I enjoyed Dr. West’s summary of upcoming ASCO highlights for lung cancer and so decided to copy him for the oral head and neck session, where the most important abstracts are broken:

#5503-Vandetanib (VAN) in locally advanced or metastatic medullarythyroid cancer (MTC): A randomized, double-blind phase III trial (ZETA).

-Medullary thyroid cancer, once incurable, is hard to treat.  Results with chemotherapy (doxorubicin) have been unimpressive, with <40% response rate, short duration of response, and toxicity.  The phase II results with vandetanib, a pill tyrosine kinase inhibitor to VEGF, RET, and EGFR were promising and so I await anxiously the results of this 331 patient trial.

#5504-Phase II trial of sunitinib in medullary thyroid cancer (MTC).

-Sunitinib (sutent) is also a pill TKI.  It’s targets are PDFRa, PDGFRb, VEGFR1, VEGFR2, VEGFR3, FLT3, CSF-1R and RET.  It is already approved for renal cell cancer.

#5505-Phase II study of oral lapatinib, a dual-tyrosine kinase inhibitor,combined with chemoradiotherapy (CRT) in patients (pts) with locally advanced, unresected squamous cell carcinoma of the head and neck (SCCHN).

-Lapatinib is an oral tyrosinke kinase inhibitor of both EGFR and HER2.  EGFR is known to be important in head and neck cancer and HER2 is its preferred dimerization partner.  I am very excited about this trial because I am running a trial of lapatinib plus capecitabine for incurable head and neck cancer.

#LBA5506-An open-label, randomized, phase III trial of zalutumumab, ahuman monoclonal EGF receptor (EGFr) antibody, versus best supportivecare, in patients with non-curable squamous cell carcinoma (SCCHN) of the head and neck who have failed standard platinum-based chemotherapy

-We have seen the efficacy of cetuximab in head and neck cancer, but in some areas of the country infusion reactions are a big problem.  This trial is of a monoclonal antibody with the same target as cetuximab, but fully humanized, so that it shouldn’t have this problem.

#5507-A phase III trial (RTOG 0129) of two radiation-cisplatin regimensfor head and neck carcinomas (HNC): Impact of radiation and cisplatin intensity on outcome.

-Combined chemotherapy and radiation represents a standard of care for most advanced but curable squamous cell carcinoma of the head and neck.  Before adding chemotherapy to radiation became a standard of care, breaking up radiation in different ways (altered fractionation) was shown to improve outcomes.  With the advent of adding chemotherapy, the benefit has been less clear.  This trial compares one group that gets three cycles of high dose cisplatin plus standard radiation therapy (over seven weeks) to an experimental group only getting two cycles of cisplatin, but accelerated fractionation with concomitant boost (over six weeks).

#5508-Postoperative accelerated radiotherapy (POPART) versusconventional postoperative radiotherapy (CPORT) in squamous cell head and neck cancer: A multicenter prospective randomized study of the Dutch Head and Neck Cooperative Study Group

-Dr. Lin and Dr. Cohen recently conducted webinars on the use of adjuvant radiation that will be available on GRACE within the next few weeks.  One key point was that patients at high risk of recurrence after surgery should have adjuvant radiation and two classes of patients who need radiation should have chemotherapy added to it-those with close margins and those with extracapsular extension in lymph nodes.  This trial randomized patients with either close/positive margins or extracapsular extension to post-operative radiotherapy (66 Gy in 5 weeks) as compared to conventionally fractionated radiotherapy (66 Gy in 7 weeks).  My major question is why no chemotherapy was given, since we know that chemotherapy has a significant benefit for this class of patients.

#5509-Prognostic significance of interleukin-8 (IL-8) and hepatocyte growth factor (HGF) in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemoradiation on a phase III trial

-I am interested to hear about this trial.  We really have only one potential prognostic or predictive marker in SCCHN-HPV.  Can IL-8 and HGH also help stratify patients?

#5510-Analysis of the effect of p16 and tobacco pack-years (p-y) onoverall (OS) and progression-free survival (PFS) for patients with oropharynxcancer (OPC) in Radiation Therapy Oncology Group (RTOG) protocol 9003.

-RTOG 9003 compared several radiation regimens–Twice-Daily Hyperfractionation vs Split-Course Accelerated Hyperfractionation vs Accelerated Fractionation with Concomitant Boost vs Standard Fractionation.  Multiple recent lines of evidence suggest that HPV (as measured by p16) is prognostic in patients treated with chemotherapy and radiation.  We’re learning more recently that the story may be more complicated.  Patients who are HPV+ may not be all the same-those who have the risk factor of smoking in addition to HPV may have a prognosis intermediate between the “pure” HPV-driven cancers and the “pure” smoking driven cancers.  I just heard Maura Gillison talk last week at Penn and she was great; I’m looking forward to learning more about HPV at this talk.

#5519-PTEN as prognostic and predictive marker in postoperativeradiotherapy for squamous cell cancer of the head and neck.

-PTEN is a very famous tumor suppressor gene.  I’m looking forward to learning more about its role as a prognostic and predictive marker in head and neck cancer.

No related posts.