Outlook for Patients with Cancer
Looking ahead, Xiao-Jing Wang, MD, PhD, professor of pathology, otolaryngology, dermatology, and craniofacial biology at the University of Colorado School of Medicine in Aurora, believes that improved risk prediction and therapeutic individualization for inflammatory, sensory, and cancer conditions will be in the spotlight of precision medicine. “Studies to increase the number of patients with durable response to therapy, particularly while receiving immunotherapy, will be the field’s main focus,” she said.
Explore this issue:January 2019
For patients with head and neck cancer, the future of precision medicine lies in figuring out how to activate the immune system against cancer cells only. “Since tumor mutations are patient specific, each patient likely has a unique set of tumor neoantigens that their T cells can respond to,” said Clint Allen, MD, associate professor of otolaryngology–head and neck surgery at Johns Hopkins, and Johns Hopkins Otolaryngology Consult at the National Institutes of Health in Bethesda, Md., “In the future, by using the same DNA sequencing that was used to try and match patients with a specific small molecule inhibitor, we may be able to determine each head and neck cancer patient’s unique array of tumor neoantigens and activate T cells against cancer cells specifically.”
Precision medicine also holds great promise to improve the efficacy and side effects of head and neck cancer treatment. While treatment outcomes for patients with HPV-positive tonsil cancer are quite good, more than 30% of all patients with HPV-negative, advanced stage head and neck cancer have disease recurrence within one year of completing treatment, Dr. Allen reported. Additionally, many cancer patients who are cured are left with devastating functional impairments in voice and swallowing.
One major issue precision medicine will hopefully address is the flexibility to adapt treatments with changing tumors. “Whether using small molecule inhibitors or immunotherapies guided by mutational analysis, tumor cells that are more susceptible to initial treatments may be killed off, while less susceptible tumor cells are left behind after initial treatments to repopulate the tumor,” Dr. Allen explained. “Head and neck cancers tend to be very heterogeneous. This suggests that any single treatment may not treat all tumor cells and lead to treatment resistance. In order to keep up with changing subpopulations of tumor cells, cancers may need to be reassessed after initial therapies stop working to determine if new or altered treatments are needed.” Many clinical trials for head and neck cancer will use this adaptive design to try and evolve along with a changing tumor during precision treatments.