; Joyce Liu, Merck Serono, Beijing, People's Republic of China; Jeltje Schulten, Merck KGaA, Darmstadt, Germany; and James A. Bonner, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Jordi Giralt
- David I. Rosenthal, Diana Bell, and Kian K. Ang, The University of Texas MD Anderson Cancer Center, Houston, TX; Paul M. Harari, University of Wisconsin, Madison, WI; Jordi Giralt, Hospital Vall d'Hebron, Barcelona, Spain; David Raben, University of Colorado School of Medicine, Aurora, CO; Joyce Liu, Merck Serono, Beijing, People's Republic of China; Jeltje Schulten, Merck KGaA, Darmstadt, Germany; and James A. Bonner, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Diana Bell
- David I. Rosenthal, Diana Bell, and Kian K. Ang, The University of Texas MD Anderson Cancer Center, Houston, TX; Paul M. Harari, University of Wisconsin, Madison, WI; Jordi Giralt, Hospital Vall d'Hebron, Barcelona, Spain; David Raben, University of Colorado School of Medicine, Aurora, CO; Joyce Liu, Merck Serono, Beijing, People's Republic of China; Jeltje Schulten, Merck KGaA, Darmstadt, Germany; and James A. Bonner, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - David Raben
- David I. Rosenthal, Diana Bell, and Kian K. Ang, The University of Texas MD Anderson Cancer Center, Houston, TX; Paul M. Harari, University of Wisconsin, Madison, WI; Jordi Giralt, Hospital Vall d'Hebron, Barcelona, Spain; David Raben, University of Colorado School of Medicine, Aurora, CO; Joyce Liu, Merck Serono, Beijing, People's Republic of China; Jeltje Schulten, Merck KGaA, Darmstadt, Germany; and James A. Bonner, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Joyce Liu
- David I. Rosenthal, Diana Bell, and Kian K. Ang, The University of Texas MD Anderson Cancer Center, Houston, TX; Paul M. Harari, University of Wisconsin, Madison, WI; Jordi Giralt, Hospital Vall d'Hebron, Barcelona, Spain; David Raben, University of Colorado School of Medicine, Aurora, CO; Joyce Liu, Merck Serono, Beijing, People's Republic of China; Jeltje Schulten, Merck KGaA, Darmstadt, Germany; and James A. Bonner, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Jeltje Schulten
- David I. Rosenthal, Diana Bell, and Kian K. Ang, The University of Texas MD Anderson Cancer Center, Houston, TX; Paul M. Harari, University of Wisconsin, Madison, WI; Jordi Giralt, Hospital Vall d'Hebron, Barcelona, Spain; David Raben, University of Colorado School of Medicine, Aurora, CO; Joyce Liu, Merck Serono, Beijing, People's Republic of China; Jeltje Schulten, Merck KGaA, Darmstadt, Germany; and James A. Bonner, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Kian K Ang
- David I. Rosenthal, Diana Bell, and Kian K. Ang, The University of Texas MD Anderson Cancer Center, Houston, TX; Paul M. Harari, University of Wisconsin, Madison, WI; Jordi Giralt, Hospital Vall d'Hebron, Barcelona, Spain; David Raben, University of Colorado School of Medicine, Aurora, CO; Joyce Liu, Merck Serono, Beijing, People's Republic of China; Jeltje Schulten, Merck KGaA, Darmstadt, Germany; and James A. Bonner, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - James A Bonner
- David I. Rosenthal, Diana Bell, and Kian K. Ang, The University of Texas MD Anderson Cancer Center, Houston, TX; Paul M. Harari, University of Wisconsin, Madison, WI; Jordi Giralt, Hospital Vall d'Hebron, Barcelona, Spain; David Raben, University of Colorado School of Medicine, Aurora, CO; Joyce Liu, Merck Serono, Beijing, People's Republic of China; Jeltje Schulten, Merck KGaA, Darmstadt, Germany; and James A. Bonner, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL.
| |
Collapse
|
123
|
Machiels JP, Schmitz S. Epidermal Growth Factor Receptor Inhibition in Squamous Cell Carcinoma of the Head and Neck. Hematol Oncol Clin North Am 2015; 29:1011-32. [DOI: 10.1016/j.hoc.2015.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
124
|
Feldman R, Gatalica Z, Knezetic J, Reddy S, Nathan CA, Javadi N, Teknos T. Molecular profiling of head and neck squamous cell carcinoma. Head Neck 2015; 38 Suppl 1:E1625-38. [PMID: 26614708 PMCID: PMC5063170 DOI: 10.1002/hed.24290] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/13/2015] [Indexed: 02/02/2023] Open
Abstract
Background Head and neck squamous cell carcinoma (HNSCC) exhibits high rates of recurrence, and with few approved targeted agents, novel treatments are needed. We analyzed a molecular profiling database for the distribution of biomarkers predictive of chemotherapies and targeted agents. Methods Seven hundred thirty‐five patients with advanced HNSCC (88 with known human papillomavirus [HPV] status), were profiled using multiple platforms (gene sequencing, gene copy number, and protein expression). Results Among the entire patient population studied, epidermal growth factor receptor (EGFR) was the protein most often overexpressed (90%), TP53 gene most often mutated (41%), and phosphatidylinositol 3‐kinase (PIK3CA) most often amplified (40%; n = 5). With the exception of TP53 mutation, other biomarker frequencies were not significantly different among HPV‐positive or HPV‐negative patients. PIK3CA mutations and phosphatase and tensin homolog (PTEN) loss are frequent events, independent of HPV status. The immune response‐modulating programmed cell death 1 (PD1) and programmed cell death ligand 1 (PDL1) axis was active across sites, stages, and HPV status. Conclusion Molecular profiling utilizing multiple platforms provides a range of therapy options beyond standard of care. © 2015 Wiley Periodicals, Inc. Head Neck38: E1625–E1638, 2016
Collapse
Affiliation(s)
| | | | | | | | - Cherie-Ann Nathan
- Louisiana State University, Feist-Weiller Cancer Center, Shreveport, Louisiana
| | | | - Theodoros Teknos
- The Ohio State University, Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
125
|
Knutzen G, Subbiah S. Cetuximab Rechallenge and Monotherapy in Patients with Squamous Cell Carcinoma of the Head and Neck. Case Rep Oncol 2015; 8:503-8. [PMID: 26668572 PMCID: PMC4677711 DOI: 10.1159/000441019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Smokers with squamous cell carcinoma of the head and neck (SCCHN) have a particularly poor prognosis when compared with human papillomavirus-positive SCCHN. Here, we present case reports of two smokers with SCCHN treated with cetuximab-based therapy, highlighting the potential benefit of cetuximab before definitive chemoradiotherapy in patients with poor performance status as well as cetuximab rechallenge after progression. We conclude that cetuximab demonstrated notable effectiveness in two patients at high risk for poor prognosis, yielding a durable response in one and retaining activity on rechallenge in the other.
