Targeted therapy in addition to radiation may be a viable approach to head and neck squamous cell carcinoma, although more research is needed before such treatment becomes part of the standard of care, according to experts interviewed for this article.
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May 2006For example, a new study (N Engl J Med. 354;6:567-578) found that concomitant high-dose radiotherapy plus cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor (EGFR), improves locoregional control and reduces mortality in patients with head and neck cancer without increasing the common toxic effects associated with radiotherapy.
One of the study’s implications is that physicians now have a biologic treatment for patients with head and neck cancer, said one of the study authors Roger B. Cohen, MD, Director of the Phase I Clinical Trials Program at the Fox Chase Cancer Center in Philadelphia, Pa. Incidentally, this is the first new therapy for the disease in more than 30 years, added Dr. Cohen, who was with M.D. Anderson Cancer Center in Houston, Tex., at the time of the study.
One day, researchers will come up with the answer of how targeted therapies should be used, but we don’t have it yet, cautioned Marshall Strome, MD, MS, Professor and Chairman of the Cleveland Clinic Head and Neck Institute (Ohio). Targeted therapies may be a treatment for some patients who aren’t up for full platinum-based chemotherapies with radiation or for those can’t undergo surgery, he said.
Research will evaluate patients who receive radiation therapy and chemotherapy after surgery due to a high risk of recurrence and see if they are also candidates for cetuximab in combination with radiation.
New Data Demonstrate Benefits
In the new randomized study, 213 patients received high-dose radiotherapy alone, while 211 received high-dose radiotherapy plus weekly cetuximab at an initial dose of 400 mg per square meter of body-surface area, followed by 250 mg per square meter weekly for the duration of radiotherapy.
The median duration of locoregional control was 24.4 months among patients treated with the combined therapy and 14.9 months among those given radiotherapy. With a median follow-up of 54.0 months, the median duration of overall survival was 49.0 months among patients treated with combined therapy and 29.3 months among those treated with radiotherapy alone. Radiotherapy plus cetuximab significantly prolonged progression-free survival (hazard ratio for disease progression or death, 0.70; P = 0.006).
We are just in the early stages of translating the work done in the lab, which shows improvement in cancer cell death and animal survival with the use of [monoclonal antibodies’, to the bedside. – mdash;Christine Gourin, MD