Immunotherapy Is Transforming The Treatment Of Head And Neck Cancer
- Ronell Klingman
- Apr 17, 2024
- 2 min read
Head and neck cancer (HNSCC) is the sixth most prevalent cancer globally, with higher incidences in developing nations. Primary risk factors include tobacco and alcohol use, as well as chronic Human Papilloma Virus (HPV) infection. Approximately 90% of incidences are head and neck squamous cell carcinomas (HNSCC) - tumors originating from mucosal epithelia in regions such as the oral cavity, pharynx, and larynx. Most HNSCC patients are diagnosed with locally advanced disease, with a heightened risk of recurrence and distant metastasis. Despite therapy advancements, managing locally advanced disease remains challenging, with high risks of recurrence and distant metastasis.
CURRENT MANAGEMENT OPTIONS
Traditionally, advanced HNSCC is managed with combined treatments including surgery, chemotherapy, and radiotherapy. However, patients with locally advanced HNSCC often have a poor prognosis, experiencing disease progression or mortality despite these interventions. Until recently, recurrent or metastatic (R/M) HNSCC not suitable for surgery was primarily treated with platinum-based chemotherapy combined with the epidermal growth factor receptor (EGFR) inhibitor cetuximab.
IMMUNOTHERAPY: HERALDING A NEW ERA
The advent of immunotherapy, particularly immune checkpoint inhibitors (ICIs), has transformed the treatment landscape for HNSCC. Monoclonal antibodies targeting programmed death receptor-1 (PD-1) have become pivotal in this context. Agents like nivolumab and pembrolizumab have shown improved overall survival (OS) rates in platinum-refractory recurrent or metastatic (R/M) HNSCC, with pembrolizumab proving superior to standard therapy in first-line settings. Recent research highlights pembrolizumab's durable antitumor activity and manageable safety profile, confirming it as the preferred first-line treatment for R/M HNSCC.
WHAT THE FUTURE HOLDS
The success of immune checkpoint inhibitors has prompted exploring earlier integration into HNSCC treatment. Trials are assessing immunotherapy in neoadjuvant settings for surgically treatable HNSCC, alongside investigating combination strategies to augment its anti-cancer effects. Yet, understanding predictive biomarkers and identifying optimal candidates for immunotherapy remain areas requiring further research.
Immunotherapy has ushered in a new era in HNSCC treatment, offering promising survival outcomes and manageable toxicity profiles. As research progresses, integrating immunotherapy into multimodal treatment approaches holds immense potential to enhance patient outcomes across the HNSCC spectrum.
To learn more:
doi: 10.1200/JCO.21.02508
doi: 10.5306/wjco.v13.i5.388
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