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Mahdavi H. Induction chemotherapy in locally advanced head and neck cancers, is there a best choice? Crit Rev Oncol Hematol 2023; 186:103986. [PMID: 37059273 DOI: 10.1016/j.critrevonc.2023.103986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/25/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023] Open
Abstract
Locally advanced stages of squamous cancers of the head and neck (LAHNCs) acquire high propensity for local and systemic relapse. Addition of systemic therapy as an induction (IC) to the standard concurrent chemoradiotherapy (CCRT) has become an approach of many practitioners. This strategy has shown to reduce metastases but did not affect survival in unselected populations. Meanwhile, the induction regimen including docetaxel, cisplatin, 5-FU (TPF) has shown superiority over other combinations, however, a survival advantage was not detected when compared to CCRT alone. This may be attributed to its high toxicity profile, inducing treatment delay, resistance, or variations in tumor sites and responses. Currently, newer systemic therapy combinations are being tested and indicators of benefit are being identified. The focus of this review is on the development of the choice of combination regimen for induction. Subsequently, proposed alternatives and strategies for patient selection will be introduced.
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Affiliation(s)
- Hoda Mahdavi
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences,Tehran, Iran; Department of Radiation Oncology, Firoozgar General Hospital, Beh-Afarin St., Karimkhan-e-Zand Ave., Vali-e-Asr Sq., Tehran, Iran.
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2
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Gedon J, Kessler M, Schmidt JM. Frontal sinus carcinoma in forty-one dogs (2001-2022). Vet Comp Oncol 2023; 21:231-239. [PMID: 36745079 DOI: 10.1111/vco.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
Reports on canine frontal sinus carcinomas (FSCs) are scarce. This retrospective review of 41 dogs with FSC (2001-2022) describes demographic and clinical characteristics of canine FSC and reports the clinical experience and overall survival following treatment with toceranib phosphate (TOC) and meloxicam in 10 cases. Median age at diagnosis was 10.6 years (range: 6.5-15.4 years). There was a male-to-female-ratio of 2.4:1. The most common breeds were Jack Russell Terriers (JRT) (n = 7; 17.1%) and Rottweilers (n = 3, 7.3%). Mesocephalic breeds (70.6%) were most commonly affected, brachycephalics accounted for 8.8%. The most frequent clinical signs included skull deformation dorsomedial to the eye (87.5%), pain/head-shyness (40.0%), ocular (22.5%)/nasal (17.5%) discharge, and exophthalmos (17.5%). Duration of symptoms prior to diagnosis varied from a few days to 9 months. There were no neurological signs at initial presentation despite imaging evidence of osteolysis of the lamina interna of the frontal bone in most dogs (69.4%). In 11.5%, pulmonary changes suggestive of metastasis or concurrent primary pulmonary neoplasia were present. Tumour types included squamous cell carcinoma (58.5%), unspecified carcinoma (29.3%), and adenocarcinoma (9.8%). Ten dogs were treated with TOC (median 2.8 mg/kg EOD or three times per week) and meloxicam (0.1 mg/kg, EOD) (TOC-M), resulting in subjective regression of skull deformity in 8/10 (80.0%) patients. Overall median survival time with TOC-M was 183.5 days (range: 120-434 days). FSCs typically present with skull deformation, but no overt neurological signs. Male dogs and JRT may be overrepresented. The use of TOC-M in FSC appears promising and warrants further prospective evaluation.
