NcXHF

PROGRESS IN HEAD AND NECK SQUAMOUS CELL CARCINOMA
Research Progress in Head and Neck Squamous Cell Carcinoma:
Best Abstracts of ICHNO 2015
Panagiota Economopoulou, MD, PhD, Jean Bourhis, MD, PhD, and Amanda Psyrri, MD, PhD
OVERVIEW
Head and neck squamous cell carcinoma (HNSCC) is a highly heterogeneous group of tumors that develop via one of the two primary
carcinogenic pathways: chemical carcinogenesis through exposure to tobacco and alcohol or virally induced tumorigenesis. HPVnegative
(HPV–) and HPV-positive (HPV) HNSCCs represent distinct disease entities, and the latter is associated with a substantially
improved outcome. Differences in molecular pathogenesis account for these different outcomes; their staging classification and
therapeutic regimens also are currently being re-evaluated, and re-evaluation would be significantly facilitated by robust biomarkers
for patient stratification. Through the past years, with the advent of the omics era, a better understanding of the biology of HNSCC
has been accompanied by the exploration of a large and rapidly expanding number of targeted agents, which might be incorporated
into standard management in the future. In the era of personalized medicine, and with a view to improve the outcomes and quality of
life of patients, current research efforts also are focused on the identification of specific biomarkers for treatment selection. Treatment
of HNSCC is expected to change in the next decade if molecular biology continues to evolve. Herein, we highlight research progress
in HNSCC presented at the fifth International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO).
Squamous cell carcinoma of the head and neck represents
a heterogeneous group of tumors, which encompasses a
variety of tumors originating in the lip/oral cavity, hypopharynx,
oropharynx, nasopharynx, or larynx. Locally advanced
HNSCC includes stage III or IV A,B carcinomas that invade
proximate structures or spread to cervical lymph nodes,
whereas recurrent/metastatic (R/M) HNSCC involves tumors
that present with locoregional recurrence or distant
metastases. 1 HNSCC historically has been associated with tobacco
and alcohol use; however, in the past decade, infection
with high-risk HPV and especially with HPV type 16
(HPV16) has been implicated in the pathogenesis of a growing
subset of HNSCCs, mainly those arising from the oropharynx.
2,3 HPV-related oropharyngeal carcinoma has
emerged as a distinct entity in terms of etiology, biology, and
clinical behavior; importantly, it has a more favorable prognosis
and might require less intensive therapy. Despite advances
and innovations in multimodality treatment and a
better understanding of head and neck carcinogenesis, survival
rates of locally advanced HNSCC have not substantially
improved, and the prognosis for R/M disease remains very
dismal. 4 The ultimate goal in the treatment of patients with
HNSCC is to enhance effıcacy while minimizing treatmentrelated
toxic effects.
Current research in HNSCC focuses on the establishment
of novel treatment approaches, such as immunotherapy and
molecular targeted therapy; the identifıcation of biomarkers
for prognostic classifıcation and treatment selection; optimization
of surgical techniques; management of treatmentrelated
side effects; and implementation of screening
methods. This year, several interesting studies presented at
the fıfth ICHNO shared important information, with potential
implications in the management of HNSCC. The results
of a randomized phase III study comparing afatinib with
methotrexate as a second-line therapy in patients with R/M
disease after platinum therapy showed a signifıcant but modest
benefıt of 0.9 months (p 0.03) in terms of progressionfree
survival (PFS; the primary endpoint of the study) in favor
of afatinib arm. 5 An individual-patient meta-analysis of chemotherapy
in nonmetastatic nasopharyngeal carcinoma
(MAC-NPC) that included 4,806 patients suggests that incorporating
induction chemotherapy or adjuvant chemotherapy
to chemoradiotherapy may further improve the
outcome in terms of tumor control probability and survival
compared with chemoradiotherapy alone. 6 A randomized
phase III study randomly assigned patients with HNSCC
who were treated with curative surgery and whose tumors
had high-risk pathologic features (positive margins or extracapsular
extension) to receive either standard postoperative
radiotherapy (SPORT) or postoperative accelerated radiotherapy
(POPART); the results suggest that a reduction in the
overall treatment time in this setting does not improve the
From the Second Department of Internal Medicine, Attikon Hospital University of Athens, Athens, Greece; Department of Radiation Oncology, Lausanne University Medical Center, Lausanne,
Switzerland.
Disclosures of potential conflicts of interest are found at the end of this article.
Corresponding author: Amanda Psyrri, MD, PhD, Attikon Hospital, Rimini 1, Athens, Greece 12461; email: dpsyrri@med.uoa.gr.
© 2015 by American Society of Clinical Oncology.
asco.org/edbook | 2015 ASCO EDUCATIONAL BOOK
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