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Marcin R. Dzienis, MBBS, of Australia’s Gold Coast University Hospital, discusses the final analysis of KEYNOTE-B10, a phase IV study in which patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) received a first-line combination regimen of pembrolizumab plus carboplatin and paclitaxel. The regimen demonstrated durable antitumor activity, irrespective of patients’ PD-L1 status (Abstract 3).
Dan P. Zandberg, MD, of UPMC Hillman Cancer Center, discusses study results showing that, although efficacy was low with both nivolumab plus ipilimumab and nivolumab plus relatlimab in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (HNSCC), selected patients had a numerically higher disease control rate, with a longer duration of stable disease (Abstract 4).
Samuel Regan, MD, and Benjamin Rosen, PhD, both of the University of Michigan, discuss results from a phase II trial showing the possibility of de-escalating chemoradiation treatment for patients with HPV-related oropharyngeal cancer, based on an FDG-PET imaging biomarker. The data suggest that patients may experience few locoregional recurrences and less toxicity (Abstract 16).
Eleni M. Rettig, MD, of Brigham and Women’s Hospital, discusses the promising but thus far limited data on using circulating tumor HPV DNA for early detection of HPV-related oropharyngeal cancers, which highlights the importance of developing a reliable biomarker (Poster Abstract 177).
Evan M. Graboyes, MD, MPH, of the Medical University of South Carolina, discusses the results of the NDURE study, which explored the delays in starting postoperative radiation therapy in patients with head and neck cancer and ways to improve the timeliness and equity of treatment. Delays in this therapy are associated with higher recurrence and poorer survival in this population (Abstract LBA2).
Evan M. Graboyes, MD, MPH, of the Medical University of South Carolina, discusses body image distress, a source of significant morbidity among head and neck cancer survivors. He recommends strategies to identify this side effect, the evidence for how best to treat, and best practices to help patients heal emotionally as well as physically.
Pooja Karukonda, MD, of Duke University Medical Center, discusses findings from the PaRTNer study, which addressed the large financial burden faced by patients with head and neck cancer undergoing radiotherapy, particularly older, non-White, female, and low-income patients. Dr. Karukonda discusses some ways to counter this adverse effect (Abstract 13).
Nabil F. Saba, MD, of Emory University, discusses phase II study results suggesting parenteral administration of TK-90 may be an effective strategy for preventing radiation-induced oral mucositis in patients with squamous cell carcinoma of the head and neck (Abstract 10).
Christopher A. Barker, MD, of Memorial Sloan Kettering Cancer Center, discusses phase II study results showing that patients with locally advanced, unresectable basal cell carcinoma of the head and neck experienced improved quality of life after induction and concurrent vismodegib with curative-intent radiation treatment. According to Dr. Barker, the data on this strategy may provide a beneficial benchmark for clinical practice (Abstract 9).
Nabil F. Saba, MD, of Emory University, discusses study findings on 2-year survival rates in patients with recurrent metastatic head and neck squamous cell carcinoma who received pembrolizumab plus cabozantinib. The progression-free survival rate of 32% and the overall survival rate of 55% suggest a durable clinical activity of this combination therapy (Abstract 2).
Jean-Pascal Machiels, MD, PhD, of Belgium’s Cliniques universitaires Saint-Luc (UCLouvain), discusses the primary results of the phase III KEYNOTE-412 study of pembrolizumab plus chemoradiation therapy (CRT) vs placebo plus CRT for patients with locally advanced head and neck squamous cell carcinoma (Abstract LBA5).
Nabil F. Saba, MD, of Winship Cancer Institute of Emory University, discusses new data from a trial of pembrolizumab and cabozantinib in patients with recurrent metastatic head and neck squamous cell carcinoma. The study met its primary endpoint of overall response rate. The regimen was well tolerated and exhibited encouraging clinical activity in this patient population (Abstract 6008).
