Head and Neck Cancer

Head and Neck Cancer

Since the 1970s, advances in therapies and surgical approaches to treating head and neck cancers have improved patients' survival and quality of life enormously. In the 2000s, the introduction of the first molecularly targeted drug brought additional hope for patients with certain advanced head and neck cancers. The ability to identify and effectively target more of the genetic drivers of head and neck cancers remains an urgent challenge for researchers.

Recent years have seen an increase in the number of head and neck cancers caused by the human papillomavirus (HPV). Research shows that HPV-driven tumors typically respond better to treatment, and the availability of an effective HPV vaccine offers the hope of eventually reducing the number of people affected by head and neck cancers worldwide.
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2019

Pembrolizumab Improves Survival in Metastatic or Unresectable Recurrent Head and Neck Cancer

Pembrolizumab Improves Survival in Metastatic or Unresectable Recurrent Head and Neck Cancer

Survival for patients with advanced head and neck squamous cell carcinoma (HNSCC) is generally poor. However, in the KEYNOTE-048 study the immunotherapy pembrolizumab (Keytruda) extended overall survival of patients with recurrent or metastatic HNSCC that is refractory to platinum-based therapy. Pembrolizumab (a checkpoint inhibitor) plus chemotherapy improves overall survival for all patients compared with cetuximab plus chemotherapy. In addition, pembrolizumab alone improves overall survival in patients with a combined positive score ≥1 for the protein programmed death-ligand 1 (PD-L1), compared with cetuximab/chemotherapy. The results lead the FDA to approve pembrolizumab for use in combination with platinum and 5-fluorouracil (5-FU) chemotherapy for all patients with HNSCC and as a single agent for patients with tumors that express PD‑L1.

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Lancet 2019;394:1915-192
FDA Approval

2017

Reduced radiation dose for HPV-associated throat cancer reduces long-term complications

Reduced radiation dose for HPV-associated throat cancer reduces long-term complications

Two clinical trials show that lowering the standard radiation dose by 15% to 20% does not compromise survival for individuals with HPV-associated oropharyngeal cancer. Furthermore, one of the studies shows that those who receive the lower dose are far less likely to have difficulty swallowing solids or impaired nutrition a year after treatment. HPV-associated oropharyngeal cancers are increasing, and while they typically respond well to treatment, those diagnosed tend to be younger and can be affected by these treatment-related complications for decades – making reductions in long-term effects especially important.

More Information: 

J Clin Oncol 2017;35:490-497
Lancet Oncol 2017;18:803-811

2016

Immunotherapy for head and neck cancer improves survival and quality of life

Immunotherapy for head and neck cancer improves survival and quality of life

A clinical trial shows that the immune checkpoint inhibitor nivolumab (Opdivo) more than doubles the one-year survival rate for recurrent or advanced head and neck squamous cell carcinoma, compared to standard, single-drug chemotherapy. The trial also finds nivolumab treatment is associated with fewer severe adverse effects and far less impact on several measures of quality of life. These findings help address a major unmet need for treatments that extend survival and are easy for patients to tolerate, as there were previously no proven life-extending treatment options for patients with cancer that progresses within six months of standard chemotherapy. The trial results also lead to FDA approval of nivolumab for this patient population.

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N Engl J Med 2016; 375:1856-1867
FDA Approval

2015

More extensive surgery helps patients with early oral cancer live longer

More extensive surgery helps patients with early oral cancer live longer

A large study resolves a decades-long debate, confirming that for patients with certain types of early oral cancers, it’s better to remove both the primary tumor and nearby lymph nodes during initial surgery for oral cancer, rather than postponing lymph node removal until the cancer comes back. The study finds that performing more extensive surgery initially lowers the risk of cancer returning and extends survival. However, the study also noted this surgical approach has a higher risk of health complications, including difficulty moving the neck and shoulders and problems with talking and swallowing.

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N Engl J Med 2015; 373:521-529
Journal of the National Cancer Institute 2015; 107(10): djv297

2010

HPV status and smoking affect prognosis for oropharyngeal cancer

2008

Adding cetuximab to initial chemotherapy extends survival for advanced cancers

Adding cetuximab to initial chemotherapy extends survival for advanced cancers

For the first time in nearly three decades (see 1991), researchers introduce a new initial ("induction") treatment strategy that extends survival for patients with advanced head and neck cancers. This strategy includes a combination of the targeted drug cetuximab (Erbitux) plus the previous standard treatment regimen, involving the chemotherapy drugs cisplatin or carboplatin with fluorouracil. Cetuximab – already available for patients with advanced disease receiving radiation therapy or whose disease progresses despite standard chemotherapy – is approved by the FDA for this broader use in 2011.

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N Engl J Med 2008; 359: 1116-1127
Taxane therapy improves survival for several types of advanced head and neck cancers

Taxane therapy improves survival for several types of advanced head and neck cancers

Badge indicating that research was paid for using federal funds

Two large studies show that patients with advanced head and neck cancers who receive initial chemotherapy with docetaxel (Taxotere), together with the drugs cisplatin and fluorouracil, have substantially longer survival than patients who receive two-drug therapy. All patients in these studies had squamous cell carcinomas, which represent approximately 90 percent of head and neck cancers.

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N Engl J Med 2007; 357: 1705-1715
N Engl J Med 2007; 357: 1695-1704
New research highlights role of HPV infection in head and neck

New research highlights role of HPV infection in head and neck

Badge indicating that research was paid for using federal funds

While studies over the prior decade had suggested a connection between HPV infection and oropharyngeal cancers, several studies offer important new insight. The first finds that DNA from HPV-16, one of the strains of HPV most commonly associated with cervical cancer, is present in nearly three-quarters of oropharyngeal tumor samples. These findings help spur research to determine if HPV vaccination could help prevent these cancers.

A second study finds that patients with certain squamous cell carcinomas of the oropharynx or larynx whose tumors test positive for the HPV virus have a better prognosis than patients with HPV-negative tumors treated with the same therapy. This is the first major study suggesting that HPV-related head and neck cancers are biologically different, and in some cases more treatable, than non-HPV-related cancers.

Around the same time, researchers report that U.S. cases of HPV-related head and neck cancers have risen nearly 1 percent each year since 1973.

More Information: 

N Engl J Med 2007; 356: 1944-1956
Journal of the National Cancer Institute 2008; 100: 261 – 269
JCO 2008; 26(4): 612-619

2006

Treatment with new targeted drug cetuximab prolongs life

Treatment with new targeted drug cetuximab prolongs life

Badge indicating that research was paid for using federal funds

Important data emerge on the value of the targeted drug cetuximab (Erbitux), showing this therapy extends survival and improves quality of life for patients with head and neck cancers.

One large trial shows that adding cetuximab to standard radiation therapy significantly extends the lives of patients with head and neck cancer that has not spread beyond this region of the body. Notably, the addition of cetuximab does not carry significant added side effects. Soon after, the FDA approves cetuximab for this use and in patients with advanced disease who have not responded to previous chemotherapy. Since the value of cetuximab has not yet been confirmed by additional positive trials, however, many researchers remain cautious about the drug's benefits.

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N Engl J Med 2006; 354: 567-578

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