Highlights on head & neck cancer 2

Dr Marika Rasschaert, a medical oncologist at the University Hospital Antwerp, Belgium, provided a comprehensive overview of critical studies presented at ASCO 2024 in the oral abstract session on Head & Neck Cancer

She discusses nine oral abstracts categorised into three primary areas: phase three studies on nasopharyngeal cancer, innovative treatments using viral vectors and vaccines, and advanced irradiation methods aimed at reducing toxicity.

The first set of studies, all conducted in China, focused on locally advanced head and neck cancer (LA-HNC), specifically stage T3 with nodes or T4 with few nodes. These studies explored different applications of immunotherapy alongside standard treatments. The first study examined camrelizumab, an anti-PD-1 therapy, as an adjuvant treatment. Patients received camrelizumab following induction chemotherapy and chemoradiation. This phase three, randomised, blinded study demonstrated a 10% improvement in EFS with camrelizumab, which was statistically significant. Importantly, the treatment did not increase toxicity, ensuring patients’ quality of life remained unchanged. The second study investigated tislelizumab, another anti-PD-1 therapy, administered in three cycles upfront with induction chemotherapy and eight cycles as adjuvant therapy, totalling eleven cycles. This large phase three randomised trial, involving 450 patients, also showed about a 10% improvement in EFS. Notably, the overall response rate was twice as high with the three cycles of induction immunotherapy compared to standard treatment. However, further evaluation is necessary to confirm these findings. The third study focused on enhancing the effectiveness of chemoradiotherapy for high-risk LA-HNC patients by incorporating an anti-angiogenic treatment. Typically, chemoradiotherapy is the standard approach for these patients, often involving cisplatin. The innovative aspect of this study was the addition of endostar, an anti-angiogenic drug not commonly used in Europe. The results were promising, showing a 10% improvement in the complete cure rate of pathologic lymph nodes, as evaluated through radiologic methods. Importantly, this combination did not result in increased toxicity, suggesting that it could be a viable option for enhancing treatment efficacy without additional side effects.

The second major segment of the head and neck oral abstract session focused on HPV-positive oropharyngeal cancers, highlighting three different viral treatment options. The first treatment discussed was ISA 101, a classical vaccine. This approach involves injecting the patient with a peptide, specifically the E67 HPV antigen, administered five times during chemotherapy. The second treatment was a more novel approach. This involves giving an HLA-protein with the E7 antigen and IL-2, all in one product. This innovative method mimics the function of an antigen-presenting cell, offering a unique way to stimulate the immune system against the HPV antigens.. The third treatment was a combination of two mRNA vaccines given concurrently, both targeting the E6 and E7 HPV-specific antigens.

The last few abstracts presented focused on radiotherapy and how to administer it to patients with the goal of reducing toxicity. The first study discussed was a non-inferiority trial comparing proton and photon radiotherapy for oropharyngeal cancer patients. This phase 3 trial, with a follow-up of about 43 months, demonstrated that proton therapy is non-inferior to photon therapy. The hazard ratio for EFS was around 0.6, slightly favouring proton therapy, In terms of the toxicity profile, proton therapy showed significant benefits: half of the patients did not need a feeding tube, a major toxicity concern, and about 85% of patients were able to maintain their weight, avoiding anorexia and cachexia. These findings indicate that proton radiotherapy not only matches the efficacy of photon therapy but also offers a better quality of life for patients. However, the widespread clinical and practical implementation of proton therapy remains to be seen, particularly due to the limited availability of proton centers in Belgium. Another important development in radiotherapy involved hypoxia-targeted de-escalation of radiotherapy. This approach aims to maintain high efficacy while reducing toxicity, and the study results were positive. Overall, these studies suggest that there are promising advancements in radiotherapy that can offer either higher efficacy or reduced toxicity or sometimes both. These improvements are encouraging for the treatment of head and neck cancer patients, providing new strategies to enhance patient outcomes and quality of life.