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Barry B, Dolivet G, Clatot F, Huguet F, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Coste F, Cupissol D, Cuvelier P, De Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, De Raucourt D. [French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. Bull Cancer 2024; 111:393-415. [PMID: 38418334 DOI: 10.1016/j.bulcan.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations. METHODOLOGY To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS). RESULTS The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey. CONCLUSION All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.
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Affiliation(s)
- Béatrix Barry
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, ORL et CCF, Nancy (54), France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Duffas
- Centre hospitalier de Libourne, ORL et CMF, Libourne, France
| | | | | | | | - Diane Evrard
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | | | - Nicolas Fakhry
- Assistance publique-Hôpitaux de Marseille, ORL et CCF, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didier Salvan
- Centre hospitalier Sud Francilien, ORL et CCF, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
| | - Véronique Block
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
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Ngamphaiboon N, Chairoungdua A, Dajsakdipon T, Jiarpinitnun C. Evolving role of novel radiosensitizers and immune checkpoint inhibitors in (chemo)radiotherapy of locally advanced head and neck squamous cell carcinoma. Oral Oncol 2023; 145:106520. [PMID: 37467684 DOI: 10.1016/j.oraloncology.2023.106520] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
Chemoradiotherapy (CRT) remains the standard treatment for locally advanced head and neck squamous cell carcinoma (LA-HNSCC), based on numerous randomized controlled trials and meta-analyses demonstrating that CRT improved locoregional control and overall survival. Achieving locoregional control is a crucial outcome for the treatment of HNSCC, as it directly affects patient quality of life and survival. Cisplatin is the recommended standard-of-care radiosensitizing agent for LA-HNSCC patients undergoing CRT, whereas cetuximab-radiotherapy is reserved for cisplatin-ineligible patients. Immune checkpoint inhibitors (ICIs) have shown promise in the treatment of recurrent or metastatic HNSCC. However, the combination of ICIs with standard-of-care radiotherapy or chemoradiotherapy in LA-HNSCC has not demonstrated significant improvement in survivals. Over the past few decades, significant advancements in radiotherapy techniques have allowed for more precise and effective radiation delivery while minimizing toxicity to surrounding normal tissues. These advances have led to improved treatment outcomes and quality of life for patients with LA-HNSCC. Despite these advancements, the development of novel radiosensitizing agents remains an unmet need. This review discusses the mechanism of radiotherapy and its impact on the immune system. We summarize the latest clinical development of novel radiosensitizing agents, such as SMAC mimetics, DDR pathway inhibitors, and CDK4/6 inhibitor. We also elucidate the emerging evidence of combining ICIs with radiotherapy or chemoradiotherapy in curative settings for LA-HNSCC, using both concurrent and sequential approaches. Lastly, we discuss the future direction of systemic therapy in combination with radiotherapy in treatment for LA-HNSCC.
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Affiliation(s)
- Nuttapong Ngamphaiboon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Arthit Chairoungdua
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand; Toxicology Graduate Program, Faculty of Science, Mahidol University, Bangkok, Thailand; Excellent Center for Drug Discovery (ECDD), Mahidol University, Bangkok, Thailand
| | - Thanate Dajsakdipon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chuleeporn Jiarpinitnun
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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3
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Muraro E, Fanetti G, Lupato V, Giacomarra V, Steffan A, Gobitti C, Vaccher E, Franchin G. Cetuximab in locally advanced head and neck squamous cell carcinoma: Biological mechanisms involved in efficacy, toxicity and resistance. Crit Rev Oncol Hematol 2021; 164:103424. [PMID: 34245856 DOI: 10.1016/j.critrevonc.2021.103424] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 06/02/2021] [Accepted: 07/04/2021] [Indexed: 12/17/2022] Open
Abstract
Since its introduction, the use of cetuximab in the treatment of head and neck squamous cell carcinoma (HNSCC) has experienced an evolution. Currently, cetuximab associated with radiotherapy is limited to the treatment of patients affected by a locally advanced malignancy and unfit for cisplatin. However, reliable biomarkers of cetuximab efficacy in this cancer setting are still lacking. This review focuses on the mechanisms of action of cetuximab, highlighting, in particular, the consequences of the binding to EGFR, and the pathways involved in the development of adverse events or acquired resistance. Indeed, adverse events, such as skin rash, have been associated with cetuximab efficacy in HNSCC several times. Acquired resistance is associated with microenvironment plasticity, which is, in turn, characterized by an increased immune infiltrate. The better definition of patients eligible for this kind of therapy could improve HNSCC management, possibly proposing a combined treatment with radiotherapy, cetuximab and immune checkpoint inhibitors as recently investigated.