Collapse
Affiliation(s)
- Greg Knutzen
- Arrowhead Regional Medical Center, Colton, Calif., and City of Hope Medical Group, Corona, Calif., USA
| | - Shanmuga Subbiah
- Arrowhead Regional Medical Center, Colton, Calif., and City of Hope Medical Group, Corona, Calif., USA
| |
Collapse
|
126
|
Joseph AW, Guo T, Hur K, Xie Y, Yin L, Califano JA, Ha PK, Quon H, Richmon JD, Eisele DW, Agrawal N, Fakhry C. Disease-free survival after salvage therapy for recurrent oropharyngeal squamous cell carcinoma. Head Neck 2015; 38 Suppl 1:E1501-9. [DOI: 10.1002/hed.24268] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Andrew W. Joseph
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
| | - Theresa Guo
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
| | - Kevin Hur
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
| | - Yanjun Xie
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
| | - Linda Yin
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
| | - Joseph A. Califano
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
- Milton J. Dance Head and Neck Center; Baltimore Maryland
| | - Patrick K. Ha
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
- Milton J. Dance Head and Neck Center; Baltimore Maryland
| | - Harry Quon
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins School of Medicine; Baltimore Maryland
| | - Jeremy D. Richmon
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
| | - David W. Eisele
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
| | - Nishant Agrawal
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
| | - Carole Fakhry
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland
- Milton J. Dance Head and Neck Center; Baltimore Maryland
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
| |
Collapse
|
127
|
Schwam ZG, Burtness B, Yarbrough WG, Mehra S, Husain Z, Judson BL. National treatment patterns in patients presenting with Stage IVC head and neck cancer: analysis of the National Cancer Database. Cancer Med 2015; 4:1828-35. [PMID: 26471244 PMCID: PMC5123708 DOI: 10.1002/cam4.546] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/31/2015] [Accepted: 09/02/2015] [Indexed: 01/17/2023] Open
Abstract
Head and neck cancer patients presenting with distant metastases are generally considered incurable. Treatment patterns and survival by primary disease site and therapy have not been described. Retrospective cohort analysis of 2525 patients in the National Cancer Database (2003–2006). Kaplan–Meier and Cox proportional hazards analyses were performed. Combined locoregional and systemic therapy was the most common treatment regimen (39.2%), followed by no treatment (23.9%), locoregional (19.0%), and systemic treatment (17.8%). Multivariate analysis demonstrated decreased survival was associated with age 65–79 years hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.14–1.80), Medicaid/uninsured status (HR 1.27, 95% CI 1.13–1.42), Medicare/other government insurance (HR 1.21, 95% 1.07–1.38), treatment at a nonacademic/research program (HR 1.17, 95% CI 1.07–1.27), and Charlson comorbidity score of 1 (HR 1.33, 95% 1.19–1.48). Compared to systemic therapy alone, receiving locoregional and systemic therapy was associated with decreased risk of death (HR 0.73, 95% CI 0.65–0.83). Only 14.6% and 0.6% of patients were recorded as receiving palliative therapy or being enrolled in a clinical trial, respectively. Significant treatment diversity exists in distantly metastatic head and neck cancer. Those who received combination locoregional and systemic therapy were more likely to have improved overall survival, but important factors in treatment selection are unknown. A small proportion of patients was found to receive either palliative therapy or was enrolled in a clinical trial, although these data likely underestimate the true proportions.
Collapse
Affiliation(s)
- Zachary G Schwam
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Barbara Burtness
- Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Wendell G Yarbrough
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Saral Mehra
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Zain Husain
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin L Judson
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
128
|
The rationale for HPV-related oropharyngeal cancer de-escalation treatment strategies. Contemp Oncol (Pozn) 2015; 19:313-22. [PMID: 26557780 PMCID: PMC4631307 DOI: 10.5114/wo.2015.54389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/08/2015] [Accepted: 03/09/2015] [Indexed: 02/06/2023] Open
Abstract
The treatment paradigms for head and neck squamous cell cancer (HNSCC) are changing due to the emergence of human papillomavirus-associated tumors (HPV-related), possessing distinct molecular profiles and responses to therapy. Retrospective studies have suggested that HPV-related HNSCCs are more frequently cured than those caused by tobacco. Current clinical trials focus on the reduction of treatment-related toxicity and the development of HPV-targeted therapies. New treatment strategies include: 1) dose reduction of radiotherapy, 2) the use of cetuximab instead of cisplatin for chemo-radiation 3) less invasive surgical options, i.e. trans-oral robotic surgery and trans-oral laser microlaryngoscopy, and 4) more specific treatment attempts, including immunotherapeutic strategies, thanks to increasing comprehension of the molecular background of HPV-related HNSCC. Whereas recently published data shed light on immune mechanisms, other studies have focused on specific vaccination against HPV-related HNSCC. A crucial problem is patient selection to the chosen bias. Truly HPV-related cancers (p16-positive and HPV DNA-positive) with biomarkers for good response to therapy could be included in randomized trials aiming for less severe and better tailored therapy.
Collapse
|
129
|
Targeted Therapy in Oropharyngeal Squamous Cell Carcinoma: The Implications of HPV for Therapy. ACTA ACUST UNITED AC 2015; 3:89-117. [PMID: 27182480 PMCID: PMC4837939 DOI: 10.1007/s40487-015-0008-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 12/13/2022]
Abstract
Oropharyngeal cancers caused by human papillomaviruses (HPV) have a different epidemiology, prognosis, genetic mutational landscape, response to treatment, and outcome when compared to HPV-negative cancers. In this review, a summary of our current understanding of HPV in head and neck cancer and the important advances that have shown HPV to be an etiological agent are discussed. HPV-positive and HPV-negative tumors are compared discussing clinicopathological factors, prognosis, outcome following treatment, and the molecular and genetic differences. Currently, the standard of care for oropharyngeal cancer is both surgery and post-operative radiotherapy with or without cisplatin or concurrent chemo-radiotherapy. The latter is used more often, especially in cancers of tonsil and base of tongue. However, there is increased interest in trying to de-intensify treatment and in the development of new treatments to target the underlying different molecular pathways of HPV-positive cancers. The current clinical trials involving surgery, chemotherapy, and radiation therapy are discussed. The new targeted treatments are also summarized. Although there is currently is no evidence from prospective studies to support a change in the treatment algorithm, the treatment options for patients with HPV-positive disease are likely to change in the future.
