Exciting data representing advances in the treatment of head and neck cancer were presented at the 2016 American Society of Clinical Oncology (ASCO) annual meeting. We highlight key studies in the recurrent and/or metastatic (R/M) arena and important studies in locally advanced head and neck squamous cell carcinoma (HNSCC).
Nasopharyngeal carcinoma (NPC) continues to represent a major therapeutic challenge. Patients with newly diagnosed NPC are treated with combined cisplatin-based chemoradiotherapy with good outcomes. However, very little progress has been made in the treatment of R/M NPC over the years, and the standard approach is typically a platinum-based doublet. The GEM 20110714 study1 randomized 181 patients to gemcitabine plus cisplatin (GP) for 4 to 6 cycles and 181 patients to infusional fluorouracil plus cisplatin for 4 to 6 cycles as first-line treatment for R/M NPC. Patients in the GP arm demonstrated benefit for the primary end point of progression-free survival (PFS) (median PFS, 7.0 vs 5.6 months; hazard ratio [HR], 0.55; 95% CI, 0.44-0.58; P < .001). Preliminary overall survival (OS) results also favored GP (median OS, 29.1 vs 20.9 months; HR, 0.62; 95% CI, 0.45-0.84; P = .002). Based on this study, GP can be recommended as standard first-line treatment for R/M NPC. Of note, the efficacy of this regimen might be diminished outside of Asia because more than 90% of the Asian study patients had World Health Organization (WHO) type II/III NPC. Furthermore, it is unclear if patients require 4 or 6 cycles of treatment, and whether Epstein-Barr virus DNA levels could guide treatment duration. We also note that chemoradiation-resistant patients (progression <6 months) were excluded; thus, their optimal management remains uncertain and challenging. In the future, GP may serve as the comparator arm for randomized trials comparing immune checkpoint inhibitors vs chemotherapy in the first-line setting for R/M NPC.
Chau NG, Tishler RB, Haddad RI. