Panelists:Ezra Cohen, MD, FRCPSC, FASCO, UC San Diego; Joshua M. Bauml, MD, University of Pennsylvania; Jared Weiss, MD, UNC Lineberger Comprehensive Cancer Center; Barbara A. Burtness, MD, Yale University School of Medicine
Ezra Cohen, MD: Before we wrap up this program, I’d like to ask each of you to provide some final takeaways regarding what we covered in this program. Josh, let me start with you.
Joshua M. Bauml, MD: I think the key thing that I keep coming back to when considering advanced therapeutics for patients with head and neck cancer—and specifically with immunotherapy, as we have this explosion of new treatments—is the importance of coming back to the science and identifying biomarkers that can help to predict who will benefit from a given treatment. I think exploring that in concert with the development of a trial is really critical and will enhance the likelihood that our trials will be positive and that will be able to benefit patients.
Ezra Cohen, MD: Thanks. Barbara?
Barbara A. Burtness, MD: I love the discussion of biomarkers. I think that there are a lot of clinical features that we can use to personalize therapy as well. We talked earlier about locally advanced treatment and how perhaps the goals are different in HPV-positive and HPV-negative disease, where with HPV-negative, we still fail to cure the majority of patients. And we need to look at perhaps more molecular specificity in what we do, ways that we can combine modalities to improve our response rate. We should be introducing immuno-oncology earlier in the management of HPV-negative patients, in short order.
And then, in the HPV-positive patients—at least for the patients who don’t have bulky disease and who are nonsmokers—we’re curing very many of them. What can we do to make sure that, 2 years out, they aren’t still having neck and shoulder pain, are not willing to eat solid foods in front of other people, or are having trouble getting back to work. So, there are many, many different strategies that offer promise for de-intensification. I think all of them have a future. I don’t think that it’s only going to be that we’re going to drop platinum or we’re going to reduce the radiation dose or everybody is going to get transoral surgery. But I think we’re going to learn a lot more about how to pick our de-intensification strategy for a given patient.
Ezra Cohen, MD: Jared, let me turn to you.
Jared Weiss, MD: We’ve spoken today about a lot of positive clinical trials that have changed our practice in advanced care. Regarding the pace of these, you could call it overwhelming or inspiring, depending on what kind of mood you’re in. But I think for any given clinical trial going on, there are so many going on now that have a higher probability of being positive and really helping that individual patient who goes on them than perhaps historically was true in head and neck cancer.
And so, I would end with a plug to consider clinical trials for your patients and to consider them much earlier in their course than you might have before. I think sometimes we consider clinical trials when all else has failed and there’s nothing that can be done as standard of care. But some of the first-line trials and curative trials that are going on now have incredibly high probability for curing more people with less morbidity. I think they should be thought of quite a bit earlier than we traditionally have.
Ezra Cohen, MD: It’s certainly an exciting time. And so, on behalf of our panel of experts, we thank you for joining us for this Peer Exchange® expert discussion.