Collapse
|
130
|
Bhatia A, Burtness B. Human Papillomavirus-Associated Oropharyngeal Cancer: Defining Risk Groups and Clinical Trials. J Clin Oncol 2015; 33:3243-50. [PMID: 26351343 DOI: 10.1200/jco.2015.61.2358] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Human papillomavirus-associated oropharynx cancer (HPVA-OPC) is rapidly increasing in incidence and has unique epidemiologic, molecular, and biologic characteristics. Despite being recognized as having superior prognosis, current evidence does not support less intense therapy compared with HPV-negative OPC. Current combined modality therapies confer a significant risk of morbidity, and patients with HPVA-OPC have a younger median age. These patients, therefore, live longer with the adverse effects of treatment, and this spurs the development of treatment deintensification trials that attempt to decrease treatment-related morbidity without compromising efficacy. Many radiation and chemotherapy de-escalation trials are underway. Minimally invasive surgical techniques are also being evaluated. It is important to identify the ideal patient group for treatment deintensification and to define prognostic risk groups to avoid undertreating the poorer-risk subset in HPVA-OPC, and validated biomarkers are needed to identify patients with the best prognosis. Significant smoking exposure mitigates the favorable prognosis of HPVA-OPC. Currently, less intense treatment is an option only in the setting of clinical trials, and patients with HPVA-OPC should be offered clinical trial options whenever they are available. Finally, recognition of novel therapeutic targets and signaling pathways is critical to the development of new treatment strategies that are desperately needed for patients with poor risk and those with recurrent and metastatic disease.
Collapse
Affiliation(s)
- Aarti Bhatia
- Aarti Bhatia, Fox Chase Cancer Center, Philadelphia, PA; and Barbara Burtness, Yale Cancer Center, Yale University School of Medicine, New Haven, CT
| | - Barbara Burtness
- Aarti Bhatia, Fox Chase Cancer Center, Philadelphia, PA; and Barbara Burtness, Yale Cancer Center, Yale University School of Medicine, New Haven, CT.
| |
Collapse
|
131
|
Massarelli E, Ferrarotto R, Glisson BS. New Strategies in Human Papillomavirus–Related Oropharynx Cancer: Effecting Advances in Treatment for a Growing Epidemic. Clin Cancer Res 2015; 21:3821-8. [DOI: 10.1158/1078-0432.ccr-14-1329] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
132
|
Zhang J, Saba NF, Chen GZ, Shin DM. Targeting HER (ERBB) signaling in head and neck cancer: An essential update. Mol Aspects Med 2015; 45:74-86. [PMID: 26163475 DOI: 10.1016/j.mam.2015.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 12/13/2022]
Abstract
HNC (head and neck cancer) remains the 6th most common carcinoma worldwide. The suboptimal survival and toxicities observed with conventional approaches warrant exploration of novel therapeutic strategies such as targeted therapies. Although targeting EGFR (epidermal growth factor receptor) with cetuximab demonstrated clinical promise, HER (human epidermal growth factor receptor) or ERBB (erythroblastic leukemia viral oncogene homolog) targeted therapy in HNC has overall been suboptimal to date in clinical settings. Overcoming the resistance as well as identifying new strategies therefore remains a significant challenge. In this review, we will discuss the emerging roles of HER members besides EGFR. A comprehensive "three-dimensional" view of HER signaling pathway from the importance of EGFR nuclear translocation to our maturing concept of receptors' "spatial regulation", as well as the interdependence and interaction among different HER members will also be addressed to complete an essential update of HER signaling in HNC.
Collapse
Affiliation(s)
- Jun Zhang
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, 1365-C Clifton Road, NE, Atlanta, GA 30322, USA; Department of Internal Medicine, Division of Hematology, Oncology and Blood & Marrow Transplantation, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, 1365-C Clifton Road, NE, Atlanta, GA 30322, USA
| | - Georgia Zhuo Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, 1365-C Clifton Road, NE, Atlanta, GA 30322, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, 1365-C Clifton Road, NE, Atlanta, GA 30322, USA.
| |
Collapse
|
133
|
Balermpas P. Anti-EGFR-Therapie in Kombination mit Radiotherapie für Patienten mit Kopf-Hals-Karzinomen – doch keine therapeutische Revolution. Strahlenther Onkol 2015. [DOI: 10.1007/s00066-015-0845-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
134
|
Szturz P, Specenier P, Van Laer C, Van Den Weyngaert D, Corthouts B, Carp L, Van Marck E, Vanderveken O, Vermorken JB. Long-term remission of locally recurrent oropharyngeal cancer after docetaxel-based chemotherapy plus cetuximab. Eur Arch Otorhinolaryngol 2015; 273:1629-36. [PMID: 26044403 DOI: 10.1007/s00405-015-3673-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 05/25/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND In recurrent head and neck squamous cell carcinoma ineligible for resection or irradiation, treatment aims primarily at symptom control and quality of life enhancement with an expected outcome of 6-12 months. METHODS In 2005, a male patient, born in 1944, with a second local recurrence of human papillomavirus negative tonsil cancer was enrolled in the EXTREME trial, and randomized to platinum/5-fluorouracil/cetuximab arm resulting in partial remission with progression-free survival of 12 months. The second-line systemic therapy comprised 5 cycles of 3-weekly docetaxel/cisplatin/5-fluorouracil regimen plus weekly cetuximab. RESULTS As confirmed on imaging and repeated biopsies, complete response was achieved with disease-free survival of 8 years and follow-up period of 12 years. Severe acute toxicities during the taxane-based chemotherapy plus cetuximab included grade 4 anorexia and grade 3 febrile neutropenia. CONCLUSIONS Poor tumor differentiation, no weight loss, oropharyngeal location, white race, and particularly the induced complete response were most likely the key favorable prognostic factors in the reported patient. The possibility of a synergistic interaction between taxanes and cetuximab should be further explored.
