The incidence of head and neck cancers varies substantially between different parts of the world. Although nasopharyngeal cancer (NPC) and oropharyngeal cancer (OPC) are the least common cancer types, their frequency in some area is increasing, which will lead to an important clinical impact.
Recently, OPC incidence has been rising in economically developed countries (e.g. United States, Japan and certain European countries) due to the human papilloma virus (HPV) epidemic. The infection has been proposed as a potential aetiologic factor for head and neck squamous cell carcinoma in India, as research will report at ESMO-ASIA 2015 (333P). “Studies with accurate subsite classification that also include HPV detection in tumours are necessary to determine the incidence of HPV-associated OPC in India,” says Dr Amanda Psyrri.
Today, prevention is having a crucial role and the incidence of tobacco-associated head and neck cancers is decreasing in countries that have adopted successful smoking cessation programmes. NPC is endemic in Asia and is Epstein–Barr virus (EBV)-related. Although rare in Europe, it represents a major health issue in South Eastern Asia and China. “NPC is not a totally unmet need but because its higher incidence is limited to few regions, the attention on this disease is not as high as it should be,” says Professor Anthony TC Chan.
Immunotherapy appears very promising in head and neck cancer. “Now we have encouraging data from early studies with immune checkpoint inhibitors”, Psyrri reports. “Pembrolizumab has shown promising activity in PD-L1 positive NPC, suggesting that its combination with chemoradiotherapy could be tested in a curable setting” (315O). Chan comments: “Currently, in the 20-30% of the metastatic recurrence patients, there isn’t effective treatment beyond first line combination chemotherapy, we really should multiply our efforts to identify the newer generation of treatment”.
Although squamous cell carcinoma is the most common type of head and neck cancer, there is not an effective second-line strategy and prognosis remains poor. In recurrent metastatic head and neck squamous cell carcinoma, a biomarker analysis will be presented from a phase III randomised study comparing afatinib to methotrexate as second-line therapy (314O). The results suggest that patients with p16 negative, EGFR-amplified, Her3 low and PTEN high tumours derived greater benefit from afatinib. Psyrri adds: “The identification of biomarkers predictive for response to afatinib is an interesting research area and validation of this biomarker signature is required.” Chan concludes: “Certainly, more efforts are needed to identify an effective treatment in second-line. Methotrexate only has a modest activity, so if afatinib shows clinically meaningful efficacy with acceptable tolerance, it would be an attractive alternative”.
ESMO Asia 2015 Session
Proffered Paper session: Head and neck cancer, 18 December, 14:30 to 15:30, Hall 332
314O Second-line afatinib vs methotrexate (MTX) in patients (pts) with recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC): Subgroup/biomarker analysis of LUX-head and neck 1 (LUX-H&N1)
315O Antitumor activity and safety of pembrolizumab in patients with PD-L1-positive nasopharyngeal carcinoma: Interim results from a phase 1b study