How I treat squamous ENT cancer

Abstract

The definition of ‘head and neck cancer’ (HNC) identifies squamous cell carcinoma arising from the pharynx, the larynx and the oral cavity. Most of them are induced by smoking and alcohol abuse, but tumours arising in the nasopharynx and in the oropharynx may be virus induced, Epstein-Barr virus and human papillomavirus, respectively. Medical oncologists are involved in HNC in locally advanced disease and in relapsed/metastatic disease not suitable for salvage radiotherapy or surgery. A close cooperation with surgeons and in particular with radiation oncologists is required in the first situation. The second situation is almost completely responsibility of medical oncologists while surgeons and radiation oncologists are involved in specific situations requiring palliative treatments. Interventions in locally advanced diseases change according to the goal of treatment. Indeed, the target may be the cure of patients unresectable disease or that have refused surgery, the adjuvant treatment of resected diseases at high risk of relapse, or organ preservation, which means sparing demolitive surgery requiring severe functional impairment, such as definitive laryngectomy. In all these situations, a close cooperation between the medical oncologist and the radiation oncologist is mandatory. Treatment of relapsed/metastatic disease is rapidly changing due to the development of immunotherapy. Although the results of immune checkpoint inhibitors in HNC are less impressive than in other tumours such as melanoma or lung cancer, these drugs are effective and allow for long-term survivors that were not expected with chemotherapy and target therapy. In particular, first-line treatment will change soon. Indeed, due to the result of a large randomised trial, immunotherapy will replace the combination of cisplatin, fluorouracil and cetuximab at least in a large proportion of patients.

Further Understanding of the Immune Microenvironment in Head and Neck Squamous Cell Carcinoma: Implications for Prognosis

“…However, among these groups, there are not yet any reliable molecular biomarkers for distinguishing different subgroups of patients at risk. 1 The tumor microenvironment (TME) is increasingly being appreciated as an important determinant of cancer outcome, including in HNSCC.…”

“…However, among these groups, there are not yet any reliable molecular biomarkers for distinguishing different subgroups of patients at risk. 1 …”

Inhibitors of Ceramide- and Sphingosine-Metabolizing Enzymes as Sensitizers in Radiotherapy and Chemotherapy for Head and Neck Squamous Cell Carcinoma

“…The US Food and Drug Administration (FDA)-approved chemotherapeutic agents for HNSCC include cisplatin, methotrexate, 5-FU, bleomycin, docetaxel, and small-molecule targeted drugs [5,6]. Combination of radiotherapy with chemotherapy, when overdosed in any combination, can lead to serious acute side effects and late-onset dysfunction [7]. Therefore, safe and effective sensitizing drugs against radiotherapy and chemotherapy are needed.…”

Keap1 inhibition sensitizes head and neck squamous cell carcinoma cells to ionizing radiation via impaired non-homologous end joining and induced autophagy

“…Survival rates of patients with head and neck squamous cell carcinomas (HNSCC) remain to be optimized [1][2][3] . In addition to conventional radiochemotherapy, great efforts were undertaken to identify both biomarkers and potential therapeutic target molecules.…”