Collapse
Affiliation(s)
- Petr Szturz
- Department of Medical Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium. .,Department of Internal Medicine, Hematology and Oncology, School of Medicine, University Hospital Brno and Masaryk University, Brno, Czech Republic.
| | - Pol Specenier
- Department of Medical Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Carl Van Laer
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Danielle Van Den Weyngaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Radiotherapy, University Radiotherapy Antwerp, Antwerp, Belgium
| | - Bob Corthouts
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Eric Van Marck
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
135
|
Abstract
INTRODUCTION Despite improvements in treatment, survival rates of head and neck squamous cell carcinoma (HNSCC) are stagnant. The existing chemotherapeutic agents are non-selective and associated with toxicities. Combinations of the only the US FDA-approved epidermal growth factor receptor (EGFR)-targeted agent, cetuximab, with chemotherapy or radiation improves overall survival. However, the response rates to cetuximab are modest. Thus, there is an urgent need for new agents that can be safely integrated into current treatment regimens to improve outcome. AREAS COVERED Current EGFR-targeted drugs under clinical development include mAbs and tyrosine kinase inhibitors. The modest efficacy of these drugs implicates intrinsic or acquired resistance. Novel molecular agents inhibiting alternative targets to overcome anti-EGFR resistance in HNSCC are under investigation. Gene therapy and immunotherapy are also promising strategies to improve efficacy and reduce toxicity. EXPERT OPINION To date, only six drugs have been FDA-approved for the treatment of head and neck cancer. Cetuximab is the only approved molecular targeting agent for HNSCC and despite ubiquitous expression of EGFR in HNSCC tumors, clinical responses are limited. Genetic and epigenetic characterization of HNSCC tumors, coupled with improved preclinical models, should facilitate the development of more effective drugs.
Collapse
Affiliation(s)
- Yihui Wen
- Sun Yat-Sen University and The First Affiliated Hospital of Sun Yat-Sen University, Department of Otolaryngology, Guangzhou, Guangzhou, PR China
- Sun Yat-Sen University and Otolaryngology Institute of Sun Yat-Sen University, Guangzhou, Guangzhou, PR China
- University of Pittsburgh and University of Pittsburgh School of Medicine, Department of Otolaryngology, Pittsburgh, PA, USA
| | - Jennifer R Grandis
- University of Pittsburgh and University of Pittsburgh School of Medicine, Department of Otolaryngology, Pittsburgh, PA, USA
- University of Pittsburgh and University of Pittsburgh School of Medicine, Department of Pharmacology, Pittsburgh, PA, USA
- Eye and Ear Institute, 200 Lothrop St., Suite 500, Pittsburgh, PA, USA
- University of California, Clinical and Translational Science Institute, Department of Otolaryngology-Head and Neck Surgery, San Francisco, CA, USA
| |
Collapse
|
136
|
Zeitlin R, Nguyen HP, Rafferty D, Tyring S. Advancements in the Management of HPV-Associated Head and Neck Squamous Cell Carcinoma. J Clin Med 2015; 4:822-31. [PMID: 26239449 PMCID: PMC4470200 DOI: 10.3390/jcm4050822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 02/04/2023] Open
Abstract
Head and neck carcinomas have long been linked to alcohol and tobacco abuse; however, within the last two decades, the human papillomavirus (HPV) has emerged as a third etiology and is specifically associated with head and neck squamous cell carcinomas (HNSCC). In this anatomical region, the oncogenic HPV-16 mediates transformation and immortalization of epithelium, most commonly in the oropharynx. Nevertheless, the recent identification of novel HPV mechanisms thought to be specific to oropharyngeal carcinogenesis has coincided with observations that HPV-associated HNSCC has differing clinical behavior-in terms of natural history, therapeutic response, and prognosis-than HPV-negative head and neck tumors. Taken together with the growing incidence of HPV transmission in younger populations, these discoveries have sparked a rapid expansion in both laboratory and clinical studies on the infection and disease. Herein, we review the clinical characteristics of HPV-associated HNSCC, with particular emphasis on recent advancements in our understanding of the management of this infectious malignancy.
Collapse
Affiliation(s)
- Ross Zeitlin
- University of Florida College of Medicine, 1600 SW Archer Rd., Gainesville, FL 32603, USA.
| | | | - David Rafferty
- Paul L. Foster School of Medicine, 5001 El Paso Dr., El Paso, TX 79905, USA.
| | - Stephen Tyring
- Department of Dermatology, University of Texas Medical School at Houston, 6655 Travis Street, Houston, TX 77030, USA.
| |
Collapse
|
137
|
Afatinib versus methotrexate as second-line treatment in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck progressing on or after platinum-based therapy (LUX-Head & Neck 1): an open-label, randomised phase 3 trial. Lancet Oncol 2015; 16:583-94. [PMID: 25892145 DOI: 10.1016/s1470-2045(15)70124-5] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (HNSCC) progressing after first-line platinum regimens have a poor prognosis and few treatment options. Afatinib, an irreversible ERBB family blocker, has shown efficacy in a phase 2 study in this setting. We aimed to assess the efficacy and safety of afatinib compared with methotrexate as second-line treatment in patients with recurrent or metastatic HNSCC progressing on or after platinum-based therapy. METHODS In this open-label, phase 3, randomised controlled trial conducted in 101 centres in 19 countries, we enrolled patients aged 18 years or older with histologically or cytologically confirmed HNSCC that was recurrent, metastatic, or both who had progressed on or after first-line platinum-based therapy, were not amenable for salvage surgery or radiotherapy, and who had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Previous treatment with more than one systemic regimen in this setting was not allowed; previous treatment with EGFR-targeted antibody therapy (but not EGFR-targeted tyrosine-kinase inhibitors) was allowed. We randomly assigned eligible patients in a 2:1 ratio to receive oral afatinib (40 mg/day) or intravenous methotrexate (40 mg/m(2) per week), stratified by ECOG performance status and previous EGFR-targeted antibody therapy for recurrent or metastatic disease. Randomisation was done centrally with an interactive voice or web-based response system. Clinicians and patients were not masked to treatment allocation; independent review of tumour response was done in a blinded manner. The primary endpoint was progression-free survival as assessed by an independent, central imaging review committee. Efficacy analyses were done in the intention-to-treat population and safety analyses were done in patients who received at least one dose of study drug. This ongoing study is registered with ClinicalTrials.gov, number NCT01345682. FINDINGS Between Jan 10, 2012, and Dec 12, 2013, we enrolled 483 patients and randomly assigned 322 to afatinib and 161 to methotrexate. After a median follow-up of 6·7 months (IQR 3·1-9·0), progression-free survival was longer in the afatinib group than in the methotrexate group (median 2·6 months [95% CI 2·0-2·7] for the afatinib group vs 1·7 months [1·5-2·4] for the methotrexate group; hazard ratio [HR] 0·80 [95% CI 0·65-0·98], p=0·030). The most frequent grade 3 or 4 drug-related adverse events were rash or acne (31 [10%] of 320 patients in the afatinib group vs none of 160 patients in the methotrexate group), diarrhoea (30 [9%] vs three [2%]), stomatitis (20 [6%] vs 13 [8%]), fatigue (18 [6%] vs five [3%]), and neutropenia (1 [<1%] vs 11 [7%]); serious adverse events occurred in 44 (14%) of afatinib-treated patients and 18 (11%) of methotrexate-treated patients. INTERPRETATION Afatinib was associated with significant improvements in progression-free survival and had a manageable safety profile. These findings provide important new insights into the treatment of this patient population and support further investigations with irreversible ERBB family blockers in HNSCC. FUNDING Boehringer Ingelheim.
