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Brancaccio G, Moscarella E, Briatico G, Verolino P, Alfano R, Argenziano G. Challenges and new perspectives in the treatment of advanced cutaneous squamous cell carcinoma. Minerva Med 2020; 111:589-600. [PMID: 32955822 DOI: 10.23736/s0026-4806.20.06821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the overall excellent survival rates in patients affected by early cutaneous squamous cell carcinoma (CSCC), advanced forms of CSCC are associated with high patient mortality. To date, only limited therapeutic modalities have been implemented, including chemotherapy and radiotherapy. Systemic therapy was enriched by the addition of epidermal growth factor receptor inhibitors (EGFRi) in the last years. Unfortunately, the overall outcome of all these therapeutic strategies remains poor, therefore important unmet clinical needs persist. Thanks to a better understanding of the biology of advanced CSCC, new treatment options are now available. This article presents the current definition of advanced CSCC along with actual therapeutic options and discusses the strengths and limitations of a new promising systemic approach, which involves the use of immune checkpoint inhibitors.
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Affiliation(s)
| | - Elvira Moscarella
- Dermatology Unit, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Giulia Briatico
- Dermatology Unit, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Pasquale Verolino
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Roberto Alfano
- Department of Anesthesiology, Surgery and Emergency, Luigi Vanvitelli University of Campania, Naples, Italy
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2
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Bonomo P, Loi M, Desideri I, Olmetto E, Delli Paoli C, Terziani F, Greto D, Mangoni M, Scoccianti S, Simontacchi G, Francolini G, Meattini I, Caini S, Livi L. Incidence of skin toxicity in squamous cell carcinoma of the head and neck treated with radiotherapy and cetuximab: A systematic review. Crit Rev Oncol Hematol 2017; 120:98-110. [DOI: 10.1016/j.critrevonc.2017.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 09/28/2017] [Accepted: 10/29/2017] [Indexed: 12/27/2022] Open
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3
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Kuhnt T, Schreiber A, Pirnasch A, Hautmann MG, Hass P, Sieker FP, Engenhart-Cabillic R, Richter M, Dellas K, Dunst J. Hyperfractionated accelerated radiation therapy plus cetuximab plus cisplatin chemotherapy in locally advanced inoperable squamous cell carcinoma of the head and neck. Strahlenther Onkol 2017; 193:733-741. [DOI: 10.1007/s00066-017-1145-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/21/2017] [Indexed: 11/30/2022]
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Gehrke T, Scherzad A, Ickrath P, Schendzielorz P, Hagen R, Kleinsasser N, Hackenberg S. Zinc oxide nanoparticles antagonize the effect of Cetuximab on head and neck squamous cell carcinoma in vitro. Cancer Biol Ther 2017; 18:513-518. [PMID: 28494171 DOI: 10.1080/15384047.2017.1323598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Zinc oxide nanoparticles (ZnO-NPs) are being used in many cosmetic products and have been shown to induce tumor-selective cell death in human head and neck squamous cell carcinoma (HNSCC) in vitro. Cetuximab is a monoclonal antibody directed against the epidermal growth factor receptor (EGFR), whose effectiveness for HNSCC, alone or in combination with cytostatic drugs, has been demonstrated intensively in the last decades. Nanoparticles are known to interact with protein structures and thus may influence their functionality. The aim of the current study was to evaluate the effect of ZnO-NPs on the antitumor properties of Cetuximab in HNSCC in vitro. Two HNSCC cell lines (FaDu and HLaC-78) were treated with 0.1, 1 or 10 μM Cetuximab as well as 0, 0.1 or 1 μg/ml ZnO-NP. Qualitative assessment of ZnO-NP was conducted via transmission electron microscopy (TEM) and immunofluorescence staining. Evaluation was done via the MTT-assay after 24, 48 and 72 hours of incubation with Cetuximab and ZnO-NPs. ZnO-NPs were shown to antagonize the anti-tumor effects of Cetuximab in a time-dependent as well as dose-dependent way. These findings suggest an inhibitory interaction of ZnO-NPs with Cetuximab, which warrants further investigation.