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Affiliation(s)
- Elena Muraro
- Immunopathology and Cancer Biomarkers Unit, Department of Translational Research, CRO Aviano National Cancer Institute, Aviano, PN, Italy.
| | - Giuseppe Fanetti
- Department of Radiation Oncology, CRO Aviano National Cancer Institute, Aviano, PN, Italy
| | - Valentina Lupato
- Unit of Otolaryngology, General Hospital "S. Maria degli Angeli", Pordenone, Italy
| | - Vittorio Giacomarra
- Unit of Otolaryngology, General Hospital "S. Maria degli Angeli", Pordenone, Italy
| | - Agostino Steffan
- Immunopathology and Cancer Biomarkers Unit, Department of Translational Research, CRO Aviano National Cancer Institute, Aviano, PN, Italy
| | - Carlo Gobitti
- Department of Radiation Oncology, CRO Aviano National Cancer Institute, Aviano, PN, Italy
| | - Emanuela Vaccher
- Department of Medical Oncology, CRO Aviano National Cancer Institute, Aviano, PN, Italy
| | - Giovanni Franchin
- Department of Radiation Oncology, CRO Aviano National Cancer Institute, Aviano, PN, Italy
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NRG-HN003: Phase I and Expansion Cohort Study of Adjuvant Pembrolizumab, Cisplatin and Radiation Therapy in Pathologically High-Risk Head and Neck Cancer. Cancers (Basel) 2021; 13:cancers13122882. [PMID: 34207599 PMCID: PMC8230356 DOI: 10.3390/cancers13122882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/05/2021] [Accepted: 06/05/2021] [Indexed: 12/13/2022] Open
Abstract
The anti-PD1 monoclonal antibody pembrolizumab improves survival in recurrent/metastatic head and neck squamous cell carcinoma (HNSCC). Patients with locoregional, pathologically high-risk HNSCC recur frequently despite adjuvant cisplatin-radiation therapy (CRT). Targeting PD1 may reverse immunosuppression induced by HNSCC and CRT. We conducted a phase I trial with an expansion cohort (n = 20) to determine the recommended phase II schedule (RP2S) for adding fixed-dose pembrolizumab to standard adjuvant CRT. Eligible patients had resected HPV-negative, stage III-IV oral cavity, pharynx, or larynx HNSCC with extracapsular nodal extension or positive margin. RP2S was declared if three or fewer dose-limiting toxicities (DLT) occurred in a cohort of 12. DLT was defined as grade 3 or higher non-hematologic adverse event (AE) related to pembrolizumab, immune-related AE requiring over 2 weeks of systemic steroids, or unacceptable RT delay. A total of 34 patients enrolled at 23 NRG institutions. During the first cohort, only one DLT was observed (fever), thus RP2S was declared as pembrolizumab 200 mg every 3 weeks for eight doses, starting one week before CRT. During expansion, three additional DLTs were observed (wound infection, diverticulitis, nausea). Of the 34 patients, 28 (82%) received five or more doses of pembrolizumab. This regimen was safe and feasible in a cooperative group setting. Further development is warranted.
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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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6
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Riesterer O, Pruschy M, Bender S, Sharma A, Bogowicz M, Tanadini-Lang S, Stieb S, Bertogg K, Weber S, Ikenberg K, Huber G, Schmid S, Bredell M, Veit-Haibach P, Rordorf T, Held U, Glanzmann C, Studer G. Consolidation cetuximab after concurrent triplet radiochemotherapy+cetuximab in patients with advanced head and neck cancer: A randomized phase II study. Radiother Oncol 2020; 150:62-69. [PMID: 32540337 DOI: 10.1016/j.radonc.2020.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Preclinical data suggest that cetuximab should be continued after end of concurrent radiotherapy+cetuximab due to its efficacy against residual tumor cells in the irradiated tumor bed. Based on this concept the phase II add-on cetuximab (AOC) study was designed. MATERIALS AND METHODS Altogether 63 patients with advanced head and neck cancer were treated with radiochemotherapy (70 Gy, cisplatin 40 mg/m2 weekly) in combination with concurrent cetuximab (loading dose 400 mg/m2, then 250 mg/m2 weekly). Thereafter patients were randomized to cetuximab consolidation (500 mg/m2 biweekly × 6) or no further treatment. The primary endpoint was the 2-year locoregional control (LRC) rate. As translational research endpoints serum markers were analyzed before and during treatment and CT-based quantitative image analysis (radiomics) was performed. RESULTS Median follow-up was 24 months. The 2-year LRC rates were 67.9% and 67.7% in the treatment arms with and without consolidation cetuximab, respectively. Higher than median levels of three serum markers were negatively associated with the 2-year LRC rate in the overall patient cohort: Osteopontin, IL8 and FasL2 (p ≤ 0.05). A radiomics model consisting of two radiomics features could be built showing that higher entropy and higher complexity of tumor Hounsfield unit distribution indicates worse LRC (concordance index 0.66). No correlation was found between biological and imaging markers. CONCLUSIONS There was no evidence that consolidation cetuximab would improve the 2-year LRC rate. Prognostic biological and imaging markers could be identified for the overall patient cohort. Studies with larger patient numbers are needed to correlate biological and imaging markers.