Collapse
|
138
|
Guo T, Qualliotine JR, Ha PK, Califano JA, Kim Y, Saunders JR, Blanco RG, D'Souza G, Zhang Z, Chung CH, Kiess A, Gourin CG, Koch W, Richmon JD, Agrawal N, Eisele DW, Fakhry C. Surgical salvage improves overall survival for patients with HPV-positive and HPV-negative recurrent locoregional and distant metastatic oropharyngeal cancer. Cancer 2015; 121:1977-84. [PMID: 25782027 DOI: 10.1002/cncr.29323] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) tumor status and surgical salvage are associated with improved prognosis for patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC). Current data regarding types of surgery and the impact of surgery for patients with distant metastatic disease are limited. METHODS A retrospective analysis of patients with recurrent OPSCC from 2 institutions between 2000 and 2012 was performed. p16 immunohistochemistry and/or in situ hybridization, as clinically available, were used to determine HPV tumor status. Clinical characteristics, distribution of recurrence site, and treatment modalities were compared by HPV tumor status. Overall survival (OS) was examined using Kaplan-Meier and Cox proportional hazards methods. RESULTS The current study included 108 patients with 65 locoregional and 43 distant metastatic first recurrences. The majority of patients were HPV-positive (80 patients). HPV-positive tumor status was associated with longer time to disease recurrence (P<.01). Anatomic site distribution of disease recurrences did not differ by HPV tumor status. HPV-positive tumor status (adjusted HR [aHR], 0.23; 95% confidence interval [95% CI], 0.09-0.58 [P = .002]), longer time to disease recurrence (≥ 1 year; aHR, 0.36; 95% CI, 0.18-0.74 [P = .006]), and surgical salvage (aHR, 0.26; 95% CI, 0.12-0.61 [P = .002]) were found to be independently associated with OS after disease recurrence. Surgical salvage was independently associated with improved OS compared with nonsurgical treatment among patients with both locoregional (aHR, 0.15; 95% CI, 0.04-0.56 [P = .005]) and distant (aHR, 0.19; 95% CI, 0.05-0.75 [P = .018]) metastatic disease recurrences. CONCLUSIONS Surgical salvage was found to be associated with improved OS for patients with recurrent locoregional and distant metastatic OPSCC, independent of HPV tumor status. Further prospective data are needed to confirm the role of surgical salvage for distant metastases.
Collapse
Affiliation(s)
- Theresa Guo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jesse R Qualliotine
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Joseph A Califano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Young Kim
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - John R Saunders
- Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Ray G Blanco
- Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Zhe Zhang
- Division of Oncology Biostatistics, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christine H Chung
- Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ana Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Nishant Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
139
|
The challenge of blocking a wider family members of EGFR against head and neck squamous cell carcinomas. Oral Oncol 2015; 51:423-30. [PMID: 25753560 DOI: 10.1016/j.oraloncology.2015.02.092] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 12/22/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) represent 95% of head and neck cancer with an incidence of over half a million people globally. The prognosis for patients with recurrent or metastatic HNSCC is generally poor with low 5-year survival rates despite treatment advances over the past few decades. Consequently, it is essential to search for new biomarkers and effective therapy options to optimize HNSCC treatment. Epidermal growth factor receptor (EGFR) is overexpressed in approximately 90% of tumours. EGFR has become one of most common targets for new therapies being investigated in HNSCC. In this way, multiple therapies targeting EGFR in HNSCC have been tested but response rates are still low especially in the recurrent or metastatic setting. This has been attributed to mechanisms of resistance to EGFR-targeted therapies. Afatinib, an oral small molecule ErbB Family Blocker that irreversibly binds to ErbB1 (EGFR), ErbB2 (HER2) and ErbB4 (HER4), is being investigated in HNSCC treatment with encouraging phase II results and several ongoing phase III trials. Results of these trials will help to understand the place of afatinib in the HNSCC treatment armamentarium.