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Affiliation(s)
- Thomas Gehrke
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Agmal Scherzad
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Pascal Ickrath
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Philipp Schendzielorz
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Rudolf Hagen
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Norbert Kleinsasser
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Stephan Hackenberg
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
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Chapman CH, Saba NF, Yom SS. Targeting epidermal growth factor receptor for head and neck squamous cell carcinoma: still lost in translation? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:80. [PMID: 27004227 DOI: 10.3978/j.issn.2305-5839.2016.01.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The epidermal growth factor receptor (EGFR) is preferentially expressed in head and neck squamous cell carcinoma (HNSCC), and is a promising therapeutic target. Yet other than cetuximab, no agent targeting EGFR has been approved for this disease, and none has shown benefit over the standard of care. Several randomized trials of antibody and small molecule agents have found no new indication for these agents, despite their initial promise. In this review, we examine the major clinical evidence and discuss potential future developments of translational science in this area, including use of these agents in risk-stratified subgroups, inhibition of downstream/parallel targets, and combination with immunotherapy.
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Affiliation(s)
- Christopher H Chapman
- 1 Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA ; 2 Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nabil F Saba
- 1 Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA ; 2 Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sue S Yom
- 1 Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA ; 2 Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Alorabi M, Shonka NA, Ganti AK. EGFR monoclonal antibodies in locally advanced head and neck squamous cell carcinoma: What is their current role? Crit Rev Oncol Hematol 2015; 99:170-9. [PMID: 26797287 DOI: 10.1016/j.critrevonc.2015.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/25/2015] [Accepted: 12/15/2015] [Indexed: 01/29/2023] Open
Abstract
Treatment options for locally advanced squamous cell carcinoma of the head and neck (SCCHN) include either surgical resection followed by radiation or chemoradiation, or definitive chemoradiation for which single-agent cisplatin is the best studied and established. The increasing understanding of the molecular biology of SCCHN has led to an interest in the development of targeted therapies. The epidermal growth factor receptor (EGFR) is over-expressed in nearly 80-90% of cases of SCCHN and correlates with poor prognosis and resistance to radiation. Preclinical evidence showed that blocking EGFR restores radiation sensitivity and enhances cytotoxicity. This finding led to clinical trials evaluating this class of agents and the approval of cetuximab in combination with radiation for the treatment of locally advanced SCCHN. This review is focused on the anti-EGFR monoclonal antibodies and their role either with radiotherapy or chemoradiation in unresectable LA SCCHN.
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Affiliation(s)
- Mohamed Alorabi
- Department of Clinical Oncology, Ain Shams University Hospitals, Cairo, Egypt
| | - Nicole A Shonka
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Apar Kishor Ganti
- Division of Oncology-Hematology, Department of Internal Medicine, VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE 68198-7680, USA.
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Miszczyk L, Maciejewski B, Tukiendorf A, Woźniak G, Jochymek B, Gawryszuk A, Szweda M. Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients-final results of a randomized clinical trial. Br J Radiol 2014; 87:20140212. [PMID: 25027170 DOI: 10.1259/bjr.20140212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Evaluation of the efficacy and toxicity of split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck (H&N) cancer patients. METHODS We enrolled 101 patients (39 in CHA-CHA and 37 in conventional (Conv.) arm completed the treatment). The CHA-CHA arm patients were irradiated twice a day, 7 days a week, using a fraction dose (fd) of 1.6 Gy up to 64 Gy with an 8-day gap in midterm. Patients in the control (Conv.) arm group were irradiated with a fd of 2 Gy, five times a week to a total dose of 72-74 Gy in the overall treatment time of 50-53 days. Quality of life (QOL) and acute mucosal reaction were evaluated during radiotherapy (RT). After RT, we followed the effect of treatment, QOL, performance status and adverse effects of radiation. For statistical analysis mainly a hierarchical multilevel modelling was used. RESULTS QOL was most deteriorated in the CHA-CHA arm; the CHA-CHA scheme also caused a relatively stronger acute injury. There were no significant differences in late adverse effects. In the CHA-CHA arm in 35% and in Conv. arm in 30% of patients, disease was controlled during follow-up. Tumour regression 1 year after the treatment was significantly better in the CHA-CHA arm. However, the overall survival rate analysis did not show significant difference between both arms. CONCLUSION Despite differences in treatment results, we cannot conclude that split-course accelerated hyperfractionated irradiation is superior to conventionally fractionated RT as a sole treatment for advanced H&N cancer patients. ADVANCES IN KNOWLEDGE Obtained results in the context of published data support the statement that altered fractionations alone do not give an advantage for advanced H&N cancer patients.
