Targeted Therapy a Potential Treatment for Head and Neck Cancer

Patients need to be selected and properly informed about the side effects of cetuximab and the potential for a slight improvement in overall survival, added Dr. Strome.

Other Agents Being Studied

In addition to, cetuximab, researchers are evaluating a number of other agents for head and neck cancer.

Monoclonal antibodies directed at the external domain of EGFR, inhibition of EGFR tyrosine kinase phosphorylation, and inhibition of angiogenesis by blocking VEGF are some areas of clinical investigation, said Christine Gourin, MD, Assistant Professor of Otolaryngology at the Medical College of Georgia Health System in Augusta. 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 such agents, to the bedside, she said.

Data regarding agents other than cetuximab are primarily results from preclinical work in head and neck squamous cell carcinoma, she added. Most clinical work has been performed in patients with lung or colon cancer because there are so many more cases of those kinds of tumors than head and neck squamous cell carcinoma.

Targeted small molecule agents such as the EGFR inhibitors gefitinib (Iressa) or erlotinib (Tarceva), which are presently used to treat lung cancer, are being studied in combination with radiation and chemotherapy in head and neck cancer patients, noted Dr. Cohen.

An important research question would be will you get the same results as [our] study if you gave Tarceva, for example, instead of cetuximab, he said.

Whether angiogenesis inhibitors like bevacizumab (Avastin) have a role in this setting by themselves, with radiation and/or chemotherapy or together with drugs like cetuximab also needs to be investigated, said Dr. Cohen.

Such research will help to answer some of the many questions regarding what role targeted agents will play in the future treatment of head and neck cancer, he concluded.

Cancer Then & Now: 1946-2006

• In 1946 the five-year survival rate for all cancers combined was about 35%; today it is 65%.
• In 1946 nearly 25% of Americans thought cancer was contagious, and many thought it could be contracted from drinking milk. Now it is known that at least half of all US cancer deaths are related to tobacco, poor nutrition, physical inactivity, overweight/obesity, and other lifestyle factors.
• In 1946 physicians used radioactive materials and a Geiger counter to try to detect breast cancer. Today, largely due to mammography screening, almost two thirds of all breast cancer cases are diagnosed at an early stage, for which the five-year survival is nearly 98%.
• In 1946 cancer was treated with surgery, x-rays, and radium. But more offbeat treatments were also used, such as Russian life serum estrogen tablets for prostate cancer; Coley’s Toxin, which used streptococcal infections to induce tumor regression in sarcomas; and nitrogen mustard gas to treat lymphoma. The standard treatment for breast cancer was a radical mastectomy. Today, there is increasing emphasis on using targeted therapies against cancer that do not harm healthy cells, and radical mastectomy is rarely used for breast cancer due to the proven efficacy of less disfiguring surgery, such as lumpectomy followed by radiation.

Source: American Cancer Society