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Affiliation(s)
- Julia Gedon
- Division of Oncology, Small Animal Clinic Hofheim, Hofheim, Germany
| | - Martin Kessler
- Division of Oncology, Small Animal Clinic Hofheim, Hofheim, Germany
| | - Jarno M Schmidt
- Division of Oncology, Small Animal Clinic Hofheim, Hofheim, Germany
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3
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Tsakonas G, Specht L, Kristensen CA, Moreno MHC, Haugen Cange H, Soderstrom K, Friesland S. Randomized Phase II Study with Cetuximab in Combination with 5-FU and Cisplatin or Carboplatin vs. Cetuximab in Combination with Paclitaxel and Carboplatin for Treatment of Patients with Relapsed or Metastatic Squamous Cell Carcinoma of the Head and Neck (CETMET Trial). Cancers (Basel) 2020; 12:cancers12113110. [PMID: 33114379 PMCID: PMC7693024 DOI: 10.3390/cancers12113110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary The purpose of the CET-MET trial was to find a new platinum- based chemotherapy regimen in combination with cetuximab for relapsed or metastatic squamous cell carcinoma of the head and neck (RM- SCCHN), that would achieve an equivalent PFS with standard cetuximab and 5-FU/platinum-based chemotherapy (EXTREME regimen), albeit with less toxicity. RM-SCCHN is a disease which affects patients with severe comorbidity and unhealthy life styles, rendering it difficult to treat with toxic regimens such as the EXTREME trial regimen. Immune checkpoint inhibition (ICI) with/or without the addition of chemotherapy has recently been introduced as a first- line treatment option for RM-SCCHN. However, these new treatment options will not be suitable for all patients. The experimental arm of this trial with Cetuximab and paclitaxel/carboplatin is easier to administer and perhaps more beneficial to combine with ICIs due to its favorable toxicity profile and the potential immunomodulatory effects of taxanes. Abstract Background: Platinum-based chemotherapy with cetuximab is the standard of care for relapsed or metastatic squamous cell carcinoma of the head and neck (SCCHN). The aim of this trial was to investigate whether cetuximab and paclitaxel/carboplatin can achieve similar progression-free survival (PFS) with standard cetuximab and 5-FU/platinum-based chemotherapy. Standard chemotherapy treatment for SCCHN is related to severe toxicity and new, less toxic regimens are needed. Methods: In this multicentre, randomized, controlled, phase 2 trial, 85 patients with relapsed or metastatic SCCHN were randomized in a 1:1 ratio to cetuximab and 5-FU/cisplatin or carboplatin (arm A) vs. cetuximab and paclitaxel/carboplatin (arm B). Eligibility criteria included age ≥18 years, Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0–1, and adequate organ functions. The primary endpoint was to investigate whether PFS in arm B is significantly worse than PFS in arm A. Results: Median PFS in arm A was 4.37 months (95% CI: 2.9–5.9 m) and 6.5 months (95% CI: 4.8–8.2 m) in arm B, (p = 0.064). Median overall survival (OS) was 8.4 months (95% CI: 5.3–11.5 m) in arm A and 10.2 months (95% CI: 5.4–15 m) in arm B, (HR = 0.71; 95% CI: 0.43–1.16). PFS HR for arm B was not significantly worse than arm A (HR = 0.65; 95% CI: 0.41–1.03). Adverse events ≥ grade 3 were more frequent in arm A than arm B (60% vs. 40%; p = 0.034). Conclusion: Cetuximab and paclitaxel/carboplatin was found to have similar efficacy and less toxicity compared to cetuximab and 5-FU/cisplatin or carboplatin. The experimental arm is easier to administer rendering it a favorable alternative to standard therapy.
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Affiliation(s)
- Georgios Tsakonas
- Theme Cancer, Medical Unit Head&Neck, Lung and Skin Cancer, Karolinska University Hospital, 17176 Stockholm, Sweden; (M.H.C.M.); (S.F.)
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
- Correspondence:
| | - Lena Specht
- Rigshospitalet, Section for Head&Neck and Thoracic Oncology, Department of Oncology, University of Copenhagen, 2100 Copenhagen, Denmark; (L.S.); (C.A.K.)
| | - Claus Andrup Kristensen
- Rigshospitalet, Section for Head&Neck and Thoracic Oncology, Department of Oncology, University of Copenhagen, 2100 Copenhagen, Denmark; (L.S.); (C.A.K.)
| | - Maria Herlestam Calero Moreno
- Theme Cancer, Medical Unit Head&Neck, Lung and Skin Cancer, Karolinska University Hospital, 17176 Stockholm, Sweden; (M.H.C.M.); (S.F.)
| | - Hedda Haugen Cange
- Department of Oncology, Sahlgrenska University Hospital, 41345 Goteborg, Sweden;
| | - Karin Soderstrom
- Department of Oncology, Norrlands University Hospital, 90185 Umea, Sweden;
| | - Signe Friesland
- Theme Cancer, Medical Unit Head&Neck, Lung and Skin Cancer, Karolinska University Hospital, 17176 Stockholm, Sweden; (M.H.C.M.); (S.F.)