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Affiliation(s)
- L Miszczyk
- 1 Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
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Strojan P, Kuhar CG, Žumer B, Kadivec M, Karner K, Fajdiga I, Jančar B, Gale N, Poljak M, Kocjan BJ, Zakotnik B. TPF induction chemotherapy and concomitant irradiation with cisplatin and cetuximab in unresectable squamous cell carcinoma of the head and neck. Head Neck 2013; 36:1555-61. [DOI: 10.1002/hed.23506] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/10/2013] [Accepted: 09/10/2013] [Indexed: 01/03/2023] Open
Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology; Institute of Oncology; Ljubljana Slovenia
| | | | - Barbara Žumer
- Department of Radiation Oncology; Institute of Oncology; Ljubljana Slovenia
| | | | - Katarina Karner
- Department of Radiation Oncology; Institute of Oncology; Ljubljana Slovenia
| | - Igor Fajdiga
- University Department of Otorhinolaryngology and Cervicofacial Surgery; University Clinical Center; Ljubljana Slovenia
| | - Boris Jančar
- Department of Radiation Oncology; Institute of Oncology; Ljubljana Slovenia
| | - Nina Gale
- Institute of Pathology, Medical Faculty; University of Ljubljana; Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Medical Faculty; University of Ljubljana; Slovenia
| | - Boštjan J Kocjan
- Institute of Microbiology and Immunology, Medical Faculty; University of Ljubljana; Slovenia
| | - Branko Zakotnik
- Department of Medical Oncology; Institute of Oncology; Ljubljana Slovenia
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Hitre E, Budai B, Takácsi-Nagy Z, Rubovszky G, Tóth E, Remenár É, Polgár C, Láng I. Cetuximab and platinum-based chemoradio- or chemotherapy of patients with epidermal growth factor receptor expressing adenoid cystic carcinoma: a phase II trial. Br J Cancer 2013; 109:1117-22. [PMID: 23942070 PMCID: PMC3778310 DOI: 10.1038/bjc.2013.468] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/12/2013] [Accepted: 07/21/2013] [Indexed: 12/13/2022] Open
Abstract
Background: Epidermal growth factor receptor (EGFR) is highly expressed in adenoid cystic carcinoma (ACC). The efficacy and toxicity of cetuximab with concomitant platinum-based chemoradio- or chemotherapy in patients with locally advanced or metastatic ACC, respectively, was evaluated. Methods: Eligible patients (9 with locally advanced tumour and 12 with metastases) had positive tumour EGFR expression. The cetuximab loading dose (400 mg m−2) was followed by 250 mg m−2 per week. Locally advanced tumours were irradiated (mean dose 65 Gy) and treated with concomitant cisplatin (75 mg m−2, intravenously). Patients with metastases received concomitant cisplatin and 5-fluorouracil (4 × 1000 mg m−2). Results: For patients with locally advanced disease (median follow-up: 52 months), the median progression-free survival (PFS) was 64 months and the 2-year overall survival (OS) rate was 100%. For patients with metastases (median follow-up: 72 months), the median PFS and OS were 13 and 24 months, respectively. In both groups the objective response rate was >40%. Skin rash, in-field dermatitis, mucositis and vomiting were the most frequent grade 3/4 adverse events. Conclusion: In this single-arm study, the efficacy of cetuximab plus chemoradio- or chemotherapy appeared favourable as compared with historical controls. All side effects were manageable and did not hamper the treatment.
