Just by its very nature, the 2018 Multidisciplinary Head and Neck Cancers Symposium stands out as exceptional because of its unique multidisciplinary design. Medical oncologists, radiation therapists and surgeons from all over the world come together to discuss new treatments and advances in the care of head and neck cancer patients.
Stand out sessions were on the new class of immune modulating drugs called checkpoint inhibitors which were led by the keynote address of Julie Bauman from the University of Arizona Cancer Center. These drugs include PD1, PDL1, and CTLA4 inhibitors some of which are FDA approved for use in the recurrent/metastatic setting for head and neck cancer. They have shown promise in the treatment of these patients, but unfortunately have a relatively low response rate. However, patients that do respond typically have lasting responses (months to years) which sets them apart from traditional agents. In order to improve response rates exciting research is looking at specific cell mutations or immune cell profiles in the tumor microenvironment to better predict which patients will benefit the most from these agents. Other studies are evaluating how combining the immune modulating drugs with traditional therapies, like surgery or radiation therapy, may improve outcomes.
Cancers affecting the oropharynx, specifically HPV related tonsil and tongue base cancers were also a heavily covered topic. Dr. Ellie Maghami from the City of Hope Cancer Center led our panel on the topic. We discussed how these virally induced tumors typically have a better prognosis than traditional cancers of the head and neck, and are more frequently seen in younger non-smoking patients. This panel of experts discussed new strategies involving radiation therapy, surgery and chemotherapy in treating patients with HPV associated cancers. In the era of HPV related cancer physicians are carefully evaluating ways to safely “de-escalate” therapy through clinical trials so that they can minimize treated related side effects yet not compromise outcomes.
The new staging system for head and neck cancer in the AJCC 8th edition was a huge undertaking, and one keynote sessions by Brian O’Sullivan from the Ontario Cancer Institute, Princess Margaret Cancer Centre was dedicated to this topic. He covered important areas around tumor thickness and how it relates to oral cancer staging in addition to how extracapsular extension is now included in the staging of the neck in HPV negative malignancies. O’Sullivan discussed the newly developed staging system for HPV positive cancer and how its prognostic value is validated regardless of treatment type (surgery and non-surgical management). One key point that came up time and time again is that the new oropharyngeal staging system is for prognostic purposes, but cannot yet be used to guide treatment. Practitioners cannot deescalate therapy until the large prospective studies show that it is safe.
The meeting had numerous other sessions on various topics including melanoma, thyroid cancer and nasopharyngeal carcinoma. Many of the sessions were case presentations where leaders in the field were asked many of the tough questions we are faced with everyday, giving their insight and wisdom in how they handle some of the clinical challenges we all face. It was a great opportunity to learn not only from but with many of my colleagues and mentors who have dedicated their lives to helping patients with cancers of the head and neck.