Nabil F. Saba, MD, FACP, director, Head and Neck Medical Oncology Program, Winship Cancer Institute of Emory University, professor, Department of Hematology and Medical Oncology, Department of Otolaryngology, Emory University School of Medicine, discusses ongoing research in squamous cell carcinoma of the head and neck.

Checkpoint inhibitors were first evaluated in the post-platinum setting and have since shown benefit in the frontline setting, says Saba. For example, in the phase III KEYNOTE-048 trial, pembrolizumab (Keytruda) demonstrated a 22% reduction in the risk of disease progression or death versus the standard EXTREME regimen of cetuximab (Erbitux) with carboplatin or cisplatin plus fluorouracil, in patients with PD-L1—positive tumors. These data led to the FDA approval of the PD-1 inhibitor for the frontline treatment of patients with metastatic or unresectable recurrent disease whose tumors express PD-L1.

In light of these data, the majority of patients are not receiving cytotoxic chemotherapy or targeted therapy in the frontline setting. As such, there has been a resurgence of interest in evaluating EGFR inhibitors, such as cetuximab, as monotherapy as well as in combination with immunotherapy post-progression. Combination strategies are likely to become a focus of research, adds Saba, following encouraging activity with lenvatinib (Lenvima) and pembrolizumab in patients with metastatic disease who progressed on ≥1 prior therapy.

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Nabil F. Saba, MD, FACP, director, Head and Neck Medical Oncology Program, Winship Cancer Institute of Emory University, professor, Department of Hematology and Medical Oncology, Department of Otolaryngology, Emory University School of Medicine, discusses ongoing research in head and neck cancer.

Dr. Saba Discusses Ongoing Research in Head and Neck Cancer

Nabil F. Saba, MD, FACP, director, Head and Neck Medical Oncology Program, Winship Cancer Institute of Emory University, professor, Department of Hematology and Medical Oncology, Department of Otolaryngology, Emory University School of Medicine, discusses investigational deintensification approaches in HPV-related oropharyngeal squamous cell carcinoma.

An ongoing area of debate in the field is whether treatment deintensification is warranted and how best to de-intensify treatment for patients with HPV-related oropharyngeal squamous cell carcinoma. Some believe transoral robotic surgery (TORS) is a way to stratify patients by their risk of progression after surgery, explains Saba. However, there is a lack of robust data comparing this approach with standard radiation and chemotherapy, he adds.

At the 2019 ASCO Annual Meeting, a small study was presented which compared the TORS procedure with radiation. Results suggested that the long-term toxicity was lower with TORS than it is with radiation. However, due to the size of the study, larger studies will be needed to confirm the signal observed.

Dr. Saba on Investigational Deintensification Approaches in HPV-Related HNSCC

Nabil F. Saba, MD, FACP, director, Head and Neck Medical Oncology Program, Winship Cancer Institute of Emory University, professor, Department of Hematology and Medical Oncology, Department of Otolaryngology, Emory University School of Medicine, discusses de-intensification of therapy for patients with HPV-related oropharyngeal squamous cell carcinoma. 

There are mixed data surrounding the benefit of treatment deintensification in HPV-related oropharyngeal squamous cell carcinoma. Therefore, it should only be explored in the context of a clinical trial, says Saba. It is ill advised to de-escalate therapy in practice given the lack of randomized data to support such approaches, he adds. Moreover, research has yet to differentiate the patients who are good candidates for treatment de-escalation from those who are not.

When it comes to patient selection, patients with high-grade disease are not thought to benefit from treatment de-escalation. There is more debate when it comes to intermediate-grade patients, adds Saba. The question of whether or not intermediate-grade patients are good candidates for treatment de-intensification will be explored in the phase II/III ECOG-ACRIN 3161 trial. Similarly, the HN-005 trial will further explore this question in patients with low-grade disease and will hopefully shed light on how best to de-escalate therapy. 

Nabil F. Saba, MD, FACP, director, Head and Neck Medical Oncology Program, Winship Cancer Institute of Emory University, professor, Department of Hematology and Medical Oncology, Department of Otolaryngology, Emory University School of Medicine, discusses treatment deintensification for patients with HPV-related oropharyngeal squamous cell carcinoma.

Dr. Saba on Treatment Deintensification in HPV-Related Oropharyngeal Squamous Cell Carcinoma

Nabil F. Saba, MD, FACP, director, Head and Neck Medical Oncology Program, Winship Cancer Institute of Emory University, professor, Department of Hematology and Medical Oncology, Department of Otolaryngology, Emory University School of Medicine, discussed the role of general practitioners in maintaining the health of their patients with cancer and how to better diagnosis select types of head and neck cancer.

With the aging population in America, the incidence of cancer is on the rise, according to Saba. Therefore, educating general practitioners on the signs and symptoms of cancer will help diagnose patients sooner.

In head and neck cancer, patients are often referred to Saba with symptoms of consistent sore throat following antibiotics. For unresolving symptoms like this, Saba encourages general practitioners to refer patients to specialists, such as a head and neck expert or an otolaryngologist, to have a closer evaluation.

Oropharyngeal cancer is on the rise and has surpassed the incidence of cervix cancer to become the most common human papillomavirus related cancer. Although this disease is currently known to affect mostly younger populations, it is projected to become most common in males over the age of 65 over the next few decades, according to Saba.

Nabil F. Saba, MD, FACP, discussed the role of general practitioners in maintaining the health of their patients with cancer and how to better diagnosis select types of head and neck cancer.

Nabil F. Saba, MD, FACP

Articles

Dr. Saba Discusses Ongoing Research in Head and Neck Cancer

Dr. Saba on Investigational Deintensification Approaches in HPV-Related HNSCC

Dr. Saba on Treatment Deintensification in HPV-Related Oropharyngeal Squamous Cell Carcinoma

Dr. Saba on Improving Cancer Detection Rates in HNSCC