Sue S. Yom, MD, PhD, of the University of California, San Francisco, discusses a translational analysis from the NRG-HN002 study. This phase II trial established the feasibility of the tumor tissue–modified viral (TTMV) human papillomavirus DNA assay in clinical trial specimens. The goal is to use such an assay to measure tumor volume, levels of TTMV over the course of treatment, and the association of TTMV to treatment outcomes (Abstract 6006).
Carryn M. Anderson, MD, of the University of Iowa Hospital, discusses phase III results of the ROMAN trial of avasopasem manganese for patients with severe oral mucositis who are receiving chemoradiotherapy for locally advanced, nonmetastatic head and neck cancer. Compared with placebo, avasopasem manganese improved severe oral mucositis (Abstract 6005).
Elizabeth D. Cash, PhD, of the University of Louisville, discusses depression among patients with head and neck cancer, the impact it can have on prognosis, and the importance of helping patients cope through screening for depressive symptoms and treatment with collaborative care models.
Michelle Mierzwa, MD, of the University of Michigan, discusses early findings from a phase II trial of FDG-PET (fluorodeoxyglucose–positron-emission tomography) de-escalated radiotherapy for patients with p16-positive orophyaryngeal cancer. An interim analysis suggests that for approximately half of patients with stage I or II disease, this type of treatment may decrease toxicity and improve quality of life.
David S. Hong, MD, of The University of Texas MD Anderson Cancer Center, discusses results from a phase II cohort, which suggest favorable antitumor activity with tisotumab vedotin-tftv in patients with head and neck squamous cell carcinoma that has progressed after treatment with a platinum-containing regimen. Additional research is warranted, says Dr. Hong, in the second-line setting as well as in treatment-naive patients in combinations with pembrolizumab and carboplatin.
Peter Zeng, MD/PhD Candidate, at Ontario’s Western University, discusses a three-gene prognostic classifier tool, known as UWO3, which was validated in six external cohorts and shown to identify patients with human papillomavirus–related head and neck cancer that is likely to recur following aggressive radiation de-escalation.
Nancy Lee, MD, of Memorial Sloan Kettering Cancer Center, discusses results from the 30ROC trial, which showed that intratreatment FMISO [(18)F-fluoromisonidazole] PET response could identify patients with human papillomavirus–positive oropharyngeal carcinoma who may be sensitive to radiation therapy. Based on this information, researchers were able to de-escalate radiotherapy to 30 Gy from the standard 70 Gy, in the setting of chemotherapy (Keynote II).
Glenn J. Hanna, MD, of Dana-Farber Cancer Institute and Harvard Medical School, discusses findings that show human papillomavirus circulating tumor DNA (HPV ctDNA) may be useful as part of surveillance monitoring of patients with oropharyngeal squamous cell carcinoma. Dr. Hanna reports that 93% of patients who had no clinical evidence of disease developed a positive HPV ctDNA test during surveillance follow-up and subsequently had confirmed disease recurrence.
Phillip Pifer, MD, PhD, of the UPMC Hillman Cancer Center, discusses findings that suggest focal adhesion kinase is a potentially important target for therapeutic sensitization in patients with mutant TP53 HPV-negative head and neck squamous cell carcinoma.
Mehmet Altan, MD, of The University of Texas MD Anderson Cancer Center, discusses findings from a phase Ib dose-escalation study, which showed early evidence of activity for NKTR-255, an investigational IL-15 receptor agonist, plus cetuximab in patients with solid tumors. Treatment appeared to lead to expansion and proliferation of NK and CD8+ cells (Abstract 957).
Shauna Campbell, DO, of Cleveland Clinic, discusses results from her study that showed hypofractionated intensity-modulated radiation therapy (H-IMRT) in the definitive or postoperative treatment of head and neck cancers using ≥ 50 Gy in 20 fractions appears to be safe and well tolerated with modest toxicity. Dr. Campbell suggests that prospective studies comparing the safety and efficacy of H-IMRT with those of conventionally fractionated IMRT are warranted (Abstract 2313).