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Affiliation(s)
- E Hitre
- National Institute of Oncology, Ráth Gy. u. 7-9, 1122 Budapest, Hungary
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10
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Ree AH, Hollywood D. Design and conduct of early-phase radiotherapy trials with targeted therapeutics: lessons from the PRAVO experience. Radiother Oncol 2013; 108:3-16. [PMID: 23830196 DOI: 10.1016/j.radonc.2013.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 05/28/2013] [Accepted: 06/10/2013] [Indexed: 12/28/2022]
Abstract
New strategies to facilitate the improvement of physical and integrated biological optimization of high-precision treatment protocols are an important priority for modern radiation oncology. From a clinical perspective, as knowledge accumulates from molecular radiobiology, there is a complex and exciting opportunity to investigate novel approaches to rational patient treatment stratification based on actionable tumor targets, together with the appropriate design of next-generation early-phase radiotherapy trials utilizing targeted therapeutics, to formally evaluate relevant clinical and biomarker endpoints. A unique aspect in the development pathway of systemic agents with presumed radiosensitizing activity will also be the need for special attention on patient eligibility and the rigorous definition of radiation dose-volume relationships and potential dose-limiting toxicities. Based on recent experience from systematically investigating histone deacetylase inhibitors as radiosensitizing agents, from initial studies in preclinical tumor models through the conduct of a phase I clinical study to evaluate tumor activity of the targeted agent as well as patient safety and tumor response to the combined treatment modality, this communication will summarize principles relating to early clinical evaluation of combining radiotherapy and targeted therapeutics.
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Affiliation(s)
- Anne Hansen Ree
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway.
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11
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Is the combination of Cetuximab with chemo-radiotherapy regimens worthwhile in the treatment of locally advanced head and neck cancer? A review of current evidence. Crit Rev Oncol Hematol 2012; 85:112-20. [PMID: 22743346 DOI: 10.1016/j.critrevonc.2012.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 05/12/2012] [Accepted: 05/31/2012] [Indexed: 12/27/2022] Open
Abstract
The administration of Cetuximab in combination with radiotherapy and chemotherapy has shown clear survival improvements within the locally advanced and the relapsed/metastatic settings respectively. These results have provided the clinical rational for the inclusion of Cetuximab into chemo-radiation regimens. Trials assessing the combination of Cetuximab with induction chemotherapy, concomitant chemo-radiotherapy or both are reviewed. Taken together, their results suggest that the addition of Cetuximab is promising in trials of induction chemotherapy, showing almost uniformly response rates higher than historical controls. In combination with concomitant hyperfractionated radiotherapy and Cisplatin the results of the RTOG 0522 trial do not suggest any benefit. However a positive effect cannot be excluded with other schedules. Although feasibility has been universally suggested, adding Cetuximab implies some toxicity enhancement. Single local and systemic toxicities are more frequent and supposedly the overall treatment intensity is increased. Moreover the drug-specific toxicities are potentially severe and deserve timely recognition and management.
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12
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Molecular targeting agents in the context of primary chemoradiation strategies. Head Neck 2012; 35:738-46. [DOI: 10.1002/hed.22012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2011] [Indexed: 01/01/2023] Open
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Niyazi M, Maihoefer C, Krause M, Rödel C, Budach W, Belka C. Radiotherapy and "new" drugs-new side effects? Radiat Oncol 2011; 6:177. [PMID: 22188921 PMCID: PMC3266653 DOI: 10.1186/1748-717x-6-177] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 12/21/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Targeted drugs have augmented the cancer treatment armamentarium. Based on the molecular specificity, it was initially believed that these drugs had significantly less side effects. However, currently it is accepted that all of these agents have their specific side effects. Based on the given multimodal approach, special emphasis has to be placed on putative interactions of conventional cytostatic drugs, targeted agents and other modalities. The interaction of targeted drugs with radiation harbours special risks, since the awareness for interactions and even synergistic toxicities is lacking. At present, only limited is data available regarding combinations of targeted drugs and radiotherapy. This review gives an overview on the current knowledge on such combined treatments. MATERIALS AND METHODS Using the following MESH headings and combinations of these terms pubmed database was searched: Radiotherapy AND cetuximab/trastuzumab/panitumumab/nimotuzumab, bevacizumab, sunitinib/sorafenib/lapatinib/gefitinib/erlotinib/sirolimus, thalidomide/lenalidomide as well as erythropoietin. For citation crosscheck the ISI web of science database was used employing the same search terms. RESULTS Several classes of targeted substances may be distinguished: Small molecules including kinase inhibitors and specific inhibitors, antibodies, and anti-angiogenic agents. Combination of these agents with radiotherapy may lead to specific toxicities or negatively influence the efficacy of RT. Though there is only little information on the interaction of molecular targeted radiation and radiotherapy in clinical settings, several critical incidents are reported. CONCLUSIONS The addition of molecular targeted drugs to conventional radiotherapy outside of approved regimens or clinical trials warrants a careful consideration especially when used in conjunction in hypo-fractionated regimens. Clinical trials are urgently needed in order to address the open question in regard to efficacy, early and late toxicity.