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Affiliation(s)
- Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland; Center for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Switzerland.
| | - Martin Pruschy
- Laboratory for Molecular Radiobiology, University of Zurich, Switzerland
| | - Sabine Bender
- Laboratory for Molecular Radiobiology, University of Zurich, Switzerland
| | - Ashish Sharma
- Laboratory for Molecular Radiobiology, University of Zurich, Switzerland
| | - Marta Bogowicz
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Sonja Stieb
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Kaja Bertogg
- Clinical Trials Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Sandra Weber
- Clinical Trials Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Kristian Ikenberg
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Switzerland
| | - Gerhard Huber
- Department of Otorhinolaryngology, University Hospital Zurich, University of Zurich, Switzerland; Department of Otorhinolaryngology, Cantonal Hospital St. Gallen, Switzerland
| | - Stephan Schmid
- Otorhinolaryngology Clinic Bethanien, Zurich, Switzerland
| | - Marius Bredell
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Patrick Veit-Haibach
- Department of Nuclear Medicine, University Hospital Zurich, Switzerland; Department of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Tamara Rordorf
- Department of Medical Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Switzerland
| | - Christoph Glanzmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland; Department of Radiation Oncology, Cantonal Hospital Lucerne, Switzerland
| | - Gabriela Studer
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland; Department of Radiation Oncology, Cantonal Hospital Lucerne, Switzerland
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7
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Powell SF, Gold KA, Gitau MM, Sumey CJ, Lohr MM, McGraw SC, Nowak RK, Jensen AW, Blanchard MJ, Fischer CD, Bykowski J, Ellison CA, Black LJ, Thompson PA, Callejas-Valera JL, Lee JH, Cohen EEW, Spanos WC. Safety and Efficacy of Pembrolizumab With Chemoradiotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma: A Phase IB Study. J Clin Oncol 2020; 38:2427-2437. [PMID: 32479189 DOI: 10.1200/jco.19.03156] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Pembrolizumab is a humanized monoclonal antibody that blocks interaction between programmed death receptor-1 (PD-1) and its ligands (PD-L1, PD-L2). Although pembrolizumab is approved for recurrent/metastatic head and neck squamous cell carcinoma (HNSCC), its role in the management of locally advanced (LA) disease is not defined. We report a phase IB study evaluating the safety and efficacy of adding pembrolizumab to cisplatin-based chemoradiotherapy in patients with LA HNSCC. PATIENTS AND METHODS Eligible patients included those with oral cavity (excluding lip), oropharyngeal, hypopharyngeal, or laryngeal stage III to IVB HNSCC (according to American Joint Committee on Cancer, 7th edition, staging system) eligible for cisplatin-based, standard-dose (70 Gy) chemoradiotherapy. Pembrolizumab was administered concurrently with and after chemoradiotherapy with weekly cisplatin. Safety was the primary end point and was determined by incidence of chemoradiotherapy adverse events (AEs) and immune-related AEs (irAEs). Efficacy was defined as complete response (CR) rate on end-of-treatment (EOT) imaging or with pathologic confirmation at 100 days postradiotherapy completion. Key secondary end points included overall (OS) and progression-free survival (PFS). RESULTS The study accrued 59 patients (human papillomavirus [HPV] positive, n = 34; HPV negative, n = 25) from November 2015 to October 2018. Five patients (8.8%) required discontinuation of pembrolizumab because of irAEs, all of which occurred during concurrent chemoradiotherapy; 98.3% of patients completed the full planned treatment dose (70 Gy) of radiotherapy without any delays ≥ 5 days; 88.1% of patients completed the goal cisplatin dose of ≥ 200 mg/m2. EOT CR rates were 85.3% and 78.3% for those with HPV-positive and -negative HNSCC, respectively. CONCLUSION Pembrolizumab in combination with weekly cisplatin-based chemoradiotherapy is safe and does not impair delivery of curative radiotherapy or chemotherapy in HNSCC. Early efficacy data support further investigation of this approach.