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
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Zhang Y, Wu LL, Zheng XL, Lin CM. C.292G>A, a novel glycine receptor alpha 1 subunit gene (GLRA1) mutation found in a Chinese patient with hyperekplexia: A case report. Medicine (Baltimore) 2020; 99:e19968. [PMID: 32332682 PMCID: PMC7220787 DOI: 10.1097/md.0000000000019968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Hyperekplexia is a rare hereditary neurological disorder; only 5 glycine receptor alpha 1 subunit gene (GLRA1) mutations have been reported in 5 Chinese patients. We report a Chinese infant with hyperekplexia and a novel mutation at c.292G > A. PATIENT CONCERNS A Chinese infant with hyperekplexia and a novel mutation at c.292G > A. DIAGNOSIS All exons of GLRA1 were sequenced in her parents and her, which revealed a mutation at c.1030C > T and another novel mutation at c.292G > A. Her diagnosis was confirmed as hereditary hyperekplexia with GlRA1 hybrid gene mutations based on the sequencing results. INTERVENTIONS She was treated with clonazepam. OUTCOMES Her muscle hypertonia recovered rapidly and the excessive startle reflex to unexpected stimuli was significantly reduced. CONCLUSION Genetic DNA sequencing is a crucial method for diagnosing hyperekplexia-related gene mutation.
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Klapproth E, Dickreuter E, Zakrzewski F, Seifert M, Petzold A, Dahl A, Schröck E, Klink B, Cordes N. Whole exome sequencing identifies mTOR and KEAP1 as potential targets for radiosensitization of HNSCC cells refractory to EGFR and β1 integrin inhibition. Oncotarget 2018; 9:18099-18114. [PMID: 29719593 PMCID: PMC5915060 DOI: 10.18632/oncotarget.24266] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/09/2018] [Indexed: 12/26/2022] Open
Abstract
Intrinsic and acquired resistances are major obstacles in cancer therapy. Genetic characterization is commonly used to identify predictive or prognostic biomarker signatures and potential cancer targets in samples from therapy-naïve patients. By far less common are such investigations to identify specific, predictive and/or prognostic gene signatures in patients or cancer cells refractory to a specific molecular-targeted intervention. This, however, might have a great value to foster the development of tailored, personalized cancer therapy. Based on our identification of a differential radiosensitization by single and combined β1 integrin (AIIB2) and EGFR (Cetuximab) targeting in more physiological, three-dimensional head and neck squamous cell carcinoma (HNSCC) cell cultures, we performed comparative whole exome sequencing, phosphoproteome analyses and RNAi knockdown screens in responder and non-responder cell lines. We found a higher rate of gene mutations with putative protein-changing characteristics in non-responders and different mutational profiles of responders and non-responders. These profiles allow stratification of HNSCC patients and identification of potential targets to address treatment resistance. Consecutively, pharmacological inhibition of mTOR and KEAP1 effectively diminished non-responder insusceptibility to β1 integrin and EGFR targeting for radiosensitization. Our data pinpoint the added value of genetic biomarker identification after selection for cancer subgroup responsiveness to targeted therapies.
