2017 Evolving Strategies sin HNSCC

The Evolving Treatment Algorithm for Advanced
Head & Neck Squamous Cell Cancer
Jan B. Vermorken, MD, PhD
Department of Medical Oncology
Antwerp University Hospital
Edegem, Belgium
prIME Oncology Meeting, Madrid, Spain, September 10, 2017

•5%-6% of all cancers (688,000 new cases in 2012; 350,000 deaths)
• ≥50% are ≥60 years of age; >90% squamous type (Western world)
•Risk factors:
–Tobacco smoking − Poor oral health
–Alcohol use − Mechanical irritation
–Betel chewing − Occupational exposure
–HPV − Malnutrition
•Localized disease 40%, regional metastases 50%, distant metastases 10%
•2/3 locally/regionally advanced
•Major threat: Local recurrence, SPT, SFT
Head & Neck Cancer
Epidemiology, Risk Factors, & Presentation
HPV, human papillomavirus; SFT, second field tumor; SPT, second primary tumor

ASCO
1982
1900 1970s
Laser
CT scan
MRI
Surgery RT
Milestones in Head & Neck Cancer Management
19th century 1980s
MACH-NC
MARCH
1990s 2000s 2010 2014
Targeted
therapies TORS
X-rays PET
Modified from Jean-Louis Lefebvre (with permission)
IT
1950s
CT
MARCH, meta-analysis of radiotherapy in squamous cell carcinomas of head and neck; MACH-NC, meta-analysis of chemotherapy in head and neck cancer;
RT, radiotherapy; CT, chemotherapy; PET, positron emission tomography; TORS, Trans-oral robotic surgery; IT, immunotherapy

Milestones in Systemic Therapies (±RT) in
Head & Neck Squamous Cell Cancer (HNSCC)
1960s Single-agent chemotherapy
Methotrexate
1970s Combination chemotherapy regimens
Platinum compounds
1980s Induction chemotherapy
Larynx preservation
1990s Concurrent chemoradiotherapy (CCRT) standard
Taxanes
2000s
Induction chemotherapy revisited
Targeted therapy
Immunotherapy

Important Recent Findings
•HPV is a risk factor for OPC (a growing epidemic)
•Tumor HPV single strongest predictor of survival (OPC)
•EGFR is a second prognostic marker
•Anti-EGFR medication is getting major attention
•Expanded role of chemotherapy (CCRT, ICT)
•Revival of immunology/immunotherapy
•Improved irradiation techniques available (IMRT)
•New imaging techniques available (PET)
•Quality of life of survivors is getting more attention
EGFR, epidermal growth factor receptor; ICT, Induction chemotherapy; IMRT, intensity modulated radiotherapy; OPC, oropharyngeal cancer