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Affiliation(s)
| | - Kathryn A Gold
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Mark M Gitau
- Roger Maris Cancer Center, Sanford Health, Fargo, ND
| | | | | | | | - Ryan K Nowak
- Sanford Cancer Center, Sanford Health, Sioux Falls, SD
| | | | | | | | - Julie Bykowski
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | | - Lora J Black
- Sanford Research, Sanford Health, Sioux Falls, SD
| | | | | | | | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, CA
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Abstract
Immunohistochemistry (IHC), also known as immunohistochemical staining, is an immune morphological analysis. It is a process of selectively identifying antigens (proteins) by antibodies in cells or tissue sections. This chapter introduces the procedure and application of immunohistochemistry. Although immunohistochemistry has a vast application in basic and clinical studies, this chapter focuses on its application in biomarker study, particularly in biomarkers that related to cancer diagnosis, prognosis, and drug development. Detail protocol of immunohistochemistry in formalin-fixed and paraffin-embedded tissue sections is included.
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Affiliation(s)
- Aihua Li
- Epitomics-An Abcam Company, Burlingame, CA, USA.
| | - Dong-Hua Yang
- Department of Pharmacology, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA.
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9
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Targets for improving tumor response to radiotherapy. Int Immunopharmacol 2019; 76:105847. [DOI: 10.1016/j.intimp.2019.105847] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/18/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023]
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10
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Schwartz DL, Hayes DN. The Evolving Role of Radiotherapy for Head and Neck Cancer. Hematol Oncol Clin North Am 2019; 34:91-108. [PMID: 31739954 DOI: 10.1016/j.hoc.2019.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The length and quality of head and neck cancer survivorship continues to meaningfully improve. Radiotherapy has been central to this process through advances in treatment delivery, fractionation schemas, radiosensitizing systemic therapy, and thoughtful interplay with technical surgical improvements. The future looks brighter still, with ongoing progress in targeted biologic therapy, immuno-oncology, and molecular-genetic tumor characterization for personalized treatment. Head and neck cancer, a disease once fraught with nihilism and failure, is evolving into a major success story of modern multidisciplinary cancer care.
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Affiliation(s)
- David L Schwartz
- Department of Radiation Oncology, UTHSC College of Medicine, 1265 Union Avenue, Memphis, TN 38104, USA; Department of Preventive Medicine, UTHSC College of Medicine, 1265 Union Avenue, Memphis, TN 38104, USA.
| | - D Neil Hayes
- Hematology/Oncology, Department of Medicine, UTHSC College of Medicine, 19 South Manassas Street, Cancer Research Building, 324, Memphis, TN 38103, USA; Department of Genetics/Genomics/Informatics, UTHSC College of Medicine, Memphis, TN, USA; Department of Preventive Medicine, UTHSC College of Medicine, Memphis, TN, USA; Department of Pathology, UTHSC College of Medicine, Memphis, TN, USA; Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
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11
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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: 38] [Impact Index Per Article: 5.4] [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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12
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Cetuximab for Squamous Cell Carcinoma of the Head and Neck. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.10502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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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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14
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Granados-García M, Aguilar-Ponce JL, Maldonado-Magos F, De la Garza-Salazar JG. Advanced Squamous Cell Carcinoma of the Head and Neck: The Current Role of Cetuximab. ORL J Otorhinolaryngol Relat Spec 2017; 78:320-333. [PMID: 28125819 DOI: 10.1159/000455891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/06/2017] [Indexed: 11/19/2022]
Abstract
We review clinical trials of squamous cell carcinoma of the head and neck (SCCHN) to address the current and potential uses of cetuximab (CTX). PubMed was reviewed to identify papers published between 2010 and 2016. The search terms used were "cetuximab" and "head and neck cancer." A total of 634 articles were identified. Phase II or III studies with CTX in patients with advanced SCCHN without treatment or with recurrent/metastatic tumors were selected. Forty-six registries were obtained. Information was critically reviewed and relevant information presented. As definitive treatment of advanced squamous cells carcinomas and as palliative treatment of recurrent/metastatic disease, CTX alone or associated with chemotherapy and/or radiotherapy is an alternative to chemoradiotherapy because of its distinct and favorable toxicity profile.
