I personally attended The Multidisciplinary Head and Neck Cancer Symposium along with hundreds of head and neck cancer specialists from around the world – surgeons, chemo therapists, and radiation therapists – to hear about the latest in state-of-the-art treatment for head and neck cancer patients.
A number of presentations struck me as important for our head and neck cancer patients and their families living in Dayton, Ohio.
1. Head and Neck Cancer Patients Can Be Sure that Radiation Therapy in Dayton, Ohio Is Just As Good As At The James Cancer Center
The key study for Southwestern Ohio head and neck cancer patients came from our own James Cancer Center at the Ohio State University. The James’ head and neck cancer specialists looked at 333 patients who had their surgery at OSU. Of these, 139 patients had their radiation at OSU and 194 patients had radiation in their hometown. The important finding was that there was no difference in survival in those patients who had their radiation at OSU (139 patients) as compared to this patients (194) who underwent radiation therapy at centers closer to home. I have always firmly believed that people do better when they stay close to their support system and when they can live life as normal as possible during treatment.
2. Immunotherapy for Recurrent Head and Neck Cancer Patients
Dr. Siewert from the University of Chicago School of Medicine reported on the Checkmate 141 trial. The Checkmate 141 trial looked at a new immune checkpoint inhibitor drug called Opdivo. Opdivo has been proven to be effective for patients with metastatic malignant melanoma as well as recurrent lung cancer. Immune checkpoint inhibitors unleash your body’s own immune system to attack your own head and neck cancer, unlike chemotherapy that suppresses your immune system.
Remarkable results were seen with Opdivo in treating patients with recurrent head and neck cancer, that is after surgery, chemotherapy, and radiation therapy. In fact, so remarkable that the study was halted early because more than 50% of patients with recurrent head and neck cancer responded to Opdivo. And with few side effects. More importantly, the effects of Opdivo lasted on average 18 months, far greater than with palliative chemotherapy.
Dr. Siewert reminded us that these patients with recurrent head and neck cancer had been, as he put it, “heavily pretreated.” That is to say, these patients had many courses of chemotherapy. These patients already had a suppressed immune system from chemotherapy. Just imagine if Opdivo would be used as first line therapy for patients with recurrent head and neck cancer. Dr. Siewert expects rapid approval of Opdivo for recurrent head and neck cancer patients by the FDA.
3. Say Goodbye to Stage IV Tonsil/Base of Tongue Cancer For HPV-positive Patients
Dr. Brian O’Sullivan of the Princess Margaret Hospital in Toronto proposed a new staging system for HPV positive patients with squamous cell carcinoma of the tonsil as well as base of tongue. His studies showed that chemotherapy and radiation therapy are so good in this patient group that a new classification system is needed for prognosis as well as to guide treatment. He proposed only 3 new stages. Stage IV is now reserved for that very rare patient who comes to clinic where the cancer has already spread to other organs, such as lung or liver.
Dr. Chera of the University of North Carolina at Chapel Hill went a step further and proposed that in early stage HPV positive head and neck cancer patients, radiation dose could be reduced from the standard 6-1/2 weeks to 5 weeks with exactly the same results – but with fewer side effects. Until further studies are done, this reduced radiation dose regimen will be for selected patients with cancer of the tonsil and base of tongue who are non-smokers/non-drinkers and HPV positive.