Loren K. Mell, MD, assistant professor, Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, discusses individualizing treatments for patients with head and neck cancer.

Mell says that investigators are making efforts to individualize care within the context of evidence-based medicine. These are inherently in conflict with one another, he explains.

With the introduction of immunotherapy, there is a different paradigm for cancer treatment, as it offers some appealing options, says Mell. This is especially true for treating older patients whose immune functions are in decline. It is a topic that is being revisited, Mell explains, and research is ongoing.

Videos

Loren K. Mell, MD, assistant professor, Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, discusses individualizing treatments for patients with head and neck cancer.
 

Dr. Mell on Individualizing Treatment for Head and Neck Cancer

Loren K. Mell, MD, assistant professor, Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, discusses flaws in the current model of risk stratification for patients with head and neck cancer.

The dominant paradigm used to risk-stratify patients with head and neck cancer is fundamentally flawed, says Mell. The current models tend to focus on 1 endpoint, or class of endpoints, called event-free survival—most commonly overall survival. This is an unambiguous endpoint, making it simple to quantify. Mell says that although it is a desirable endpoint to know, it does not account for patients who have an appreciable risk of dying from something other than cancer.

Mell claims that these current models fail because they treat death from cancer equally to a death not from cancer. This results in a patient with very advanced cancer being put in the same category as a patient with cancer who is at a high-risk for death due to separate health problems. These patients need different treatment regimens, and nothing will be solved if these events are not separated, Mell says. Risk stratification schemes should not focus solely on the tumors, because at best, they are only explaining part of the problem.

Loren K. Mell, MD, assistant professor, Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, discusses flaws in the current model of risk stratification for patients with head and neck cancer.
 

Dr. Mell Discusses Flaws in Risk Stratification for Head and Neck Cancer

Loren K. Mell, MD, assistant professor, Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, discusses factors that contribute to risk stratification and treatment of head and neck cancer.

Mell says that characteristics of the tumor, as well as genetic factors, have been rightly focused on in the process of risk stratification for patients with head and neck cancer. There are other factors that are of importance in this disease though, such as age and existing health problems, which should be considered when deciding treatment, Mell adds.

Dr. Mell on Factors of Risk Stratification in Head and Neck Cancer

Loren K. Mell, MD, assistant professor, Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, discusses risk stratification for patients with head and neck cancer. 

According to Mell, it is important to understand which patients are likely to benefit from more or less intensive therapies. 

Researchers are undergoing efforts to make staging patients more mathematical, explains Mell. Staging is used to get a sense for how extensive the cancer is and which treatment option will be most beneficial.

Loren K. Mell, MD, assistant professor, Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, discusses risk stratification for patients with head and neck cancer.

Dr. Mell on Risk Stratification for Head and Neck Cancer

Loren K. Mell, MD, chief, Head and Neck Malignancy Service, associate professor, University of California, San Diego, discusses toxicities associated with GL-ONC1 for the treatment of patients with head and neck cancer.

GL-ONC1 is an attenuated vaccinia virus that demonstrated safety and clinical benefit when delivered intravenously with concurrent chemoradiation therapy for patients with locoregionally advanced head and neck cancer, as seen in a phase I study.

GL-ONC1 was found to be a well-tolerated agent in this study. The most common adverse events observed were low-grade, short-term rash and flu-like symptoms. Based on the foundation of GL-ONC1, its safety profile was expected. However, researchers were unsure if the agent would be just as tolerable when combined with chemotherapy.

Loren K. Mell, MD, chief, Head and Neck Malignancy Service, associate professor, University of California, San Diego, discusses toxicities associated with GL-ONC1 for the treatment of patients with head and neck cancer.


Loren K. Mell, MD

Articles

Dr. Mell on Individualizing Treatment for Head and Neck Cancer

Dr. Mell Discusses Flaws in Risk Stratification for Head and Neck Cancer

Dr. Mell on Factors of Risk Stratification in Head and Neck Cancer

Dr. Mell on Risk Stratification for Head and Neck Cancer

Dr. Mell on Toxicities Associated With GL-ONC1 for Head and Neck Cancer