Collapse
|
140
|
Tinhofer I, Jöhrens K, Keilholz U, Kaufmann A, Lehmann A, Weichert W, Stenzinger A, Stromberger C, Klinghammer K, Becker ET, Dommerich S, Stölzel K, Hofmann V, Hildebrandt B, Moser L, Ervens J, Böttcher A, Albers A, Stabenow R, Reinecke A, Budach V, Hoffmeister B, Raguse J. Contribution of human papilloma virus to the incidence of squamous cell carcinoma of the head and neck in a European population with high smoking prevalence. Eur J Cancer 2015; 51:514-521. [DOI: 10.1016/j.ejca.2014.12.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/20/2014] [Indexed: 11/24/2022]
|
141
|
Gilbert J, Schell MJ, Zhao X, Murphy B, Tanvetyanon T, Leon ME, Neil Hayes D, Haigentz M, Saba N, Nieva J, Bishop J, Sidransky D, Ravi R, Bedi A, Chung CH. A randomized phase II efficacy and correlative studies of cetuximab with or without sorafenib in recurrent and/or metastatic head and neck squamous cell carcinoma. Oral Oncol 2015; 51:376-82. [PMID: 25593015 DOI: 10.1016/j.oraloncology.2014.12.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 12/15/2014] [Indexed: 01/15/2023]
Abstract
INTRODUCTION A combination of cetuximab and sorafenib in patients with recurrent and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) were assessed for potential benefit. MATERIAL AND METHODS In a randomized phase II study, R/M HNSCC patients were treated with cetuximab 400mg/m(2) IV on day 1 followed by 250mg/m(2) IV weekly (Arm A), or cetuximab at the same dose/schedule plus sorafenib 400mg PO twice-a-day (Arm B). Each cycle was 21days. Tumor p16 and HPV status, and plasma immunomodulatory cytokine levels were assessed. RESULTS Of 55 patients enrolled (Arm A-27, Arm B-28), 52 patients received assigned treatments and 43 were evaluable for response. Overall response rate was 8% for both arms. Median overall survival (OS) and progression-free survival (PFS) were 9.0 and 3.0months in Arm A, and 5.7 and 3.2months in Arm B, respectively. Forty-four patients had tumors available for p16 staining (35-negative, 9-positive). Three of nine p16-positive tumors were also HPV positive. The p16-negative patients had significantly better PFS compared to the p16-positive patients (3.7 vs. 1.6months; p-value: 0.03), regardless of study arms. Twenty-four plasma samples were tested for 12 cytokine levels and patients with higher TGFβ1 levels had inferior PFS compared to lower levels (1.9 vs. 4.7months; adjusted p-value: 0.015), regardless of study arms. CONCLUSIONS A subset of R/M patients with p16-negative tumors or lower plasma TGFβ1 levels had longer PFS given the cetuximab-based therapy. However, both arms showed only modest response and sorafenib given with cetuximab did not demonstrate clinical benefit.
Collapse
Affiliation(s)
- Jill Gilbert
- Vanderbilt University, Nashville, TN, United States.
| | | | - Xiuhua Zhao
- H. Lee Moffitt Cancer Center, Tampa, FL, United States.
| | | | | | - Marino E Leon
- H. Lee Moffitt Cancer Center, Tampa, FL, United States.
| | - D Neil Hayes
- UNC Lineberger Cancer Center, Chapel Hill, NC, United States.
| | - Missak Haigentz
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States.
| | - Nabil Saba
- Emory Winship Cancer Institute, Atlanta, GA, United States.
| | - Jorge Nieva
- University of Southern California, Los Angeles, CA, United States.
| | - Justin Bishop
- Johns Hopkins Medical Institutions, Baltimore, MD, United States.
| | - David Sidransky
- Johns Hopkins Medical Institutions, Baltimore, MD, United States.
| | - Rajani Ravi
- Johns Hopkins Medical Institutions, Baltimore, MD, United States.
| | - Atul Bedi
- Johns Hopkins Medical Institutions, Baltimore, MD, United States.
| | | |
Collapse
|
142
|
Cortelazzi B, Verderio P, Ciniselli CM, Pizzamiglio S, Bossi P, Gloghini A, Gualeni AV, Volpi CC, Locati L, Pierotti MA, Licitra L, Pilotti S, Perrone F. Receptor tyrosine kinase profiles and human papillomavirus status in oropharyngeal squamous cell carcinoma. J Oral Pathol Med 2014; 44:734-45. [DOI: 10.1111/jop.12301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara Cortelazzi
- Laboratory of Experimental Molecular Pathology Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Paolo Verderio
- Unit of Medical Statistics Biometry and Bioinformatics Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Chiara Maura Ciniselli
- Unit of Medical Statistics Biometry and Bioinformatics Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Sara Pizzamiglio
- Unit of Medical Statistics Biometry and Bioinformatics Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Paolo Bossi
- Head and Neck Cancer Medical Oncology Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Annunziata Gloghini
- Laboratory of Experimental Molecular Pathology Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Ambra V. Gualeni
- Laboratory of Experimental Molecular Pathology Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Chiara C. Volpi
- Laboratory of Experimental Molecular Pathology Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Laura Locati
- Head and Neck Cancer Medical Oncology Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | | | - Lisa Licitra
- Head and Neck Cancer Medical Oncology Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Silvana Pilotti
- Laboratory of Experimental Molecular Pathology Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Federica Perrone
- Laboratory of Experimental Molecular Pathology Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| |
Collapse
|
143
|
|
144
|
Fakhry C, Cohen E. The rise of HPV-positive oropharyngeal cancers in the United States. Cancer Prev Res (Phila) 2014; 8:9-11. [PMID: 25468833 DOI: 10.1158/1940-6207.capr-14-0425] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This perspective highlights a study that reports an increasing proportion of human papillomavirus-positive oropharyngeal cancer among blacks in recent calendar periods. The results are discussed in the context of other studies which evaluated racial differences in the distribution of human papillomavirus-positive oropharyngeal cancer and survival.
Collapse
Affiliation(s)
- Carole Fakhry
- Johns Hopkins School of Medicine, Department of Otolaryngology Head and Neck Surgery, Baltimore, Maryland. Milton J. Dance Jr. Head and Neck Cancer Center, Baltimore, Maryland.