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Affiliation(s)
- Erik Klapproth
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Ellen Dickreuter
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Falk Zakrzewski
- German Cancer Consortium (DKTK), Dresden 01307, Germany
- German Cancer Research Center (DKFZ), Dresden partner site, Heidelberg 69120, Germany
- Core Unit for Molecular Tumor Diagnostics (CMTD), National Center for Tumor Diseases (NCT), Dresden 01307, Germany
| | - Michael Seifert
- Institute for Medical Informatics and Biometry (IMB), Technische Universität Dresden, Dresden 01307, Germany
- National Center for Tumor Diseases (NCT), Dresden 01307, Germany
| | - Andreas Petzold
- Deep Sequencing Group, BIOTEChnology Center, Technische Universität Dresden, Dresden 01307, Germany
| | - Andreas Dahl
- Deep Sequencing Group, BIOTEChnology Center, Technische Universität Dresden, Dresden 01307, Germany
| | - Evelin Schröck
- German Cancer Consortium (DKTK), Dresden 01307, Germany
- German Cancer Research Center (DKFZ), Dresden partner site, Heidelberg 69120, Germany
- Core Unit for Molecular Tumor Diagnostics (CMTD), National Center for Tumor Diseases (NCT), Dresden 01307, Germany
- Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany
| | - Barbara Klink
- German Cancer Consortium (DKTK), Dresden 01307, Germany
- German Cancer Research Center (DKFZ), Dresden partner site, Heidelberg 69120, Germany
- Core Unit for Molecular Tumor Diagnostics (CMTD), National Center for Tumor Diseases (NCT), Dresden 01307, Germany
- Deep Sequencing Group, BIOTEChnology Center, Technische Universität Dresden, Dresden 01307, Germany
- Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany
| | - Nils Cordes
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- German Cancer Consortium (DKTK), Dresden 01307, Germany
- German Cancer Research Center (DKFZ), Dresden partner site, Heidelberg 69120, Germany
- Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology, Dresden 01328, Germany
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7
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Bozec A, Ebran N, Radosevic-Robin N, Chamorey E, Yahia HB, Marcie S, Gautier M, Penault-Llorca F, Milano G. Combination of phosphotidylinositol-3-kinase targeting with cetuximab and irradiation: A preclinical study on an orthotopic xenograft model of head and neck cancer. Head Neck 2016; 39:151-159. [DOI: 10.1002/hed.24560] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/24/2016] [Accepted: 06/27/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Alexandre Bozec
- University Institute of the Face and Neck; Nice cedex France
| | - Nathalie Ebran
- Department of Oncopharmacology; Antoine Lacassagne Comprehensive Cancer Centre; Nice cedex France
| | - Nina Radosevic-Robin
- Department of Pathology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
- ERTICa Research Group; University of Auvergne; Clermont-Ferrand France
| | - Emmanuel Chamorey
- Department of Clinical Research; Innovation and Statistics (DRIS), Antoine Lacassagne Comprehensive Cancer Centre; Nice cedex France
| | - Hedi Ben Yahia
- Department of Oncopharmacology; Antoine Lacassagne Comprehensive Cancer Centre; Nice cedex France
| | - Serge Marcie
- Department of Physics; Antoine Lacassagne Comprehensive Cancer Centre; Nice cedex France
| | - Mathieu Gautier
- Department of Physics; Antoine Lacassagne Comprehensive Cancer Centre; Nice cedex France
| | - Frédérique Penault-Llorca
- Department of Pathology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
- ERTICa Research Group; University of Auvergne; Clermont-Ferrand France
| | - Gérard Milano
- Department of Oncopharmacology; Antoine Lacassagne Comprehensive Cancer Centre; Nice cedex France
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8
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Trivedi S, Concha-Benavente F, Srivastava RM, Jie HB, Gibson SP, Schmitt NC, Ferris RL. Immune biomarkers of anti-EGFR monoclonal antibody therapy. Ann Oncol 2015; 26:40-47. [PMID: 24997207 PMCID: PMC4269339 DOI: 10.1093/annonc/mdu156] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 12/23/2022] Open
Abstract
The tumor antigen (TA)-targeted monoclonal antibodies (mAb) cetuximab and panitumumab target the human epidermal growth factor receptor and have been integrated into treatment regimens for advanced squamous cell carcinoma of the head and neck (SCCHN). The therapeutic efficacy of these mAbs has been found to be enhanced when combined with radiotherapy and chemotherapy. However, clinical trials indicate that these findings are limited to fewer than 20% of treated patients. Therefore, identifying patients who are likely to benefit from these agents is crucial to improving therapeutic strategies. Interestingly, it has been noted that TA-targeted mAbs mediate their effects by contributing to cell-mediated cytotoxicity in addition to inhibition of downstream signaling pathways. Here, we describe the potential immunogenic mechanisms underlying these clinical findings, their role in the varied clinical response and identify the putative biomarkers of antitumor activity. We review potential immunological biomarkers that affect mAb therapy in SCCHN patients, the implications of these findings and how they translate to the clinical scenario, which are critical to improving patient selection and ultimately outcomes for patients undergoing therapy.
