The era of treating every patient with head and neck cancer with the same regimen—a combination of aggressive surgery, chemotherapy, and radiation therapy—is coming to a close. Advances in care in the past decade, most notably in the past few years, have opened the doors to new ways of thinking that are extending survival and improving quality of life for patients.

More-targeted approaches are being developed based on findings from clinical trials examining tumor-killing drugs previously used primarily for other types of cancer, immunotherapy, blood-based biomarkers for early detection and treatment prediction, and radiation dose de-escalation particularly for specific human papilloma virus (HPV)–positive patients. Proton therapy, in certain cases, allows us to better spare normal tissues in patients receiving radiotherapy. Additionally, the use of single-port, robot-assisted systems for head and neck surgeries, as well as other new technologies, are providing more options for patients.

Not all cancer programs have the ability to bring together these cutting-edge treatments with robust, specialized therapy and rehabilitation programs, as well as much-needed survivorship clinics. However, it’s something we should be striving for in order to have the greatest impact on our patients and their families.

At Miami Cancer Institute, we are fortunate to have the only board-certified cancer center-based oral medicine specialist in South Florida. The treated conditions include oral lichen planus, aphthous ulcers, dry mouth, jaw osteonecrosis, burning mouth syndrome, temporomandibular disorders and oral infections (herpes simplex virus and candidiasis), oral precancers such as leukoplakia, and oral toxicities of targeted therapies and immunotherapies.

One of the trials in which we have had good enrollment is the phase 2 PRESERVE trial (NCT03997643). Its purpose is to compare quality of life after either standard primary radiation therapy or a secondary targeted radiation therapy approach for patients with at least 1 pN0 hemi-neck following resection of a squamous cell carcinoma of the oral cavity.

Current radiation protocols—typically 7 weeks with 70 Gy—were developed during a time when most head and neck cancers were smoking related. The majority of today’s head and neck cancers are tied to HPV and respond better to treatment relative to other types of head and neck cancers. Therefore, we need to remake the standard of care and focus on whether treatment can succeed with less intense treatment; methods to use special imaging or biomarkers to identify patients suitable for lower radiation dosage or less systemic therapy are being studied.

Although our goal is to de-escalate treatment and maintain excellent disease control, we are also hoping to reduce radiation toxicities altogether by omitting radiation therapy for some head and neck cancer patients who have no positive nodes.

Other clinical trials we are leading or participating in include the following:

Phase 2 study of proton versus photon beam radiotherapy in the treatment of head and neck cancer (NCT02923570).

Photobiomodulation to demonstrate safety and reduce the incidence of oral mucositis in adult patients with head and neck
cancer (NCT03972527).

Phase 2 study of AAV2-hAQP1 gene therapy in participants with radiation-induced late xerostomia (AQUAX2; NCT05926765).

As we make progress in our fight against cancer, survivorship programs must also be a priority. It’s estimated that by 2029 there will be 21.7 million people living with cancer.

Our Brain Fitness Lab helps to restore and prevent chemotherapy-induced cognitive impairment and our exercise program helps patients transition safely to an active life. We offer 

rehabilitation and pain management, psychosocial services, stress management and resiliency training, nutrition, and social work services and support groups and educational programs.

As clinicians, we also need to be doing more to prevent cancer, and today there is 1 very effective way to prevent many head and neck cancers—and cervical cancers—and that is the HPV vaccine.

Vaccines are available and recommended for children and young adults aged 9 through 26 years and are offered to adults aged 27 through 45 years. Vaccination before exposure is most effective, but it can still help prevent cancers if received afterward. Although the vaccine does not protect against all forms of the virus that can lead to cancer, it is safe and highly effective against many of the most common types.

I urge you to encourage your friends, families, and patients at every opportunity to have further discussion with their primary care physician or obstetrician-gynecologist about being vaccinated. If they were vaccinated early on and are younger than 46 years, they can consider talking to their doctor about receiving 1 of the newer vaccines on the market that protects against more types of HPV that can lead to cancer.

Additionally, everyone needs to be aware of symptoms of head and neck cancer, including a lump in the neck, difficulty swallowing, hoarseness, and non-healing sores in the throat.

There’s no doubt that the advances we are making today will result in improved outcomes and better quality of life for patients. As we learn more about de-escalation, blood-based biomarkers, and immunotherapy, we will continue to personalize care. It’s an exciting time to be part of the head and neck cancer landscape. 

Healthy People 2030. US Department of Health and Human Services. Accessed July 15, 2024. bit.ly/3xLM1be

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Noah Kalman, MD, MBA, details new technology for treating head and neck cancer, and ongoing trials examining therapies at Miami Cancer Institute. 

Noah Kalman, MD, MBA

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Tumor-Killing Technology in Head and Neck Cancer