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Affiliation(s)
- Maximilian Niyazi
- Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 München, Germany
| | - Cornelius Maihoefer
- Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 München, Germany
| | - Mechthild Krause
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Claus Rödel
- Klinik für Strahlentherapie und Onkologie, Johann Wolfgang Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Wilfried Budach
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Heinrich Heine Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Claus Belka
- Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 München, Germany
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Gobbo M, Ottaviani G, Mustacchi G, Di Lenarda R, Biasotto M. Acneiform rash due to epidermal growth factor receptor inhibitors: high-level laser therapy as an innovative approach. Lasers Med Sci 2011; 27:1085-90. [PMID: 22120470 DOI: 10.1007/s10103-011-1029-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 11/03/2011] [Indexed: 12/27/2022]
Abstract
Acneiform rash associated with epidermal growth factor receptor inhibitors frequently presents facial manifestations. The treatment modality for such lesions still needs to be elucidated. The aim of this original report was to evaluate the effectiveness of high-level laser therapy in reducing the severity of facial acneiform rash induced by cetuximab, an epidermal growth factor receptor inhibitors. Four patients with metastatic colorectal cancer and two patients with head and neck cancer showing cetuximab-induced facial rash were treated by high-level laser therapy in two 8-min-long consecutive sessions/day over a 4-day treatment. Patients wore protective glasses to prevent eye damage related to laser light. Subsequently, patients were seen once a week for up to 21 days and after 180 days. During each day of treatment and each follow-up recall, patients were asked to complete a questionnaire about the onset and progression of their acneiform rash (for a total of eight sessions). Cetuximab-related toxicity and general discomfort visual analogue scales were also recorded in each of these eight sessions in the treated and control areas in each patient. After the fourth session of high-level laser therapy, the patients showed a noteworthy decrease in both cetuximab-related toxicity and visual analogue scales, up to a complete regression of the lesions at the end of the follow-up in all treated areas. The high-level laser therapy was effective in the healing of acneiform rash associated with epidermal growth factor receptor inhibitors with no side effects.
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Affiliation(s)
- M Gobbo
- Division of Oral Pathology, Dental Science Department, University of Trieste, Ospedale Maggiore, Piazza dell'Ospitale 2, 34100, Trieste, Italy
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Abstract
The concept of immunotherapy as a treatment for cancer patients has been in existence for decades. However, more recent immune therapeutic approaches have involved targeting of tumor-specific antigens. Although improvements have been made in using such immune stimulatory treatment strategies for a variety of solid cancers, the use of these strategies for patients with head and neck squamous cell carcinoma (HNSCC) is lagging behind. Immunotherapeutic approaches for HNSCC are particularly complicated by the profound immune suppression that is induced by HNSCC, which potentially decreases the effectiveness of immune stimulatory efforts. Trials involving patients with various solid cancers have shown the enhanced effectiveness of combining various immunotherapeutic approaches or combining immunotherapy with chemotherapy or radiation therapy. Treatment of HNSCC with such combination approaches has not been extensively investigated and has the added challenge of the need to overcome the HNSCC-induced immune suppression. This study focuses on clinical trials that have tested immunotherapeutic approaches for HNSCC patients and the challenges associated with such approaches. In addition, it will call attention to immunotherapeutic strategies that have been shown to be successful in the treatment of other solid cancers to identify potential strategies that may apply to the treatment of HNSCC.
