Daily highlight in head and neck cancer

Reported by Dr Marika Rasschaert – University Hospital Antwerp

The GORTEC 2014-04 trial sought to assess the efficacy of omitting chemotherapy after Stereotactic Ablative Radiotherapy (SABR) in first-line treatment for metastatic head and neck cancer patients. The study enrolled patients with controlled primary tumors located above the clavicle, presenting with (1-3) oligometastases. Evaluation criteria included Overall Survival (OS) and Quality of Life (QoL) after one year. Results indicated that the addition of chemotherapy did not improve OS, nor did it impact QoL. Clinically, this suggests that radiotherapy alone can be considered for patients unfit for chemotherapy due to frailty.

The MACH-EGFR meta-analysis explored the effects of adding EGFR antibodies or substituting chemotherapy with EGFR antibodies in the curative treatment of locally advanced head and neck cancer patients. The addition of EGFR antibodies conferred limited benefits, primarily observed in a small subset of young patients with aggressive tumor types. However, substituting chemotherapy with EGFR antibodies led to worsened OS outcomes for most patients. This effect was particularly pronounced in the absence of induction therapy before radiotherapy, in female patients, non-smokers, and those with oropharyngeal cancer.

A novel approach to treatment refinement involves the use of circulating tumor DNA (ctDNA) as a predictive biomarker for minimal residual disease (MRD) in both HPV-positive and HPV-negative patients. In this very pragmatic study setup with 24 selected genes and HPV-directed DNA fragments, blood samples were collected before and within 12 weeks after curative intent treatment. Findings revealed that post-treatment ctDNA within 12 weeks serves as a predictive biomarker for MRD. Detection of ctDNA correlated with shorter Progression-Free Survival (PFS) and OS, signifying its potential in defining patients at risk. These groundbreaking results by Honoré et al. were recently published in the Annals of Oncology, offering a promising avenue for patient risk stratification.

However, the INTERLINK-1 study reported disappointing results in second-line metastatic disease, an area with pressing need for additional treatment options. The combination of monalizumab with cetuximab did not yield superior outcomes in OS, PFS, or Overall Response Rate (ORR) compared to placebo with cetuximab. Further subgroup analyses are underway, but as of now, monalizumab has not demonstrated any significant benefits.

References:

Juliette Thariat – OMITting frontline chemotherapy in head and neck cancer (HNSCC) patients with 1-3 oligometastases using stereotactic ablative radiotherapy (SABR), the GORTEC 2014-04 “OMET” randomized phase 2 trial ESMO 2023 – 853O

Pierre Blanchard – MACH-EGFR: Individual patient data (IPD) meta-analysis of anti-EGFR monoclonal antibodies (Ab) in patients (pts) with locally advanced (LA) squamous cell carcinomas of head and neck (SCCHN) ESMO 2023 – 857O

Natasha Honoré – Minimal residual disease (MRD) diagnosed by a plasma tumor-agnostic circulating tumor DNA (ctDNA) assay after curative therapy in locally advanced (LA) squamous cell carcinoma of the head and neck (SCCHN) predicts disease relapse and survival. ESMO 2023 – 858O

Jérome Fayette – INTERLINK-1: Phase 3 study of cetuximab (CTX) ± monalizumab (M) in participants (pts) with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) with disease progression on/after platinum chemotherapy (CT) and previously treated with an immune checkpoint inhibitor (ICI) ESMO2023 – 854O