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Immunotherapy and De-Escalation Best Practices for Head and Neck Cancers Dominate HNCS18

Op-Med is a collection of original articles contributed by Doximity members.

Nearly 1,000 experts dedicated to the care of head and neck cancer patients gathered in the rainy Arizona desert for the biannual Multidisciplinary Head and Neck Cancer Symposium (Feb. 15–17). Specialists from otolaryngology, radiation oncology, medical oncology and other specialties attended the event to learn about the latest advances in the field.

Over two and a half days, more than 300 abstracts were presented from investigators traveling from around the globe. Head and neck cancer affects over 60,000 people each year in the U.S. and over 500,000 patients worldwide. A series of sessions focused on specific types of head and neck cancer, but throughout, two topics dominated the meeting: The role of immunotherapy in head and neck cancer and how to best de-escalate the intensity of treatment for patients with human papillomavirus (HPV) driven head and neck cancers.

A few notable sessions include:

  • Julie Bauman, a medical oncologist from the University of Arizona gave an outstanding keynote lecture on the first day summarizing what we currently know about immunotherapy in head and neck cancer. While she declared at the beginning of her talk that she was not an immunologist, by the end of her outstanding overview, most in the audience disagreed with this assessment.

  • On the second day, Scott Strome, a head and neck surgeon from the University of Maryland provided a historical perspective of the development of immunotherapy in head and neck cancer and identified potential new approaches to harnessing the immune system to fight this deadly cancer.
  • During the K. Kian Ang Commemorative Plenary Session, Lillian Sui from Princess Margaret Cancer Centre in Toronto and Maura Gillison from MD Anderson Cancer Center in Houston presented early results of clinical trials (i.e. CONDOR and RTOG 3504, respectively) integrating immunotherapy into the care of head and neck cancer patients.
  • Glenn Hanna from the Dana-Farber Cancer Institute and James Rocco from the Ohio State University Hospital presented data investigating how we could identify patients most likely to benefit from these potentially toxic therapies.

Overall, all speakers agreed that additional studies are needed to continue to refine the role of immunotherapy in head and neck cancer and to identify and validate biomarkers for patient selection.

Human papillomavirus is the cause of the majority of head and neck cancer arising in the oropharynx in the U.S. These patients have improved outcomes (see below) compared to patients whose cancer is not caused by HPV, when treated with standard therapies. Three institutions shared their experience treating these patients on de-intensification protocols. While their approaches differed significantly, the studies demonstrated different ways we may one day be able to de-intensify therapy for patients with HPV-positive oropharyngeal cancer. The results presented from each study were highly promising, but at this time the speakers all agreed with Sue Yom from the University of California at San Francisco that outside the setting of a controlled trial, the standard of care for patients with HPV-positive oropharyngeal cancer remains unchanged.

Differences in prognosis based on HPV-status formed the basis for changes in the AJCC/UICC staging system for oropharynx cancer. Brian O’Sullivan, a radiation oncologist from the Princess Margaret Hospital in Toronto, Canada, and one of the architects of the new staging system, presented some of the data underlying the changes. Most notably, the new system differentiates between patients with HPV-driven cancers of the oropharynx and those with non-HPV driven cancers of the oropharynx based on the differences in the biology of these cancers. As was mentioned several times during this meeting, the updated staging system provides information on prognosis but should not be used to make treatment decisions.

While the majority of the meeting focused on clinical advances, a group of scientists also presented exciting data on what may become the next major advance in head and neck cancer. Antonio Jimeno, a medical oncologist at the University of Colorado discussed how advances in animal models are allowing his lab to study interactions between cancer cells and the tumor microenvironment that would have been impossible just a few years ago. In addition, Greg Gan, a physician scientist at the University of New Mexico, showed intriguing data on MK2, an intracellular signaling protein, that promotes resistance to radiation in both HPV-positive and HPV-negative Head and Neck Cancer. Heiko Enderling from the Moffitt Cancer Center shared how his lab is using mathematical modeling to predict the optimal radiation fractionating scheme for individual patients. My own lab showed data demonstrating how tumor genomics can be used to identify drugs that can be combined with radiation to improve cancer control using patient-derived xenograft models. While these, and other similar studies, are clearly preliminary, expect to see some of these being highlighted at the 2020 Multidisciplinary Head and Neck Cancer Symposium.

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