Head and neck carcinoma in the United States

Abstract

BACKGROUND: Detailed information about how patients with head and neck carcinoma (HNC) are treated across practice settings does not exist. The authors conducted a prospective, observational study to examine the patterns of care for a series of patients with newly diagnosed HNC in the United States and to test 2 hypotheses: 1) There is no difference in the pattern of care between community and academic settings; and 2) the results of major randomized clinical trials will change the pattern of care in both practice settings within 1 year of publication in peer-reviewed journals. METHODS: Patients aged !18 years were enrolled in the Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN) after providing written informed consent if they had a confirmed diagnosis of new HNC and were scheduled to receive treatment other than surgery alone. RESULTS: Between 2005 and 2010, 100 centers enrolled 4243 patients, including 2612 patients (62%) from academic investigators and 1631 patients (38%) from community centers. Initial treatments were radiation with concurrent chemotherapy (30%) or cetuximab (9%), adjuvant radiotherapy (21%), induction chemotherapy (16%), and other (24%). Intensity modulated radiation therapy was the dominant radiation technique (84%). Singleagent cisplatin was prescribed in nearly half of patients and more often in academic centers (53% vs 43% of patients; P < .0001). Single-agent cetuximab was the next most common drug used (19%) and was prescribed more frequently in community settings (24% vs 17%; P ¼ .0001). The data rejected the 2 prospective hypotheses. CONCLUSIONS: LORHAN documented differences in patient characteristics and treatments between community and academic settings for a large series of patients in the United States. Cancer 2012;118:5783-92.

PDCD1 (PD-1) promoter methylation predicts outcome in head and neck squamous cell carcinoma patients

“…Despite intensive local treatment, HNSCCs generally have an unsatisfactory prognosis due to the high percentage of locoregional tumor recurrence and distant metastasis [11]. As a consequence, these tumors do not only require the standard surgical and radiation treatments but additional effective systemic treatment.…”

Therapeutic Insights from Genomic Studies of Head and Neck Squamous Cell Carcinomas

“…Unlike many other epithelial cancers, the majority of HNSCCs present at a locally advanced stage with cervical lymph node metastases. Over 90% of patients are treated with curative intent using a combination of surgery, radiation therapy and chemotherapy(2). To date, treatment approaches have been dictated by the anatomic site of the primary tumor with oral cavity cancers treated primarily with surgical resection and pharyngeal and laryngeal tumors with chemoradiation(3).…”

“…In the absence of information regarding the biologic underpinnings of individual tumors, predictive biomarkers have been lacking to guide therapy in both the initial treatment setting and in the treatment of relapsed/refractory disease. Establishing robust therapeutic biomarkers in HNSCCs has been challenging for several reasons including the heterogeneity of these tumors which display diversity in terms of their anatomy, clinical characteristics and in their association with conventional risk factors such as tobacco and alcohol exposure as well as with infection with the oncogenic Human Papilloma Virus (HPV) and Epstein-Barr Virus (EBV)(2, 5). Recent large-scale genomic profiling studies, notably that of The Cancer Genome Atlas (TCGA), have shed light on the molecular underpinnings of the diversity of HNSCCs.…”

EGFR and RB1 as Dual Biomarkers in HPV-Negative Head and Neck Cancer

“…Head and neck cancer is the sixth most common cancer worldwide; head and neck squamous cell carcinoma (HNSCC) accounts for more than 90% of cases (1). In spite of advances in surgical and radiation techniques, as well as the incorporation of chemotherapy in multimodality treatment designs, the 5-year overall survival (OS) remains at about 50% and has not improved much over the last decades (2).…”