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Affiliation(s)
- S Trivedi
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | | | - R M Srivastava
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | - H B Jie
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | - S P Gibson
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | - N C Schmitt
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | - R L Ferris
- Department of Otolaryngology, University of Pittsburgh School of Medicine; Department of Immunology, University of Pittsburgh; Cancer Immunology Program, University of Pittsburgh Cancer Institute, Pittsburgh, USA.
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9
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EGFR inhibitors and autophagy in cancer treatment. Tumour Biol 2014; 35:11701-9. [PMID: 25293518 DOI: 10.1007/s13277-014-2660-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/18/2014] [Indexed: 12/19/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) inhibitor treatment is a strategy for cancer therapy. However, innate and acquired resistance is a major obstacle of the efficacy. Autophagy is a self-digesting process in cells, which is considered to be associated with anti-cancer drug resistance. The activation of EGFR can regulate autophagy through multiple signal pathways. EGFR inhibitors can induce autophagy, but the specific function of the induction of autophagy by EGFR inhibitors remains biphasic. On the one hand, autophagy induced by EGFR inhibitors acts as a cytoprotective response in cancer cells, and autophagy inhibitors can enhance the cytotoxic effects of EGFR inhibitors. On the other hand, a high level of autophagy after treatment of EGFR inhibitors can also result in autophagic cell death lacking features of apoptosis, and the combination of EGFR inhibitors with an autophagy inducer might be beneficial. Thus, autophagy regulation represents a promising approach for improving the efficacy of EGFR inhibitors in the treatment of cancer patients.
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10
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Selzer E, Kornek G. Targeted drugs in combination with radiotherapy for the treatment of solid tumors: current state and future developments. Expert Rev Clin Pharmacol 2014; 6:663-76. [PMID: 24164614 DOI: 10.1586/17512433.2013.841540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The continuously rising use of novel drugs, especially of molecules belonging to the group of targeted drugs is now shaping the therapeutic landscape. However, treatment combinations of targeted drugs with radiotherapy are still rare. Only the monoclonal antibody cetuximab (Erbitux®) has been approved for the treatment of locally advanced squamous cell cancer of the head and neck in combination with radiotherapy. Several targeted compounds are in advanced stages of clinical development for combination treatments with radiotherapy, of which substances with either anti-EGFR or anti-angiogenic mechanisms, such as trastuzumab, panitumumab, erlotinib, cilengitide and bevacizumab are the most promising. Aim of this article is to provide, mainly from a radio-oncological point of view, an overview about the current state as well as to give an outlook on the near future of the most advanced targeted combined treatment concepts for solid tumors.
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Affiliation(s)
- Edgar Selzer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
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11
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Masterson L, Moualed D, Masood A, Dwivedi RC, Benson R, Sterling JC, Rhodes KM, Sudhoff H, Jani P, Goon P. De-escalation treatment protocols for human papillomavirus-associated oropharyngeal squamous cell carcinoma. Cochrane Database Syst Rev 2014; 2014:CD010271. [PMID: 24532092 PMCID: PMC10654373 DOI: 10.1002/14651858.cd010271.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Human papillomavirus-associated oropharyngeal squamous cell carcinomas are a distinct subgroup of tumours that may have a better prognosis than traditional tobacco/alcohol-related disease. Iatrogenic complications, associated with conventional practice, are estimated to cause mortality of approximately 2% and high morbidity. As a result, clinicians are actively investigating the de-escalation of treatment protocols for disease with a proven viral aetiology. OBJECTIVES To summarise the available evidence regarding de-escalation treatment protocols for human papillomavirus-associated, locally advanced oropharyngeal squamous cell carcinoma. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 25 June 2013. SELECTION CRITERIA Randomised controlled trials investigating de-escalation treatment protocols for human papillomavirus-associated, locally advanced oropharyngeal carcinoma. Specific de-escalation categories were: 1) bioradiotherapy (experimental) versus chemoradiotherapy (control); 2) radiotherapy (experimental) versus chemoradiotherapy (control); and 3) low-dose (experimental) versus standard-dose radiotherapy (control). The outcomes of interest were overall and disease-specific survival, treatment-related morbidity, quality of life and cost. DATA COLLECTION AND ANALYSIS Three authors independently selected studies from the search results and extracted data. We planned to use the Cochrane 'Risk of bias' tool to assess study quality. MAIN RESULTS We did not identify any completed randomised controlled trials that could be included in the current version of this systematic review. We did, however, identify seven ongoing trials that will meet our inclusion criteria. These studies will report from 2014 onwards. We excluded 30 studies on methodological grounds (seven randomised trials with post hoc analysis by human papillomavirus status, 11 prospective trials and 12 ongoing studies). AUTHORS' CONCLUSIONS There is currently insufficient high-quality evidence for, or against, de-escalation of treatment for human papillomavirus-associated oropharyngeal carcinoma. Future trials should be multicentre to ensure adequate power. Adverse events, morbidity associated with treatment, quality of life outcomes and cost analyses should be reported in a standard format to facilitate comparison with other studies.