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Affiliation(s)
- Martín Granados-García
- Head and Neck Cancer Department, Instituto Nacional de Cancerología, Mexico City, Mexico
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15
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Bossi P, Platini F. Radiotherapy plus EGFR inhibitors: synergistic modalities. CANCERS OF THE HEAD & NECK 2017; 2:2. [PMID: 31093349 PMCID: PMC6460772 DOI: 10.1186/s41199-016-0020-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 12/21/2016] [Indexed: 12/31/2022]
Abstract
Locally advanced (stage III or IV) squamous cell carcinoma of the head and neck (SCCHN) often requires multimodal treatment, consisting of a combination of surgery, radiation, and/or systemic therapy, namely chemotherapy or targeted agents. The expression of the epidermal growth factor receptor (EGFR) has been detected in more than 90% of all cases of SCCHN and has been correlated with decreased survival rates, resistance to radiotherapy, loco-regional treatment failure, and increased rates of distant metastases. This paper discusses several strategies aimed at targeting EGFR in combination with radiation. Until now, cetuximab, an anti-EGFR monoclonal antibody, is the only targeted agent that has been shown to improve overall survival in combination with radiation therapy. However, considering that there are multiple mechanisms of primary and acquired resistance to EGFR inhibitors, we focused on dissecting molecular pathways of EGFR inhibition to find alternative or complementary strategies for increasing tumour responsiveness. We suggest that the combination of treatments targeting the EGFR pathway and drugs aimed at increasing immune responses represent a promising approach that deserves to be further explored.
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Affiliation(s)
- Paolo Bossi
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Francesca Platini
- Medical Oncology Unit, University Hospital Maggiore della Carità, Novara, Italy
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Marur S, Li S, Cmelak AJ, Gillison ML, Zhao WJ, Ferris RL, Westra WH, Gilbert J, Bauman JE, Wagner LI, Trevarthen DR, Balkrishna J, Murphy BA, Agrawal N, Colevas AD, Chung CH, Burtness B. E1308: Phase II Trial of Induction Chemotherapy Followed by Reduced-Dose Radiation and Weekly Cetuximab in Patients With HPV-Associated Resectable Squamous Cell Carcinoma of the Oropharynx- ECOG-ACRIN Cancer Research Group. J Clin Oncol 2016; 35:490-497. [PMID: 28029303 DOI: 10.1200/jco.2016.68.3300] [Citation(s) in RCA: 325] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is treatment-responsive. Definitive chemoradiation results in high cure rates but causes long-term toxicity and may represent overtreatment of some patients. This phase II trial evaluated whether complete clinical response (cCR) to induction chemotherapy (IC) could select patients with HPV-associated OPSCC for reduced radiation dose as a means of sparing late sequelae. Methods Patients with HPV16 and/or p16-positive, stage III-IV OPSCC received three cycles of IC with cisplatin, paclitaxel, and cetuximab. Patients with primary-site cCR to IC received intensity-modulated radiation therapy (IMRT) 54 Gy with weekly cetuximab; those with less than cCR to IC at the primary site or nodes received 69.3 Gy and cetuximab to those regions. The primary end point was 2-year progression-free survival. Results Of the 90 patients enrolled, 80 were evaluable. Their median age was 57 years (range, 35 to 73 years), with the majority having stage T1-3N0-N2b OPSCC and a history of ≤ 10 pack-years of cigarette smoking. Three cycles of IC were delivered to 77 of the 80 patients. Fifty-six patients (70%) achieved a primary-site cCR to IC and 51 patients continued to cetuximab with IMRT 54 Gy. After median follow-up of 35.4 months, 2-year progression-free survival and overall survival rates were 80% and 94%, respectively, for patients with primary-site cCR treated with 54 Gy of radiation (n = 51); 96% and 96%, respectively, for patients with < T4, < N2c, and ≤ 10 pack-year smoking history who were treated with ≤ 54 Gy of radiation (n = 27). At 12 months, significantly fewer patients treated with a radiation dose ≤ 54 Gy had difficulty swallowing solids (40% v 89%; P = .011) or had impaired nutrition (10% v 44%; P = .025). Conclusion For IC responders, reduced-dose IMRT with concurrent cetuximab is worthy of further study in favorable-risk patients with HPV-associated OPSCC. Radiation dose reduction resulted in significantly improved swallowing and nutritional status.