Daniel J. Ma, MD, of the Mayo Clinic Alix School of Medicine, discusses results from a phase III study of patients with HPV-associated oropharyngeal squamous cell carcinoma. Comparing a 2-week course of de-escalated adjuvant radiation therapy with the standard 6-week course, investigators found that the shorter treatment appeared to have less toxicity, higher quality of life, and similar disease control as the longer standard-of-care treatment (Abstract LBA1).
David A. Palma, MD, PhD, of Ontario’s London Health Sciences Centre, discusses results of the ORATOR2 study, which compared two treatment options that could be de-escalated for patients with HPV-associated oropharyngeal squamous cell carcinoma: a lower-dose radiation approach (6 weeks instead of 7, often with chemotherapy) vs a transoral surgical approach (with low-dose radiation afterward, for 5 weeks) (Abstract LBA2).
David G. Pfister, MD, of Memorial Sloan Kettering Cancer Center, discusses the many considerations when caring for patients with head and neck cancers, such as dental and nutritional issues; side effects from radiation, including necrosis of the bone; oral health; problems with speech; and the concerns of younger patients who may have to cope with the sequelae of treatment such as altered function or disfigurement for years to come.
Ezra E.W. Cohen, MD, of the University of California, San Diego, discusses primary results of the phase III JAVELIN trial of locally advanced squamous cell carcinoma of the head and neck, in which the immune checkpoint inhibitor avelumab was combined with chemoradiotherapy followed by avelumab maintenance. Although the study results were negative, Dr. Cohen suggests other regimens that may prove to be effective (Abstract 910O).
Christopher Nutting, MD, PhD, of the Royal Marsden Hospital and Institute of Cancer Research, discusses phase III results from the first study to demonstrate the functional benefit of swallow-sparing intensity-modulated radiotherapy in oro- and hypopharyngeal cancers (Abstract 6508).
Pam Baker DeGuzman, PhD, of the University of Virginia School of Nursing, discusses her study findings on the use of the NCCN Distress Thermometer, which identified and addressed distress in patients treated for head and neck cancer who were then referred to speech pathologists, lymphedema specialists, and social workers (Abstract HSR20-082).
Sue Sun Yom, MD, PhD, of the University of California, San Francisco, talks about the variety of evolving ways to deintensify radiation therapy, the critical need to counsel patients on the risks and benefits, and the ethical importance of respecting patient preferences in choosing their cancer therapies.
Jared Weiss, MD, of the University of North Carolina, Chapel Hill, discusses outcomes for patients with stage III or IV disease who are ineligible for the standard treatment of cisplatin plus radiotherapy. His data suggest that treatment with pembrolizumab/radiotherapy instead is tolerable, with improvements seen in progression-free and overall survival (Abstract LBA1).
Jonathan D. Schoenfeld, MD, MPH, of Dana-Farber Cancer Institute and Brigham and Women’s Hospital, discusses phase II study results with the PD-1 inhibitor nivolumab or the combination of PD-1/CTLA-4 inhibition with nivolumab/ipilimumab in patients with newly diagnosed untreated oral cavity cancer (Abstract 1).
Gopal K. Bajaj, MD, MBA, of the Inova Schar Cancer Institute, discusses the results of a small study that showed prophylactic gabapentin can be safely and effectively used to significantly reduce pain and the use of opioids in patients undergoing radiotherapy or chemoradiotherapy for head and neck squamous cell carcinoma.
David Adelstein, MD, of the Cleveland Clinic, discusses the hypothesis that treatment can be de-intensified in patients with HPV-associated oropharyngeal cancer and a good prognosis.
Jill Gilbert, MD, of Vanderbilt University Medical Center, discusses this ongoing area of investigation and which patients can safely undergo a de-intensification of treatment. Based on two randomized trials, cetuximab should not be substituted for cisplatin as a de-intensification strategy in HPV-positive oropharyngeal cancer.