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Affiliation(s)
- Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
| | - Daniel Moualed
- Great Western Hospitals NHS Foundation TrustENT DepartmentSwindonUK
| | - Ajmal Masood
- Norfolk and Norwich University HospitalENT DepartmentNorwichUK
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
| | - Richard Benson
- Addenbrooke's HospitalOncology CentreBox 193CambridgeUKCB2 2QQ
| | - Jane C Sterling
- Addenbrooke's HospitalDepartment of DermatologyBox 46CambridgeUKCB2 2QQ
| | - Kirsty M Rhodes
- University of CambridgeMRC Biostatistics UnitNewnham CollegeSidgwick AvenueCambridgeCambridgeshireUKCB3 DF
| | - Holger Sudhoff
- Bielefeld Academic Teaching HospitalDepartment of Otolaryngology, Head and Neck SurgeryTeutoburger Str. 50BielefeldGermany33604
| | - Piyush Jani
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
| | - Peter Goon
- University of CambridgeDepartment of PathologyCambridgeUK
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12
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Baykara M, Buyukberber S, Ozturk B, Coskun U, Unsal DK, Demirci U, Dane F, Kaplan MA, Bora H, Benekli M. Efficacy and safety of concomitant chemoradiotherapy with cisplatin and docetaxel in patients with locally advanced squamous cell head and neck cancers. Asian Pac J Cancer Prev 2013; 14:2557-61. [PMID: 23725174 DOI: 10.7314/apjcp.2013.14.4.2557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemoradiation (CRT) using cisplatin-based regimens has become the standard of care in the treatment of squamous cell head and neck cancers (SCHNC). The impact of taxanes as radiosensitizing agents with concurrent CRT regimens is unknown. We therefore retrospectively evaluated the efficacy and tolerability of a weekly cisplatin+docetaxel combination with CRT in locally advanced SCHNC. METHODS Sixty-six patients with locally advanced SCHNC (39.4% stage IV, 53% stage III, and 7.6% stage II) were assessed retrospectively. Total radiation dose to the PTV of gross disease (primary and/or node) was 70 Gy/ 35 fractions, 5 fractions per week. Minimum doses of 60 Gy and 50 Gy were administered to PTVs of elective high risk and low risk disease, respectively. Chemotherapy (CT) consisted of weekly cisplatin (20 mg/m2) +docetaxel (20 mg/m2) concurrently with RT. RESULTS The median age of the patients was 58 years (range, 32-77). Objective response rate was 83.3%. The 2-year progression-free survival (PFS) and overall survival (OS) were 75.7% and 78.3%, respectively. The most common grade 3 and 4 toxicities were mucositis (36.4%), nausea and vomiting (12.1%), neutropenia (4.5%). CONCLUSION Weekly cisplatin and docetaxel concurrent with RT for locally advanced SCHNC was found tolerable with high efficacy.