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Affiliation(s)
- Shanthi Marur
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Shuli Li
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Anthony J Cmelak
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Maura L Gillison
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Weiqiang J Zhao
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Robert L Ferris
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - William H Westra
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Jill Gilbert
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Julie E Bauman
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Lynne I Wagner
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - David R Trevarthen
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Jahagirdar Balkrishna
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Barbara A Murphy
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Nishant Agrawal
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - A Dimitrios Colevas
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Christine H Chung
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
| | - Barbara Burtness
- Shanthi Marur and William H. Westra, Johns Hopkins University, Baltimore, MD; Shuli Li, Dana Farber Cancer Institute, Boston, MA; Anthony J. Cmelak, Jill Gilbert, and Barbara A. Murphy, Vanderbilt University, Nashville, TN; Maura L. Gillison and Weiqiang J. Zhao, Ohio State University, Columbus, OH; Robert L. Ferris and Julie E. Bauman, University of Pittsburgh, Pittsburgh, PA; Lynne I. Wagner, Wake Forest School of Medicine, Winston-Salem, NC; David R. Trevarthen, Colorado Cancer Research Program, Denver, CO; Jahagirdar Balkrishna, University of Minnesota, St Paul, MN; Nishant Agrawal, University of Chicago Medicine, Chicago, IL; A. Dimitrios Colevas, Stanford University, Stanford, CA; Christine H. Chung, Moffitt Cancer Center, Tampa, FL; and Barbara Burtness, Yale University, New Haven, CT
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Vesci L, Milazzo FM, Anastasi AM, Petronzelli F, Chiapparino C, Carollo V, Roscilli G, Marra E, Luberto L, Aurisicchio L, Pacello ML, Spagnoli LG, De Santis R. Intra-tumor AvidinOX allows efficacy of low dose systemic biotinylated Cetuximab in a model of head and neck cancer. Oncotarget 2016; 7:914-28. [PMID: 26575422 PMCID: PMC4808042 DOI: 10.18632/oncotarget.6089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/26/2015] [Indexed: 12/15/2022] Open
Abstract
For locally advanced and metastatic head and neck squamous cell carcinoma (HNSCC), the current clinical use of Cetuximab in chemo/radiotherapy protocols is often associated to severe systemic toxicity. Here we report in vitro data in human FaDu pharynx SCC cells, showing that inactive concentrations of biotinylated Cetuximab (bCet) become active upon anchorage to AvidinOX on the surface of tumor cells. AvidinOX-anchored bCet induces apoptosis and DNA damage as well as specific inhibition of signaling, degradation and abrogation of nuclear translocation of EGFR. In the mouse model of FaDu cancer, we show that intra-tumor injection of AvidinOX allows anti-tumor activity of an otherwise inactive, intraperitoneally delivered, low dose bCet. Consistently with in vitro data, in vivo tumor inhibition is associated to induction of apoptosis, DNA damage and reduced angiogenesis. AvidinOX is under clinical investigation for delivering radioactive biotin to inoperable tumors (ClinicalTrials.gov NCT02053324) and present data support its use for the local treatment of HNSCC in combination with systemic administration of low dose bCet.
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Affiliation(s)
- Loredana Vesci
- Biotechnology, Research & Development, Sigma-Tau SpA, 00071 Pomezia, Rome, Italy
| | | | - Anna Maria Anastasi
- Biotechnology, Research & Development, Sigma-Tau SpA, 00071 Pomezia, Rome, Italy
| | - Fiorella Petronzelli
- Biotechnology, Research & Development, Sigma-Tau SpA, 00071 Pomezia, Rome, Italy
| | - Caterina Chiapparino
- Biotechnology, Research & Development, Sigma-Tau SpA, 00071 Pomezia, Rome, Italy
| | - Valeria Carollo
- Tissue Macro Array Lab, University of Tor Vergata, via della Ricerca Scientifica, 00133, Rome, Italy
| | | | | | | | | | | | - Luigi Giusto Spagnoli
- Tissue Macro Array Lab, University of Tor Vergata, via della Ricerca Scientifica, 00133, Rome, Italy
| | - Rita De Santis
- Biotechnology, Research & Development, Sigma-Tau SpA, 00071 Pomezia, Rome, Italy
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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.
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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.
