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ESMO 2018: Dr. Cohen Reflects on Practice-Changing Data in Head and Neck Cancer

Ezra Cohen, MD
Published: Friday, Nov 02, 2018



Ezra Cohen, MD, associate director, Moores Cancer Center at the University of California, San Diego, reflects on head and neck cancer data that were presented at the 2018 ESMO Congress.

At the congress, data sets were presented that are slated to be immediately practice-changing for the future treatment landscape of head and neck cancer, Cohen says.

KEYNOTE-048 was a phase III trial looking at frontline immunotherapy in a patient population that progressed on curative-intent therapy. Researchers hypothesized that single-agent pembrolizumab (Keytruda) would be superior in selective patients compared to the standard triplet chemotherapy regimen. The anti–PD-1 inhibitor is already been approved by the FDA as second-line treatment. This was a positive trial, as both arms of pembrolizumab and pembrolizumab with chemotherapy were superior to the standard regimen, Cohen notes. This regimen now represents a new standard of care in recurrent metastatic disease for patients irrespective of PDL-1 expression, he says.

Cohen also shared the latest findings from the De-ESCALaTE trial which compared cetuximab (Erbitux) versus cisplatin in patients with HPV. This was an important negative trial, he explains, as cetuximab was found to be to be just as toxic as cisplatin-based radiation, which remains the still the standard of care.

After discussing some of the other research being conducted in the space, Cohen shared what he thinks the landscape of head and neck cancer might look like a year from now. He postulated that by that time, pembrolizumab will be accepted as a firstline therapy in recurrent metastatic disease. Specifically, pembrolizumab alone will be indicated for PD-L1 expressing tumors, while pembrolizumab and chemotherapy will be indicated for other tumors. He added that although he does not believe mature data sets with the potential to change standard of care will be available in a year, investigators will be close.
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Ezra Cohen, MD, associate director, Moores Cancer Center at the University of California, San Diego, reflects on head and neck cancer data that were presented at the 2018 ESMO Congress.

At the congress, data sets were presented that are slated to be immediately practice-changing for the future treatment landscape of head and neck cancer, Cohen says.

KEYNOTE-048 was a phase III trial looking at frontline immunotherapy in a patient population that progressed on curative-intent therapy. Researchers hypothesized that single-agent pembrolizumab (Keytruda) would be superior in selective patients compared to the standard triplet chemotherapy regimen. The anti–PD-1 inhibitor is already been approved by the FDA as second-line treatment. This was a positive trial, as both arms of pembrolizumab and pembrolizumab with chemotherapy were superior to the standard regimen, Cohen notes. This regimen now represents a new standard of care in recurrent metastatic disease for patients irrespective of PDL-1 expression, he says.

Cohen also shared the latest findings from the De-ESCALaTE trial which compared cetuximab (Erbitux) versus cisplatin in patients with HPV. This was an important negative trial, he explains, as cetuximab was found to be to be just as toxic as cisplatin-based radiation, which remains the still the standard of care.

After discussing some of the other research being conducted in the space, Cohen shared what he thinks the landscape of head and neck cancer might look like a year from now. He postulated that by that time, pembrolizumab will be accepted as a firstline therapy in recurrent metastatic disease. Specifically, pembrolizumab alone will be indicated for PD-L1 expressing tumors, while pembrolizumab and chemotherapy will be indicated for other tumors. He added that although he does not believe mature data sets with the potential to change standard of care will be available in a year, investigators will be close.
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Online CME Activities
TitleExpiration DateCME Credits
Medical Crossfire®: How Can We Optimize Outcomes in Head and Neck Cancers with Immunotherapeutic Strategies?Oct 31, 20191.5
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