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Affiliation(s)
- Meltem Baykara
- Department of Medical Oncology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
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Nagadia R, Pandit P, Coman WB, Cooper-White J, Punyadeera C. miRNAs in head and neck cancer revisited. Cell Oncol (Dordr) 2013; 36:1-7. [PMID: 23338821 DOI: 10.1007/s13402-012-0122-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2012] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cause of cancer mortality in the world and the 5th most commonly occurring cancer. Tobacco smoking, alcohol consumption and human papilloma virus (HPV) infections have been associated with the occurrence of HNSCC. Despite advances that have been made in HNSCC treatment, smoking-associated HNSCC patients still exhibit a poor 5 year survival rate (30-50 %) and a concomitant poor quality of life. The major clinical challenge to date lies in the early detection of dysplastic lesions,which can progress to malignancy. In addition, there are currently no tools available to monitor HNSCC patients for early stages of local recurrences or distant metastases. In the recent past, micro-RNAs (miRNA) have been assessed for their role in cancer initiation and progression, including HNSCC. It is now well-established that deregulation of these single stranded, small non-coding, 19-25 nt RNAs can e.g. enhance the expression of oncogenes or subdue the expression of tumor suppressor genes. The aims of this review are three-fold: first to retrieve from the literature miRNAs that have specifically been associated with HNSCC, second to group these miRNAs into those regulating tumor initiation, progression and metastasis, and third to discern miRNAs related to smoking-associated HNSCC versus HPV-associated HNSCC development. CONCLUSIONS This review gives an overview on the miRNAs regulating the development of head and neck cancers. The ultimate establishment of miRNA expression profiles that are HNSCC specific, and miRNAs that orchestrate altered gene and protein expression levels in HNSCC, could pave the way for a better understanding of the mechanism underlying its pathogenesis and the development of novel, targeted therapies.
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Affiliation(s)
- Rahul Nagadia
- The Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St Lucia, Australia
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Harrington K, Berrier A, Robinson M, Remenar E, Housset M, de Mendoza FH, Fayette J, Mehanna H, El-Hariry I, Compton N, Franklin N, Biswas-Baldwin N, Lau M, Legenne P, Kumar R. Randomised Phase II study of oral lapatinib combined with chemoradiotherapy in patients with advanced squamous cell carcinoma of the head and neck: rationale for future randomised trials in human papilloma virus-negative disease. Eur J Cancer 2012; 49:1609-18. [PMID: 23265705 DOI: 10.1016/j.ejca.2012.11.023] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 11/19/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND This randomised Phase II study assessed the activity and safety of concurrent chemoradiotherapy (CRT) and lapatinib followed by maintenance treatment in locally advanced, unresected stage III/IVA/IVB head and neck cancer. PATIENTS AND METHODS Patients were randomised 1:1 to concurrent CRT and placebo followed by placebo or concurrent CRT and lapatinib followed by lapatinib. Treatment continued until disease progression or study withdrawal. Primary end-point was complete response rate (CRR) by independent review 6 months post-CRT. RESULTS Sixty-seven patients (median age 56 years; 97% Eastern Cooperative Oncology Group performance status ≤1; 82% stage IV) were recruited. CRT dose intensities were unaffected by lapatinib: median radiation dose 70 Gy (lapatinib, placebo), duration 49 (lapatinib) and 50 days (placebo); median cisplatin dose 260 mg/m(2) (lapatinib) and 280 mg/m(2) (placebo). Lapatinib combined with CRT was well-tolerated. Grade 3/4 toxicities during CRT were balanced between arms, with the exception of an excess of grade 3 diarrhoea (6% versus 0%) and rash (9% versus 3%) and two grade 4 cardiac events in the lapatinib arm. CRR at 6 months post-CRT was 53% with lapatinib versus 36% with placebo in the intent-to-treat population. The progression-free survival (PFS) and overall survival rates at 18 months were 55% versus 41% and 68% versus 57% for the lapatinib and placebo arms, respectively. The difference between study arms was greatest in p16-negative disease (median PFS >20.4 months [lapatinib] versus 10.9 [placebo]). CONCLUSION Lapatinib combined with CRT is well-tolerated with numeric increases in CRR at 6 months post-CRT and median PFS in p16-negative disease.