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Specenier P, Vermorken JB. Cetuximab in the treatment of squamous cell carcinoma of the head and neck. Expert Rev Anticancer Ther 2011; 11:511-24. [PMID: 21504318 DOI: 10.1586/era.11.20] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The majority of the head and neck cancers are squamous cell carcinomas, which commonly overexpress the EGF receptor (EGFR). Cetuximab is a chimeric monoclonal antibody that binds with high affinity to the extracellular domain of EGFR, and in addition induces antibody-dependent cellular cytoxicity. In a randomized Phase III trial in patients with locoregionally advanced squamous cell carcinoma of the head and neck, the addition of cetuximab to radiotherapy prolonged the median time of locoregional control from 14.9 to 24.4 months and increased the median overall survival from 29.3 to 49.0 months. In patients with platinum-refractory recurrent and/or metastatic disease, the objective response and disease-control rates in various studies ranged from 10 to 13% and from 46 to 56%, respectively. In the EXTREME trial, the addition of cetuximab to platinum/5-fluorouracil as first-line treatment of recurrent/metastatic squamous cell carcinoma of the head and neck not only led to significant improvements in survival, response rate and disease control, but also induced a better symptom control in comparison with that observed with platinum/5-fluorouracil alone.
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Affiliation(s)
- Pol Specenier
- Department of Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
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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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Molecular-targeted therapy of head and neck squamous cell carcinoma: beyond cetuximab-based therapy. Curr Opin Oncol 2011; 23:241-8. [DOI: 10.1097/cco.0b013e328344f581] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hong L, Li S, Han Y, Du J, Zhang H, Li J, Zhao Q, Wu K, Fan D. Angiogenesis-related molecular targets in esophageal cancer. Expert Opin Investig Drugs 2011; 20:637-44. [DOI: 10.1517/13543784.2011.571203] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sano D, Matsumoto F, Valdecanas DR, Zhao M, Molkentine DP, Takahashi Y, Hanna EY, Papadimitrakopoulou V, Heymach J, Milas L, Myers JN. Vandetanib restores head and neck squamous cell carcinoma cells' sensitivity to cisplatin and radiation in vivo and in vitro. Clin Cancer Res 2011; 17:1815-27. [PMID: 21350000 DOI: 10.1158/1078-0432.ccr-10-2120] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE We investigated whether vandetanib, an inhibitor of the tyrosine kinase activities of vascular endothelial growth factor receptor-2 (VEGFR-2), epidermal growth factor receptor (EGFR), and rearranged during transfection (RET), could augment the antitumor activity of radiation with or without cisplatin in preclinical in vitro and in vivo models of human head and neck squamous cell carcinoma (HNSCC). EXPERIMENTAL DESIGN OSC-19 and HN5 HNSCC cells that were cisplatin and radioresistant were treated with vandetanib, cisplatin, and radiation alone or in combination in vitro and in vivo using an orthotopic nude mouse model. Treatment effects were assessed using clonogenic survival assay, tumor volume, bioluminescence imaging, tumor growth delay, survival, microvessel density, tumor and endothelial cell apoptosis, and EGFR and Akt phosphorylation data. RESULTS Vandetanib plus cisplatin radiosensitized HNSCC cells in vitro and in vivo. The combination treatment with vandetanib, cisplatin, and radiation was superior to the rest of treatments (including the double combinations) in antitumoral effects, prolonging survival, decreasing cervical lymph node metastases in vivo. It also increased both tumor and tumor-associated endothelial cell apoptosis and decreased microvessel density in vivo. An analysis of tumor growth delay data revealed that vandetanib plus cisplatin enhanced radioresponse in vivo. All vandetanib-containing treatments inhibited EGFR and Akt phosphorylation in vitro and in vivo. CONCLUSION The addition of vandetanib to combination therapy with cisplatin and radiation was able to effectively overcome cisplatin and radioresistance in in vitro and in vivo models of HNSCC. Further study of this regimen in clinical trials may be warranted.
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Affiliation(s)
- Daisuke Sano
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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