Evolving Head and Neck Cancer Treatment Landscape


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Twenty years ago, head and neck cancers (HNCs) were largely associated with smoking and drinking. Today, other risk factors have been linked to HNCs, such as Epstein—Barr virus (EBV) and human papillomavirus (HPV), according to Barbara Murphy, MD. Clinicians knew only about HPV-negative disease a decade ago, says Ezra Cohen, MD, which is the more traditional tobacco-associated cancer identified with squamous cell carcinoma of the head and neck. This disease occurs in many sites, including the oral cavity, oropharynx, hypopharynx, and larynx.

As education regarding the harm of smoking improved, rates of smoking declined, and in turn, the incidence of HPV-negative cancer in Americans also declined. By contrast, the incidence of HPV-positive HNCs continues to grow today. HPV-positive HNCs frequently occur in nonsmokers, in nondrinkers, and often in patients who are younger. Murphy states that it is imperative for clinicians to recognize there is an HPV epidemic in the United States. HPV-positive HNCs primarily arise in the oropharynx, and this particular malignancy is now one of the fastest growing cancers in the United States.

As the understanding of HNCs etiology evolved, so have the available agents to treat the disease. Robert Ferris, MD, notes that cetuximab was introduced in 2006 and was the first targeted agent for HNC to be approved in 4 decades. Cetuximab is a therapeutic monoclonal antibody that targets EGFR.

A phase III study by Bonner et al, known as the Bonner trial, demonstrated the efficacy of using cetuximab with radiotherapy in patients with locally advanced HNC, while the EXTREME trial demonstrated improved overall survival in patients with recurrent metastatic disease treated with cetuximab and platinum 5-fluorouracil (5-FU). Ferris adds that today therapeutic monoclonal antibodies, particularly cetuximab, have become the standard of care in HNC treatment, a notable shift from available therapies 10 years ago.

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