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Acevedo-Henao C, Valette G, Miglierini P, Lefur E, Pradier O. Radiotherapy combined with cetuximab for locally advanced head and neck cancer: Results and toxicity. Cancer Radiother 2012; 16:601-3. [DOI: 10.1016/j.canrad.2012.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/10/2012] [Accepted: 06/14/2012] [Indexed: 11/15/2022]
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Bouzid K, Bedairia N, Marty M. Anticorps monoclonaux thérapeutiques en cancérologie. ACTA ACUST UNITED AC 2012; 60:223-8. [DOI: 10.1016/j.patbio.2012.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
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EGFR and HER2-Akt-mTOR signaling pathways are activated in subgroups of salivary gland carcinomas. Virchows Arch 2012; 461:271-82. [PMID: 22828828 DOI: 10.1007/s00428-012-1282-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 06/11/2012] [Accepted: 07/02/2012] [Indexed: 01/30/2023]
Abstract
Salivary gland carcinomas encompass a wide spectrum of histological entities. To identify candidate therapeutic targets and innovative treatment options for these carcinomas, we examined epidermal growth factor receptor (EGFR), phosphorylated EGFR (p-EGFR), HER2, and phosphorylated forms of Akt (p-Akt) and mammalian target of rapamycin (p-mTOR) in 47 salivary gland tumors using immunohistochemistry. EGFR overexpression was found in 51 % of the tumors (24/47); in particular, EGFR overexpression occurred in mucoepidermoid (seven out of seven) and salivary duct carcinomas (9/12). Although EGFR amplification was not detected by fluorescence in situ hybridization analysis, increased copy number due to polysomy of chromosome 7, which houses EGFR, was observed in 4 of the 24 tumors with EGFR overexpression; this polysomy occurred most frequently in salivary duct carcinomas (three out of nine). HER2 overexpression was observed in 21 % (10/47) of all tumors; in these 10 tumors, HER2 gene amplification was found in seven cases. p-Akt was found in 51 % (24/47) of all tumors, most frequently in mucoepidermoid carcinomas (six out of seven). p-mTOR was found in 57 % of the latter (four out of seven). Consequently, different signaling cascades were found activated: (1) an EGFR/HER2(-Akt)-mTOR-dependent axis, with gene gains of HER2 and/or EGFR, activated in salivary duct carcinoma and carcinoma ex pleomorphic adenoma; (2) an EGFR(-Akt)-mTOR-dependent pathway activated in mucoepidermoid carcinoma or acinic cell carcinoma, without HER2 or EGFR gene alterations; and (3) an Akt-dependent pathway without EGFR/HER2 activation in other types. These findings indicate that phosphoprotein mapping of components in the EGFR/HER2-Akt-mTOR pathways may be a useful guide to select appropriate targeting regimens.
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Haerle SK, Soyka MB, Schmid DT, Ahmad N, Huber GF, Crook DW, Hany TF. Improved treatment outcomes with 18F-FDG PET/CT for patients with advanced head and neck squamous cell carcinoma. Head Neck 2011; 34:1205-11. [DOI: 10.1002/hed.21887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/13/2011] [Accepted: 06/27/2011] [Indexed: 11/11/2022] Open
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Current World Literature. Curr Opin Oncol 2011; 23:303-10. [DOI: 10.1097/cco.0b013e328346cbfa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Babu JM, Prathibha R, Jijith VS, Hariharan R, Pillai MR. A miR-centric view of head and neck cancers. Biochim Biophys Acta Rev Cancer 2011; 1816:67-72. [PMID: 21549178 DOI: 10.1016/j.bbcan.2011.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/15/2011] [Accepted: 04/19/2011] [Indexed: 02/08/2023]
Abstract
Head and Neck Squamous Cell Carcinomas (HNSCCs) constitute the sixth most common cancer worldwide with an average 5-year survival rate of around 50%. Several microRNAs, small non-coding RNAs involved in post-transcriptional gene regulation, have been linked to HNSCC based on their differential expression in tumors. Here, we present a compilation of multiple types of information on each HNSCC linked miRNA including their expression status in tumors, their molecular targets relevant to cancer, results of gene manipulation studies and association with clinical outcome. Further, we use this information to devise a new scheme for classifying them into causal and non-causal miRNAs in HNSCC. We also discuss the possibility of using miRNAs as prognostic and diagnostic biomarkers for HNSCC, based on existing literature. Finally, we present available evidence that shows how altered expression of specific miRNAs can contribute to various "hallmarks of cancer" phenotypes such as limitless replicative potential owing to abnormal cell cycle regulation, evasion of apoptosis, reduced response to anti-growth signals, and Epithelial-Mesechymal transition (EMT).
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Affiliation(s)
- Janki Mohan Babu
- Intergrated Research Program, Rajiv Gandhi Centre Biotechnology, Thiruvananthapuram, India
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