Jared Weiss, MD
The development of new agents for patients with head and neck cancer continues to evolve, particularly for immunotherapy regimens, according to Jared Weiss, MD.
“There are multiple clinical trials that are near reporting looking at the role of single- or double-agent immunotherapy for the first treatment for recurrent or metastatic head and neck cancer,” says Weiss.
In an interview with OncLive,
Weiss, assistant professor, UNC Lineberger Comprehensive Cancer center, discussed the evolving role of immunotherapy and other promising developments in head and neck cancer.
OncLive: What is the current role of immunotherapy in head and neck cancer?
At the current time, the role of immunotherapy in head and neck cancer is restricted to recurrent metastatic head and neck cancer. We’re mostly talking about patients who have been treated for cure—sometimes with multiple attempts at cure—who are no longer curable. This is either as a consequence of metastatic disease, meaning a cancer that spread outside of the local regional area, or cancer that has recurred enough times that the patient is out of surgical and radiation options.
We're talking about patients who have been previously treated or are typically platinum refractory. That’s where nivolumab (Opdivo) and pembrolizumab (Keytruda) have their FDA approval and where their standard use is found.
However, we’re actively investigating these agents as well as others in other contexts. There are multiple clinical trials that are near reporting looking at the role of single or double agent immunotherapy for the first treatment for recurrent or metastatic head and neck cancer. There are multiple clinical trials integrating these agents into a cure.
These fall into 2 or 3 basic areas. They’re being studied as induction chemotherapy so either immunotherapy alone or immunotherapy given with chemotherapy before an attempt at cure, such as surgery, radiation, or chemoradiotherapy. Second, they’re being evaluated together, concurrent with radiation and then there is at least one study looking at them in the adjuvant context.
These studies are very important because the average patient with head and neck cancer is not incurable in contrast to many other cancers. The average head and neck cancer is local or locoregionally advanced and being treated for cure, so there is real hope that these agents can improve the cure rates in those contexts.
What combinations are being investigated in immunotherapy?
Multiple combinations are being [explored] for immunotherapy in head and neck cancer. We know that we have approval of PD-1 agents and we will soon have PD-L1 agents in the recurrent metastatic setting. We are going to have data within months for the combinations with CTLA-4, such as ipilimumab (Yervoy) and nivolumab or durvalumab (Imfinzi) and tremelimumab.
The other combination that shows early promise is the combination of PD-1 and IDO. IDO is a catalytic enzyme involved in tryptophan metabolism and can influence the immunosuppressive tumor microenvironment. We saw some early data at ASCO that perhaps showed early promise for that combination.
There are many combination studies beyond that going on. Once you get past the PD-1/CTLA-4 combination and the PD-1/IDO combination, you get into the realm of deep speculation and opinion for what is going to hold promise, but one has high hopes that with so many things being studied, more than 1 will hit.
What role do CDK4/6 inhibitors have in the head and neck and cancer space?
At the current time, there is no standard FDA approved role for CDK4/6 inhibitors. However, there are multiple clinical trials looking at them in combination with other agents, either to improve efficacy of therapy, to decrease neutropenia, or both.
Is there anything that you are currently working on that you would like to discuss?
We all tend to favor our own work. I have multiple clinical trials that I am privileged to be a part of that try to incorporate immunotherapy agents into a cure.
I have a clinical trial of pembrolizumab together with radiation, which is a collaboration between my institution, UNC, Fox Chase Cancer Center, Johns Hopkins Medicine, and The University of Chicago Medicine, looking to ultimately replace cisplatin with a higher cure rate and less of the dramatic toxicity.