NcXHF

PROGRESS IN HEAD AND NECK SQUAMOUS CELL CARCINOMA
patient test results; identifıcation of targetable molecular aberration;
and the availability of a targeted drug known to inhibit
the function of the molecular alteration. 39 Highthroughput
sequencing technology provides the means to
conduct a comprehensive analysis of all somatic alterations
in the cancer genomes. However, interpretation of the large
amount of genomic data that emerge from these genomescale
investigations for the development of new therapeutic
strategies requires the effıcient validation of genomic data
and the characterization of mutations. It is important to determine
whether the identifıed mutations are responsible for
disease pathogenesis (driver mutations) or have been generated
as the consequence of genomic instability but without
obvious advantage to the cancerous cells (benign mutations).
To address the challenge of fragmentation of cancer research
in Europe that generates diffıculties in translating preclinical
discoveries into benefıts that improve patients’ lives, the Eurocan
Plus project aims for the establishment of a European
platform for translational cancer research by linking comprehensive
cancer centers and basic/preclinical research centers.
39 The Eurocan Platform project was approved by the
European Commission in 2010 and aims to develop a consortium
for translational cancer research by linking 23 cancer
research centers and fıve European cancer organizations.
One of the most important aims is to promote personalized
cancer medicine that is based on the better understanding of
the biology of the tumor and normal tissues so that personalized
treatment can be applied at an early stage of the disease.
Furthermore, prevention strategies should be
established in cancer biology to identify and target high-risk
individuals.
NASOPHARYNGEAL CANCER
What Is the Best Treatment in Nasopharyngeal
Carcinoma? An Individual Patient Data Network
Meta-Analysis
With the improvement in local control accomplished by more
precise imaging and RT, the predominant pattern of failure for
nasopharyngeal carcinoma (NPC) is distant metastases. Concurrent
cisplatin and RT with or without adjuvant PF (cisplatin/
fluorouracil) chemotherapy is the standard treatment approach
for stages IIB and above disease. 1 The role of induction chemotherapy
is not well defıned. MAC-NPC presented the results of
network meta-analysis, which allows one to perform simultaneous
inference regarding the treatments and select the best
among them. 6 Nineteen trials of RT with or without chemotherapy
in 4,806 patients with nonmetastatic NPC were identifıed,
and updated individual patient data were obtained. Treatments
were grouped in the following categories: RT alone (RT), induction
chemotherapy (IC) followed by concomitant chemoradiotherapy
(IC-CRT), concomitant chemoradiotherapy (CRT), or
concomitant chemoradiotherapy followed by adjuvant chemotherapy
(CRT-AC). For the entire network, CRT-AC ranked as
the best treatment in terms of OS, with a probability of 94%. 6
The probability that either CRT-AC or IC-CRT was the best
treatment was 97% for OS, 96% for PFS, 81% for locoregional
failure-free survival, and 93% for distant metastasis-free survival.
When the network was restricted to cisplatin-based trials,
as a sensitivity analysis, CRT-AC and IC-CRT remained the best
treatments regarding PFS and OS. 6 This network meta-analysis
of the treatment of nonmetastatic NPC suggests that incorporating
IC or AC to CRT may further improve the outcome in
terms of tumor control probability and survival versus CRT
alone. Of course, as the authors point out, these results should be
validated by well-powered randomized trials.
CONCLUSION
HNSCC comprises a heterogeneous disease in terms of epidemiology,
etiologic factors, and clinical and biologic behavior.
HPV status is the most important biomarker in this disease. Research
efforts concentrate on identifıcation of prognostic and
predictive biomarkers for the personalization of treatment, deintensifıcation
of treatment to reduce late toxicity in goodprognosis
HPV subsets, and the discovery of new treatments
in poor-prognosis HPV– HNSCC. Immunotherapy, such as
checkpoint inhibitors, is being explored as treatment strategy in
HNSCC in different settings. In Europe and the United States,
research funding for new treatments in HNSCC is rather limited,
and progress against this disease has been diffıcult. Intergroup
efforts may allow the execution of large, randomized trials
that will improve the outcome of this devastating disease.
Disclosures of Potential Conflicts of Interest
The author(s) indicated no potential conflicts of interest.
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