Jared Weiss, MD, assistant professor, UNC Lineberger Comprehensive Cancer Center, discusses current clinical trials in head and neck cancer.

Currently, Weiss is involved in a clinical trial incorporating immunotherapy with radiation—which has investigators from various cancer centers hopeful that this regimen could be a replacement for cisplatin, with a higher cure rate and less toxicities.

There is also a study that combines durvalumab (Imfinzi) carboplatin and nab-paclitaxel as induction therapy prior to surgery for hard-to-treat patients.

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Dr. Weiss Discusses Current Clinical Trials in Head and Neck Cancer

Jared Weiss, MD, assistant professor, UNC Lineberger Comprehensive Cancer Center, discusses biomarkers in head and neck cancer.

Currently, one of the only available biomarkers for head and neck cancer is HPV. If the cancer is driven by HPV, it has more curative potential. But, this is not the optimal indicator for choosing treatment for patients with head and neck cancer, according to Weiss.

In regard to immunotherapy efficacy, Weiss says HPV isn’t a good biomarker. PD-L1 biomarkers are also problematic for immunotherapy, but some studies on interferon gamma signatures appear promising.

Dr. Weiss on Biomarkers in Head and Neck Cancer

Jared Weiss, MD, assistant professor, UNC Lineberger Comprehensive Cancer Center, discusses next steps for immunotherapy agents in the treatment of patients with head and neck cancer.

On the horizon, Weiss sees immunotherapy agents, such as nivolumab (Opdivo) and pembrolizumab (Keytruda), moving into the frontline setting of head and neck cancer treatment. Multiple studies are currently trying to tease out the benefits and drawbacks of chemotherapy versus PD-1/PD-L1 agents alone, versus the combination of PD-1/PD-L1 agents with CTLA4 agents. those trials are near accruing. Weiss expects these data within the next year, with legitimate maturity approximately 1 or 2 years after that.

However, he also says it is important to note that, in contrast to lung cancer, for example, most head and neck cancer incidences are not incurable. In fact, the overwhelming majority of these patients present with locally advanced disease that is treated for cure, he explains.

From a perspective of duration and quality of life in this setting, Weiss says that curative therapy is actually where oncologists should begin to direct their focus. Treatments in this space, such as radiation therapy and cisplatin, are rather difficult for patients to tolerate, with adverse events including long-term loss of speaking and swallowing function, mild hearing loss, and neuropathy, among other toxicities.

Dr. Weiss on Next Steps for Immunotherapy in Head and Neck Cancer

Jared Weiss, MD, assistant professor, UNC Lineberger Comprehensive Cancer Center, discusses immunotherapy as treatment to control disease for patients with lung cancer. 

Durable disease control has been observed in a minority of patients due to immunotherapy, says Weiss. With the newer therapies of PD-1/PD-L1 both alone and in combination with CTLA-4 inhibitors and other agents, higher rates of disease control is being seen than previously. 

Only a small number of patients achieve what appears to be a cure, but immunotherapy is a bigger step in the evolution of cancer care. Many people are thriving longer with lower toxicities but a cure still needs to be researched, explains Weiss.

Jared Weiss, MD, assistant professor, UNC Lineberger Comprehensive Cancer Center, discusses immunotherapy as treatment to control disease for patients with lung cancer.

Dr. Weiss on Disease-Control Rate of Immunotherapy for Lung Cancer

Jared Weiss, MD, assistant professor, UNC Lineberger Comprehensive Cancer Center, discusses the development of biomarkers in the study of lung cancer.

PD-L1 is a much contested biomarker in this field, Weiss explains. While its positive predictive value is beneficial, PD-L1 expression does not provide a stable negative predictor.

According to Weiss, researchers should move on from PD-L1 and start looking into different biomarkers such as mismatch repair, mutational load and mRNA expression signatures, which all show promise.

Jared Weiss, MD

Articles

Dr. Weiss Discusses Current Clinical Trials in Head and Neck Cancer

Dr. Weiss on Biomarkers in Head and Neck Cancer

Dr. Weiss on Next Steps for Immunotherapy in Head and Neck Cancer

Dr. Weiss on Disease-Control Rate of Immunotherapy for Lung Cancer

Dr. Weiss on PD-L1 Biomarker in Lung Cancer