Assuntina G. Sacco, MD, of the University of California, San Diego, discusses the results of a small phase II study, which suggest that pembrolizumab plus cetuximab may show activity for platinum-refractory/-ineligible patients with recurrent or metastatic head and neck squamous cell carcinoma (Abstract 15).
Nadeem Riaz, MD, of Memorial Sloan Kettering Cancer Center, discusses the biomarkers that have emerged for immunotherapy and their tumor microenvironments, from PD-L1 staining and the Combined Positive Score to next-generation genomic technologies.
Carryn M. Anderson, MD, of the University of Iowa Hospital, discusses the investigational agent GC4419, previously shown to be safe and effective in decreasing the duration, incidence, and severity of oral mucositis in patients receiving concurrent cisplatin and radiation for oral cavity and oropharyngeal squamous cancers. The 2-year tumor outcome data suggest that GC4419 does not seem to compromise tumor control (Abstract LBA2).
Francis P. Worden, MD, of the University of Michigan Health System Comprehensive Cancer Center, explores the use of novel biomarkers that may help predict response to induction chemotherapy and survival in patients with locally advanced laryngeal cancer.
Sue Sun Yom, MD, PhD, of the University of California, San Francisco, discusses phase II results showing that swallowing-related quality of life after deintensified chemoradiation therapy may improve in patients with p16-positive, nonsmoking-associated, locoregionally advanced disease (Abstract LBA10).
David Routman, MD, of the Mayo Clinic, discusses his study findings showing that detectable human papillomavirus circulating tumor DNA in the postoperative setting may be linked to disease progression, which may help improve patient selection for treatment intensity (Abstract LBA5).
Danny Rischin, MD, of Peter MacCallum Cancer Centre, discusses phase III results that support pembrolizumab with and without platinum-based chemotherapy plus fluorouracil as new first-line standards of care for recurrent or metastatic head and neck squamous cell carcinoma (Abstract 6000).
Michael Becker, a former CEO for two biotechnology companies, discusses his terminal head and neck cancer diagnosis and his message for oncologists: be proactive and, at the appropriate time, talk with your patients about death and dying. For more information about Michael Becker’s blog and his HPV vaccine advocacy, visit mdbcancerjourney.com. To read about Michael Becker's advocacy efforts to increase vaccination rates for human papillomavirus-related cancers, see his Patient's Corner column "HPV-Related Cancers Like Mine Are Avoidable, So Why Aren't More Kids Being Vaccinated?" published in the May 10, 2018 issue of The ASCO Post.
Thomas Galloway, MD, of Fox Chase Cancer Center, summarizes a session on head and neck cancer that included findings on reducing oral mucositis, improving quality of life with deintensified chemoradiotherapy, and the costs of dose de-escalation (Scientific Session 31).
Bhisham Chera, MD, of the University of North Carolina, discusses using human papillomavirus found in plasma circulating tumor DNA to monitor cancer recurrence in HPV-associated oropharyngeal cancer (Abstract LBA6).
Ezra E.W. Cohen, MD, of the University of California, San Diego, discusses the effectiveness of anti–PD-1 therapy in patients with recurrent head and neck cancer and the studies that might help predict who will benefit, how to combine agents, and ways to reduce long-term toxicity.
Manisha H. Shah, MD, of The Ohio State University Comprehensive Cancer Center, summarizes a session she chaired on progress in tailored treatments for medullary and anaplastic thyroid cancers as well as salivary gland cancer.
Jed A. Katzel, MD, of Kaiser Permanente, discusses his team’s findings on the disparities in head and neck cancer treatment for women and the possible missed opportunities to take a more aggressive and beneficial approach (Abstract LBA6002).
Bhishamjit S. Chera, MD, of the University of North Carolina, discusses quantification of human papillomavirus 16 in circulating tumor DNA during de-intensified chemoradiation therapy for favorable-risk HPV-associated oropharyngeal squamous cell carcinoma (Presentation 92).
Robert I. Haddad, MD, of Dana-Farber Cancer Institute, discusses phase III study results on treatment beyond disease progression with nivolumab in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (Abstract 1043O).