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Historic Perspective on Recurrent HNSCC

Insights From: Ezra Cohen, MD, UC San Diego Moores Cancer Center; Robert L. Ferris, MD, PhD, University of Pittsburgh Cancer Institute; Nabil F Saba, MD, FACP, Emory University
Published: Tuesday, Feb 07, 2017


Transcript:

Nabil F. Saba, MD:
Patients with advanced head and neck cancer have a relatively short survival time. The median survival, even with multimodal chemotherapy, is about 8 to 11 months. The treatment has side effects that are significant on patients, including physical side effects that also influence their emotional well-being, as well as psychosocial functioning, and affects their overall quality of life. And those side effects in the acute phase of the treatment may include mucositis, may include tiredness and other side effects. Long-term include side effects such as xerostomia (or dry mouth), difficulty swallowing, and disfigurement, which also leads to affecting the psychosocial well-being of patients and their social functioning. And so, when we look at novel therapies for treating head and neck cancer, we take these items into consideration. I think immune therapy, as it is becoming a modality that is thought to preserve quality of life for patients, will have a future role in affecting this item, which is a major issue for head and neck cancer patients.

Robert L. Ferris, MD, PhD: Patients with advanced head and neck cancer, whether it’s locally advanced or recurrent disease, experience a large disruption in their quality of life, as well as their function and their abilities to speak, breathe, and swallow. Therefore, we need to balance the choice of therapeutic options with those that induce the least toxicity (or side effects) and permit improvements in quality of life and function.

Nabil F. Saba, MD: I would also add that the survival after failing platinum-based therapy for head and neck patients is very short. Treatments that would extend survival, but also preserve quality of life, for patients is going to be important in this particular group of patients. Because not only do they have a short survival, but their quality of life usually deteriorates fairly fast once they fail first-line therapy.

Robert L. Ferris, MD, PhD: Cetuximab was FDA-approved for head and neck cancer for locally advanced disease in 2006 and for recurrent metastatic disease in 2011. This had been the only FDA-approved agent until 2016 when we got the new immunotherapeutic agents, the checkpoint inhibitors. So, the field has been hungering for new agents to improve survival, response rates, and to improve quality of life and function by providing new agents to target this challenging disease.

Ezra Cohen, MD: When we think about patients with recurrent disease or metastatic disease, we really begin to shift our goals of therapy to ones of palliation and quality of life. So, we pay a lot more attention to what the symptoms are and what the toxicities of therapies are, realizing that, unfortunately, these patients are not in a curable situation and we really want to improve quality of life for as long as possible.

For patients with a recurrent disease, the first thing we still ask is, can this patient be cured? For the majority of those patients, the answer is going to be no. There are some patients who can be salvaged with surgery or with re-radiation, but they comprise only about 10% to 15% of that population.

So, for many patients, we’re beginning to think about some sort of systemic therapy. And recently, we’ve seen that the immunotherapy—specifically anti-PD-1 antibodies—not only have efficacy in this setting, but they do so with a very favorable toxicity profile.

Transcript Edited for Clarity
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Transcript:

Nabil F. Saba, MD:
Patients with advanced head and neck cancer have a relatively short survival time. The median survival, even with multimodal chemotherapy, is about 8 to 11 months. The treatment has side effects that are significant on patients, including physical side effects that also influence their emotional well-being, as well as psychosocial functioning, and affects their overall quality of life. And those side effects in the acute phase of the treatment may include mucositis, may include tiredness and other side effects. Long-term include side effects such as xerostomia (or dry mouth), difficulty swallowing, and disfigurement, which also leads to affecting the psychosocial well-being of patients and their social functioning. And so, when we look at novel therapies for treating head and neck cancer, we take these items into consideration. I think immune therapy, as it is becoming a modality that is thought to preserve quality of life for patients, will have a future role in affecting this item, which is a major issue for head and neck cancer patients.

Robert L. Ferris, MD, PhD: Patients with advanced head and neck cancer, whether it’s locally advanced or recurrent disease, experience a large disruption in their quality of life, as well as their function and their abilities to speak, breathe, and swallow. Therefore, we need to balance the choice of therapeutic options with those that induce the least toxicity (or side effects) and permit improvements in quality of life and function.

Nabil F. Saba, MD: I would also add that the survival after failing platinum-based therapy for head and neck patients is very short. Treatments that would extend survival, but also preserve quality of life, for patients is going to be important in this particular group of patients. Because not only do they have a short survival, but their quality of life usually deteriorates fairly fast once they fail first-line therapy.

Robert L. Ferris, MD, PhD: Cetuximab was FDA-approved for head and neck cancer for locally advanced disease in 2006 and for recurrent metastatic disease in 2011. This had been the only FDA-approved agent until 2016 when we got the new immunotherapeutic agents, the checkpoint inhibitors. So, the field has been hungering for new agents to improve survival, response rates, and to improve quality of life and function by providing new agents to target this challenging disease.

Ezra Cohen, MD: When we think about patients with recurrent disease or metastatic disease, we really begin to shift our goals of therapy to ones of palliation and quality of life. So, we pay a lot more attention to what the symptoms are and what the toxicities of therapies are, realizing that, unfortunately, these patients are not in a curable situation and we really want to improve quality of life for as long as possible.

For patients with a recurrent disease, the first thing we still ask is, can this patient be cured? For the majority of those patients, the answer is going to be no. There are some patients who can be salvaged with surgery or with re-radiation, but they comprise only about 10% to 15% of that population.

So, for many patients, we’re beginning to think about some sort of systemic therapy. And recently, we’ve seen that the immunotherapy—specifically anti-PD-1 antibodies—not only have efficacy in this setting, but they do so with a very favorable toxicity profile.

Transcript Edited for Clarity
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