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Anti EGFR therapy in the treatment of non-metastatic head and neck squamous cell carcinoma: The current evidence. J Egypt Natl Canc Inst 2016; 28:141-8. [DOI: 10.1016/j.jnci.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022] Open
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Husain ZA, Burtness BA, Decker RH. Cisplatin Versus Cetuximab With Radiotherapy in Locally Advanced Squamous Cell Carcinoma of the Head and Neck. J Clin Oncol 2016; 34:396-8. [DOI: 10.1200/jco.2015.64.7586] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Assessment of the total cfDNA and HPV16/18 detection in plasma samples of head and neck squamous cell carcinoma patients. Oral Oncol 2016; 54:36-41. [PMID: 26786940 DOI: 10.1016/j.oraloncology.2015.12.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 12/08/2015] [Accepted: 12/21/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The advantages of the circulating cell-free DNA (cfDNA) methodology are quick results and the possibility of repeated analysis. The main aim of our study was to establish the relationship of the total cfDNA with patients' clinical characteristics and circulating HPV DNA detection in the blood of patients with head and neck squamous cell carcinoma (HNSCC). METHODS The cfDNA level of 200 HNSCC patients in plasma was quantified using TaqMan-based TERT amplification. TaqMan technology was also used for HPV16/18 detection. Additionally, mutations in KRAS and EGFR were investigated. RESULTS A higher level (p=0.011) of the total cfDNA was found in patients with oropharyngeal squamous cell carcinoma (OPSCC) (9.60 ± 6.23 ng/ml) in comparison with other HNSCC (7.67 ± 4.44 ng/ml). The level of cfDNA in patients with clinical N2-N3 disease (9.28 ± 6.34 ng/ml) was (p=0.015) higher than in patients with a clinical N0-N1 disease (7.50 ± 3.69 ng/ml). It was also higher in patients with stage IV (9.16 ± 6.04 ng/ml) compared with stages I-III of cancer (7.26 ± 3.63 ng/ml) (p=0.011). Analysis of HPV16/18 in plasma revealed that 14% of patients were HPV-positive, the majority of whom had the type HPV16 (96.4%). CfDNA level was comparable in HPV-positive and HPV-negative HNSCC patients, as well in the OPSCC subgroup. Somatic mutations in EGFR and KRAS were not found. CONCLUSIONS A high level of cfDNA is specific for patients with OPSCC. HPV detection in cfDNA does not depend on the cfDNA concentration. Our results prove the diagnostic potential of plasma-based HPV cfDNA tests for the early detection and monitoring of HPV-positive HNSCC.
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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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Derer A, Deloch L, Rubner Y, Fietkau R, Frey B, Gaipl US. Radio-Immunotherapy-Induced Immunogenic Cancer Cells as Basis for Induction of Systemic Anti-Tumor Immune Responses - Pre-Clinical Evidence and Ongoing Clinical Applications. Front Immunol 2015; 6:505. [PMID: 26500646 PMCID: PMC4597129 DOI: 10.3389/fimmu.2015.00505] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/16/2015] [Indexed: 01/18/2023] Open
Abstract
Radiotherapy (RT) primarily aims to locally destroy the tumor via the induction of DNA damage in the tumor cells. However, the so-called abscopal, namely systemic and immune–mediated, effects of RT move over more and more in the focus of scientists and clinicians since combinations of local irradiation with immune therapy have been demonstrated to induce anti-tumor immunity. We here summarize changes of the phenotype and microenvironment of tumor cells after exposure to irradiation, chemotherapeutic agents, and immune modulating agents rendering the tumor more immunogenic. The impact of therapy-modified tumor cells and damage-associated molecular patterns on local and systemic control of the primary tumor, recurrent tumors, and metastases will be outlined. Finally, clinical studies affirming the bench-side findings of interactions and synergies of radiation therapy and immunotherapy will be discussed. Focus is set on combination of radio(chemo)therapy (RCT) with immune checkpoint inhibitors, growth factor inhibitors, and chimeric antigen receptor T-cell therapy. Well-deliberated combination of RCT with selected immune therapies and growth factor inhibitors bear the great potential to further improve anti-cancer therapies.
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Affiliation(s)
- Anja Derer
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen , Germany
| | - Lisa Deloch
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen , Germany
| | - Yvonne Rubner
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen , Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen , Germany
| | - Benjamin Frey
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen , Germany
| | - Udo S Gaipl
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen , Germany
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Abstract
Squamous ovarian cancer (SOC) represents a (very) rare subtype of ovarian cancer. The lack of evidence on which to base management presents significant challenges. The small number of patients prohibits randomised studies to establish level 1 evidence, and no non-randomised studies or prospective series have been reported. Here, we present a review of the available literature on squamous ovarian cancer and explore some lessons learnt from squamous cancers originating from other primary sites to see if these can be applied to SOC.