| | - Ezra Cohen
- Department of Medicine, University of California, San Diego Moores Cancer Center, La Jolla, California
| |
Collapse
|
145
|
Eng C, Chang GJ, Nancy You Y, Das P, Rodriguez-Bigas M, Xing Y, Vauthey JN, Rogers JE, Ohinata A, Pathak P, Sethi S, Phillips JK, Crane CH, Wolff RA. The role of systemic chemotherapy and multidisciplinary management in improving the overall survival of patients with metastatic squamous cell carcinoma of the anal canal. Oncotarget 2014; 5:11133-42. [PMID: 25373735 PMCID: PMC4294384 DOI: 10.18632/oncotarget.2563] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 01/30/2023] Open
Abstract
Metastatic squamous cell carcinoma (SCCA) of the anal canal is a rare malignancy for which no standard treatment algorithm exists. To determine the best approach, all patients diagnosed with metastatic SCCA of the anal canal treated at a single institution were evaluated for choice of chemotherapy and treatment outcome. A retrospective study from January 2000 to May 2012 was conducted. Electronic medical records were reviewed for diagnosis of metastatic SCCA of the anal canal. All patients were treatment naïve for metastatic disease and completed all radiographic imaging at our institution. The purpose of this study was to evaluate outcomes among patients who received systemic chemotherapy and if appropriate were referred for multidisciplinary intervention (e.g., surgery, radiofrequency ablation, etc.). Seventy-seven patients fulfilled eligibility criteria. Forty-two patients (55%) received 5-fluorouracil (5-FU) + cisplatin (PF); 24 patients (31%) received carboplatin + paclitaxel (CP); 11 patients (14%) received an alternative regimen. After a median follow-up of 42 months, the median progression-free survival (PFS) for all patients was 7 months; the median overall survival (OS) was 22 months. Thirty-three patients (43%) underwent multidisciplinary management for metastatic disease resulting in a median PFS of 16 months (95% CI: 9.2 -22.8) and median OS of 53 months (95% CI: 28.3 - 77.6). Systemic chemotherapy provides durable survival for patients with surgically unresectable metastatic SCCA of the anal canal. Multidisciplinary management for select patients with metastatic disease effectively improves survival and should be considered whenever possible.
Collapse
Affiliation(s)
- Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - George J. Chang
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Y. Nancy You
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Miguel Rodriguez-Bigas
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Yan Xing
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Jane E. Rogers
- Division of Pharmacy, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Aki Ohinata
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Priyanka Pathak
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Salil Sethi
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Jonathan K. Phillips
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Christopher H. Crane
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Robert A. Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| |
Collapse
|
146
|
Kang H, Kiess A, Chung CH. Emerging biomarkers in head and neck cancer in the era of genomics. Nat Rev Clin Oncol 2014; 12:11-26. [PMID: 25403939 DOI: 10.1038/nrclinonc.2014.192] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Head and neck cancer (HNC) broadly includes carcinomas arising from the mucosal epithelia of the head and neck region as well as various cell types of salivary glands and the thyroid. As reflected by the multiple sites and histologies of HNC, the molecular characteristics and clinical outcomes of this disease vary widely. In this Review, we focus on established and emerging biomarkers that are most relevant to nasopharyngeal carcinoma and head and neck squamous-cell carcinoma (HNSCC), which includes primary sites in the oral cavity, oropharynx, hypopharynx and larynx. Applications and limitations of currently established biomarkers are discussed along with examples of successful biomarker development. For emerging biomarkers, preclinical or retrospective data are also described in the context of recently completed comprehensive molecular analyses of HNSCC, which provide a broad genetic landscape and molecular classification beyond histology and clinical characteristics. We will highlight the ongoing effort that will see a shift from prognostic to predictive biomarker development in HNC with the goal of delivering individualized cancer therapy.
Collapse
Affiliation(s)
- Hyunseok Kang
- Department of Oncology, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 1650 Orleans Street, CRB-1 Room 344, Baltimore, MD 21287-0013, USA
| | - Ana Kiess
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 1650 Orleans Street, CRB-1 Room 344, Baltimore, MD 21287-0013, USA
| | - Christine H Chung
- 1] Department of Oncology, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 1650 Orleans Street, CRB-1 Room 344, Baltimore, MD 21287-0013, USA. [2] Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 1650 Orleans Street, CRB-1 Room 344, Baltimore, MD 21287-0013, USA
| |
Collapse
|
147
|
Yoshitake Y, Fukuma D, Yuno A, Hirayama M, Nakayama H, Tanaka T, Nagata M, Takamune Y, Kawahara K, Nakagawa Y, Yoshida R, Hirosue A, Ogi H, Hiraki A, Jono H, Hamada A, Yoshida K, Nishimura Y, Nakamura Y, Shinohara M. Phase II clinical trial of multiple peptide vaccination for advanced head and neck cancer patients revealed induction of immune responses and improved OS. Clin Cancer Res 2014; 21:312-21. [PMID: 25391695 DOI: 10.1158/1078-0432.ccr-14-0202] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The peptides derived from ideal cancer-testis antigens, including LY6K, CDCA1, and IMP3 (identified using genome-wide cDNA microarray analyses), were used in immunotherapy for head and neck squamous cell cancer (HNSCC). In this trial, we analyzed the immune response to and safety and efficacy of vaccine therapy. EXPERIMENTAL DESIGN A total of 37 patients with advanced HNSCC were enrolled in this trial of peptide vaccine therapy, and the OS, PFS, and immunologic response were evaluated using enzyme-linked ImmunoSpot (ELISPOT) and pentamer assays. The peptides were subcutaneously administered weekly with IFA. The primary endpoints were evaluated on the basis of differences between HLA-A*2402-positive [A24(+)] patients treated with peptide vaccine therapy and -negative [A24(-)] patients treated without peptide vaccine therapy among those with advanced HNSCC. RESULTS Our cancer vaccine therapy was well tolerated. The OS of the A24(+) vaccinated group (n = 37) was statistically significantly longer than that of the A24(-) group (n = 18) and median survival time (MST) was 4.9 versus 3.5 months, respectively; P < 0.05. One of the patients exhibited a complete response. In the A24(+) vaccinated group, the ELISPOT assay identified LY6K-, CDCA1-, and IMP3-specific CTL responses in 85.7%, 64.3%, and 42.9% of the patients, respectively. The patients showing LY6K- and CDCA1-specific CTL responses demonstrated a longer OS than those without CTL induction. Moreover, the patients exhibiting CTL induction for multiple peptides demonstrated better clinical responses. CONCLUSIONS The immune response induced by this vaccine may improve the prognosis of patients with advanced HNSCC.
