Ezra Cohen, MD
The treatment paradigm of head and neck squamous cell carcinoma (HNSCC) has evolved rapidly with the introduction of immunotherapy. Currently, the anti–PD-1 agents pembrolizumab (Keytruda) and nivolumab (Opdivo) are approved for patients who have progressed on platinum-based chemotherapy.
Ezra Cohen, MD, said that while recent data have brought excitement to the field of head and neck cancer, challenges remain in selecting patients, resistance, and treating those who do not respond to current immunotherapies. Overall, he said, the future is bright for head and neck cancer.
In an interview with OncLive
, Cohen, professor of medicine, Division of Hematology/Oncology, University of California, San Diego, associate director for Translational Science, Moores Cancer Center, discussed the future role of immunotherapy in the treatment of patients with HNSCC.
OncLive: What updates can you share regarding immunotherapy in head and neck cancer?
: For HNSCC, we have certainly seen some incredible advances in the last few years for immunotherapy. What is startling is that things are happening so fast. We now how 2 immunotherapy agents in head and neck cancer—nivolumab and pembrolizumab—which are approved for patients with platinum-refractory disease.
The future is going to be incredibly exciting. We have seen combinations that appear to double the response rate, such as agents that modulate the tumor microenvironment through myeloid-derived suppressor cells like a STAT3, oligonucleotide, or an IDO inhibitor. We are seeing a more than doubling of response rate with anti–PD-1 alone. We have seen the combination with innate immune activators, like toll-like receptor 9 agonists, that appear to double the response rate compared with anti–PD-1 alone.
Recently, a publication using an HPV vaccine in HPV-positive head and neck cancers appeared to enhance the response rate. Combinations are now being explored in larger randomized trials to make sure that they will hold up. Thus far, both the response rates and the duration of those responses appear to be incredibly promising.
In the near term, we are going to see the first-line data for the phase III trials. Now, nivolumab and pembrolizumab are approved in platinum-refractory patients, and we are very excited to see what happens to patients who have yet to be exposed to platinum-based therapy, either alone or in combination with chemotherapy. We already have a hint that those studies may be positive.
What results are you looking forward to from the 2018 ESMO Congress?*
I have said, half-jokingly, that it is the year for head and neck cancer. I have never been as excited to attend a conference as I will be for the 2018 ESMO Congress. We know that we are going to see the KEYNOTE-048 data, which are the first-line data for pembrolizumab alone or in combination with chemotherapy versus the standard of care of platinum, 5-fluorouracil, and cetuximab (Erbitux). We already have a hint from a news release that this study, at least in part, is going to be positive.
The other major trial that is going to be presented is the De-ESCALaTE trial, which enrolled patients with HPV-positive disease in the locally advanced setting and treated them with curative intent—with either cisplatin and radiation or cetuximab and radiation. We are very excited for those data, because it is going to dramatically influence the standard of care for HPV-positive patients, no matter the result.