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Affiliation(s)
- Patricia Roxburgh
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK,
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Brand TM, Iida M, Stein AP, Corrigan KL, Braverman CM, Coan JP, Pearson HE, Bahrar H, Fowler TL, Bednarz BP, Saha S, Yang D, Gill PS, Lingen MW, Saloura V, Villaflor VM, Salgia R, Kimple RJ, Wheeler DL. AXL Is a Logical Molecular Target in Head and Neck Squamous Cell Carcinoma. Clin Cancer Res 2015; 21:2601-12. [PMID: 25767293 PMCID: PMC5032632 DOI: 10.1158/1078-0432.ccr-14-2648] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/27/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Head and neck squamous cell carcinoma (HNSCC) represents the eighth most common malignancy worldwide. Standard-of-care treatments for patients with HNSCC include surgery, radiation, and chemotherapy. In addition, the anti-EGFR monoclonal antibody cetuximab is often used in combination with these treatment modalities. Despite clinical success with these therapeutics, HNSCC remains a difficult malignancy to treat. Thus, identification of new molecular targets is critical. EXPERIMENTAL DESIGN In the current study, the receptor tyrosine kinase AXL was investigated as a molecular target in HNSCC using established cell lines, HNSCC patient-derived xenografts (PDX), and human tumors. HNSCC dependency on AXL was evaluated with both anti-AXL siRNAs and the small-molecule AXL inhibitor R428. Furthermore, AXL inhibition was evaluated with standard-of-care treatment regimens used in HNSCC. RESULTS AXL was found to be highly overexpressed in several models of HNSCC, where AXL was significantly associated with higher pathologic grade, presence of distant metastases, and shorter relapse-free survival in patients with HNSCC. Further investigations indicated that HNSCC cells were reliant on AXL for cellular proliferation, migration, and invasion. In addition, targeting AXL increased HNSCC cell line sensitivity to chemotherapy, cetuximab, and radiation. Moreover, radiation-resistant HNSCC cell line xenografts and PDXs expressed elevated levels of both total and activated AXL, indicating a role for AXL in radiation resistance. CONCLUSIONS This study provides evidence for the role of AXL in HNSCC pathogenesis and supports further preclinical and clinical evaluation of anti-AXL therapeutics for the treatment of patients with HNSCC.
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Affiliation(s)
- Toni M Brand
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mari Iida
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrew P Stein
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kelsey L Corrigan
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cara M Braverman
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - John P Coan
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hannah E Pearson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Harsh Bahrar
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tyler L Fowler
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Bryan P Bednarz
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Sandeep Saha
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - David Yang
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Parkash S Gill
- Departments of Medicine and Pathology, University of Southern California, Los Angeles, California
| | - Mark W Lingen
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois
| | - Vassiliki Saloura
- Division of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Victoria M Villaflor
- Division of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Ravi Salgia
- Division of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Deric L Wheeler
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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AKT and MET signalling mediates antiapoptotic radioresistance in head neck cancer cell lines. Oral Oncol 2014; 51:158-63. [PMID: 25499462 DOI: 10.1016/j.oraloncology.2014.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 10/27/2014] [Accepted: 11/07/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Induction of apoptosis is a major mechanism of radiosensitivity in different types of cancer. In contrast, EGFR/PI3K/AKT signalling and recently the presence of so-called cancer stem cells are discussed as reasons for radioresistance. MATERIALS AND METHODS The study investigates mechanisms of apoptosis, key oncogenes of the PI3K/AKT pathway and the presence of cancer cells with stem cell properties during irradiation in two cell lines (PCI-9A, and PCI-15) of head and neck squamous cell carcinoma. WST-1-tests, qRT-PCR, western blots and FACS analysis were performed for analysis. RESULTS The two cell lines presented different degrees of cell death upon irradiation. The radiosensitive cell line PCI-9A showed increased apoptosis after irradiation measured by expressed cleaved caspases 3 and 7 while the radioresistant cell line PCI-15 upregulated antiapoptotic Survivin and BCL2A1 mRNA. Besides, increased PI3K/AKT- and ERK1/2-signalling was associated with radioresistance accompanied by loss of PTEN function through phosphorylation on S380. Blockade of pAKT increased radiation-induced cell death, and moreover, led to an upregulation of pMET in the radioresistant cell line. The percentage of ALDH-positive tumour cells was markedly decreased after irradiation in the radiosensitive cell line. CONCLUSIONS Functional apoptosis is mandatory for sensitivity to irradiation in head neck cancer cells. Upregulation of the AKT-pathway seems to be one reason for poor radioresponse. Activated MET may also predict radioresistance, possibly through ERK1/2 signalling. Moreover MET may indicate the presence of cancer stem cells facilitating radioresistance as shown by increased ALDH expression.
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Letter regarding Meade et al. entitled “Models of acute mucosal tolerance to radiotherapy alone applied to synchronous chemo-radiation schedules in head and neck cancer”. Tumour Biol 2014; 35:12777-8. [DOI: 10.1007/s13277-014-2874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/18/2014] [Indexed: 11/26/2022] Open
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