[Preclinical models to establish innovative therapy strategies : Ex‑vivo assessment of head and neck tumor chemo- and immune responses]

The pharmacological treatment of head and neck squamous cell carcinoma (HNSCC) is currently experiencing an expansion of the spectrum of targeting therapies. It can be expected that use of immune modulators, e.g., checkpoint-inhibitors, and their combination with chemotherapy will lead to a plethora of therapeutic options in the near future, from which the best one for the individual patient can be selected. HNSCCs are heterogeneous in their biology, and responses to chemotherapy are nonuniform and often only observable in subgroups. It would be valuable to know the chance of success of a particular treatment in advance. Evidence-based selection of the best individual treatment is difficult, since predictive biomarkers which are assessable prior to the treatment decision and reliably indicate the suitability of particular therapeutics are lacking. Pretherapeutic predictive ex-vivo chemoresponse testing of HNSCC biopsy specimens could enable identification of responders and allow a more suitable therapy regimen to be chosen for potential non-responders, without exposing them to likely ineffective therapy attempts. However, early ex-vivo assays failed regarding reliable prediction of therapeutic success, even with tolerable doses of pharmaceuticals and, in particular, their combinations. Predictive testing was hence deemed improper for the clinic. Improved methodology has now led to a reappraisal of predictive testing and its additional use in analysis of antitumor immune responses ex vivo. Here we describe recent advances and new results from ex-vivo chemoresponse testing of HNSCC and highlight their ability to facilitate establishment of innovative therapy strategies.

The current role of systemic chemotherapy in the primary treatment of head and neck cancer

The treatment of patients with locoregionally advanced squamous cell carcinoma of the head and neck (HNSCC) is still evolving into the perfect combination of the different multidisciplinary approaches. Induction chemotherapy (ICT) prior to planned definitive local therapy is widely used in this patient population for over 30 years but it is still unclear how to incorporate ICT into multimodality treatment the best. It appears to have a role in selected clinical situations especially for those patients with high risk for distant metastasis. However, since ICT protocols in different studies varies a lot, a comparative and consistent statement of benefits is difficult. We show the recent developments including randomized trials comparing radiochemotherapy (RCT) and ICT followed by definitive RCT here. This review summarizes how ICT has developed over the years, provides critical remarks of recent developments, and discusses how clinical trials including ICT should be conducted in the future.

[Main results of studies on primary therapy of head and neck squamous cell carcinoma : highlights of the ASCO Meeting 2014]

The two available options for primary radiochemotherapy (RCT) of locally advanced head and neck squamous cell carcinoma are discussed in the current study: concomitant and sequential RCT. At the annual meeting of the American Society of Clinical Oncology (ASCO) 2014, results of current trials on the primary nonsurgical therapy of locally advanced head and neck tumors were presented. A selection of the most important trials will be summarized in this article. Studies including cisplatin-based RCT as standard therapy for locally advanced head and neck tumors, alternatives for cisplatin, combination with targeted therapy, application of the epidermal growth factor receptor (EGFR) antibody cetuximab and the comparison of concomitant and sequential RCT are discussed. The first completely recruited phase III trial comparing concomitant and sequential RCT will also be presented.