The RapidReporter: Recent Developments, Findings, and Research in Head and Neck Cancer

By Diane West
Published: Tuesday, Jul 06, 2010

San Diego, CA

New Role for Immune Activation of Antibody Therapy May Fine-Tune Approach to

    Head and Neck Cancer Treatment

    Presence of FcyR genotype may point to best therapeutic approach in some patients

Identifying head and neck cancer patients who possess the FcyR genotype may help predict whether they will respond to monoclonal antibodies, which work by killing cancer cells bearing epidermal growth factor receptors (EGFR) on their surface.

“There may be a relationship between patients who possess this certain FcR genotype and their ability to mediate immune activation with certain monoclonal antibody therapies, but this is still to be validated,” said Robert L. Ferris, MD, Associate Professor, Co-Leader of the Cancer Immunology Program and Chief of Head and Neck Surgery at the University of Pittsburgh Cancer Institute. [Dr. Ferris and his colleague, Dr. Andres Lopez-Albaitero, presented their findings at the American Head and Neck Society’s {AHNS} recent Annual Meeting in San Diego.]

This finding may be potentially substantial because monoclonal antibodies like Erbitux (cetuximab) by Bristol-Myers Squibb/ ImClone, which was originally approved to treat advanced colorectal cancer, are now used to treat some forms of mouth, tongue and voice box cancer. A study published in the New England Journal of Medicine in February 2006, for example, found cetuximab plus radiation therapy nearly doubled the median survival in patients with certain head and neck cancers, particularly oropharyngeal cancers. Another EGFR-specific antibody, panitumumab (Vectibix) is also FDA approved. Identifying patients with the FcyR genotype may further fine-tune whether these monoclonal antibodies will work for them. Until this is proven, however, chemoradiotherapy with cisplatin remains the accepted standard of care for these types of cancers. Toxicity with this platinum-based treatment remains high, however, leading researchers to look for other alternatives.

“We know that antibody-dependent cell-mediated cytotoxicity (ADCC) can happen even with low levels of EGFR, and the may be due to the presence of the FG gamma receptor,” said Dr. Ferris, who has served as a consultant and investigator for both BMS/Im- Clone and Amgen, respectively. “If the FcyR genotype influences the antitumor response to [a monoclonal antibody such as] cetuximab in squamous cell carcinoma cells of the head and neck in vitro and in vivo, ADCC activity should be correlated with the FcR genotype and other immune biomarkers.”

Robots and Lasers Change the Face of Head and Neck Cancer Surgery

Precision robotic arms and targeted carbon laser are changing the face of traditional head and neck surgery while preserving the faces of patients, especially those with advanced and hard-to-reach cancers. Surgeons who support these new approaches hope they will one day render the current “saw-to-jaw” approach to many head and neck cancers obsolete.

“Traditional oral cancer surgery often requires making an incision, removing the lymph nodes and moving the jaw bone just to get to the cancer,” said Dr. Michael L. Hinni of the Mayo Clinic in Scottsdale, Arizona. “Transoral laser microsurgery (TLM) allows us to come in right through the mouth, completely remove the tumor, and achieve clear margins.” Dr. Hinni presented his findings and the results of some of his surgeries at an American Head and Neck Cancer meeting this past Spring.

With TLM, a high-powered microscope is threaded down to the larynx, a common site for hard-to-reach and advanced oral cancers. Once the tumor and surrounding cancerous tissue is identified, a CO2 laser carves it out. The advantages, Dr. Hinni says, are many.

“The CO2 laser does not put a lot of heat into surrounding tissues,” he says, “and not taking a patient’s face apart avoids a lot of swelling.” Additionally, Dr. Hinni says, TLM can reduce the need to perform a tracheotomy from the current 100% for cancers located at the base of the tongue to less than 25%, further speeding the patient’s return to normalcy after surgery.

Dr. Hinni and his colleagues conducted a multicenter trial where patients with Stage III or Stage IV squamous cell carcinoma of the glottic or supraglottic larynx were treated with TLM and followed up for two years. “The results,” he said, “were quite acceptable.” Dr. Hinni is guarded about stating more exact results because, while no “standard of care” for the treatment of advanced stage laryngeal cancer exists, radiation and chemotherapy remain the accepted standard to approach tumors that have become too large or too inaccessible to safely remove or remove without creating a need for extensive reconstructive facial surgery. However, he hopes that TLM will change this one day soon.

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