Collapse
Affiliation(s)
- Yoshihiro Yoshitake
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Itoh Dento-Maxillofacial Hospital, Kumamoto, Japan.
| | - Daiki Fukuma
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Akira Yuno
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Department of Immunogenetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masatoshi Hirayama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Department of Immunogenetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideki Nakayama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takuya Tanaka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masashi Nagata
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Minamata City General Hospital and Medical Center, Minamata, Japan
| | - Yasuo Takamune
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenta Kawahara
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshihiro Nakagawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryoji Yoshida
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Akiyuki Hirosue
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hidenao Ogi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Akimitsu Hiraki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirofumi Jono
- Department of Pharmacy, Kumamoto University Hospital and Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Akinobu Hamada
- Department of Pharmacy, Kumamoto University Hospital and Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan. Department of Clinical Pharmacology Group for Translational Research Support Core National Cancer Center Research Institute, Tokyo, Japan
| | - Koji Yoshida
- Laboratory of Molecular Medicine, Human Genome Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan. OncoTherapy Science Incorporation, Research and Development Division, Kanagawa, Japan
| | - Yasuharu Nishimura
- Department of Immunogenetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusuke Nakamura
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Masanori Shinohara
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
148
|
Masterson L, Moualed D, Liu ZW, Howard JEF, Dwivedi RC, Tysome JR, Benson R, Sterling JC, Sudhoff H, Jani P, Goon PKC. De-escalation treatment protocols for human papillomavirus-associated oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis of current clinical trials. Eur J Cancer 2014; 50:2636-48. [PMID: 25091798 DOI: 10.1016/j.ejca.2014.07.001] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/27/2014] [Accepted: 07/01/2014] [Indexed: 11/26/2022]
Abstract
Iatrogenic complications associated with current treatment protocols for oropharyngeal squamous cell carcinoma are noted to cause high rates of acute and chronic morbidity. The aims of this study are to provide an overview of the current de-escalation trials for human papillomavirus positive (HPV+) oropharyngeal carcinoma and to evaluate the evidence supporting improved response to treatment of patients within this viral cohort. This study reviewed all completed or in progress randomised controlled trials (RCTs) assessing clinical interventions for human papillomavirus-associated locally advanced oropharyngeal squamous cell carcinoma. We utilised a validated 'risk of bias' tool to assess study quality. We identified nine RCTs that met the full inclusion criteria for this review (all of which are currently on-going and will report from 2015 onwards). Five RCTs performed a post hoc analysis by HPV status, which allowed meta-analysis of 1130 patients. The data reveal a significant difference in overall survival (hazard ratio (HR) 0.49 [95% confidence interval (CI) 0.35-0.69]), loco-regional failure (HR 0.43 [95% CI 0.17-1.11]) and disease specific survival (0.41 [95% 0.3-0.56]) in favour of the HPV+ category. In considering de-escalation treatment protocols, nine studies are currently ongoing. Our meta-analysis provides strong evidence for an improved prognosis in the viral associated cohort when treated by platinum based chemotherapy in combination with radiotherapy or primary radiotherapy. So far, one trial (with moderate to high risk of bias) suggests a reduced survival outcome for the HPV+ population when using the epidermal growth factor receptor (EGFR) inhibitor cetuximab.
Collapse
Affiliation(s)
- Liam Masterson
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Pathology, University of Cambridge, UK.
| | - Daniel Moualed
- ENT Department, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Zi Wei Liu
- ENT Department, Barts Health NHS Trust, London, UK
| | - James E F Howard
- Oncology Centre, University College Hospital NHS Trust, London, UK
| | - Raghav C Dwivedi
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James R Tysome
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital, Bielefeld, Germany
| | - Piyush Jani
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | |
Collapse
|
149
|
Psyrri A, Dafni U. Combining cetuximab with chemoradiotherapy in locally advanced head and neck squamous cell carcinoma: is more better? J Clin Oncol 2014; 32:2929-31. [PMID: 25002730 DOI: 10.1200/jco.2014.56.1902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
150
|
Guo Y, Shi M, Yang A, Feng J, Zhu X, Choi YJ, Hu G, Pan J, Hu C, Luo R, Zhang Y, Zhou L, Cheng Y, Lüpfert C, Cai J, Shi Y. Platinum-based chemotherapy plus cetuximab first-line for Asian patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck: Results of an open-label, single-arm, multicenter trial. Head Neck 2014; 37:1081-7. [PMID: 24710768 DOI: 10.1002/hed.23707] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/28/2014] [Accepted: 04/04/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the efficacy, safety, and pharmacokinetics of cisplatin-based chemotherapy plus cetuximab as first-line treatment in Chinese and Korean patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). METHODS Patients (n = 68) received cetuximab weekly plus 3-week cycles of cisplatin/5-fluorouracil (5-FU) chemotherapy for up to 6 cycles. The primary endpoint was overall response rate. RESULTS The overall response rate was 55.9%, including 2 complete responses (CRs). Median overall survival (OS) was 12.6 months and median progression-free survival (PFS) was 6.6 months. Grade 3/4 adverse events (AEs) were reported in 41 (60.3%) patients. The safety profile was in line with previous clinical experience. The pharmacokinetic profile was in line with that observed with cetuximab in white and Japanese patients. CONCLUSION The efficacy, safety, and pharmacokinetic findings from this study support the use of first-line platinum-based chemotherapy plus cetuximab in Chinese and Korean patients with recurrent and/or metastatic SCCHN (ClinicalTrials.gov NCT01177956).
Collapse
Affiliation(s)
- Ye Guo
- Medical Oncology Department, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Mei Shi
- Radiation Oncology Department, Xijing Hospital - The First Affiliated Hospital of the Fourth Military Medical University, Shanxi Province, China
| | - Ankui Yang
- Head and Neck Department, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jifeng Feng
- Medical Oncology Department, Jiangsu Cancer Hospital, Nanjing, Jiangsu Province, China
| | - Xiaodong Zhu
- Radiotherapy Department, Affiliated Cancer Hospital, Guangxi Medical University, Nanning, Guangxi Province, China
| | - Young-Jin Choi
- Medical Oncology Department, Pusan National University Hospital, Seo-Gu, Busan, Korea
| | - Guoqin Hu
- Cancer Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Chunhong Hu
- Oncology Department, The Second Xiangya Hospital of Central South University, Changsha, Hu'nan Province, China
| | - Rongcheng Luo
- Cancer Medical Department, Nanfang Hospital, Guangzhou, China
| | - Yiping Zhang
- Chemotherapy Center, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
| | - Liang Zhou
- Head and Neck Surgery Department, Eye and Ear, Nose, and Throat Hospital of Fudan University, Xuhui District, Shanghai, China
| | - Ying Cheng
- Medical Oncology Department, Jilin Cancer Hospital, Changchun, Jilin, China
| | | | - Junliang Cai
- Merck Serono (Beijing) Pharmaceutical R&D Company, The Center, Shanghai, China
| | - Yuankai Shi
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Chaoyang District, Beijing, China
| |
Collapse
|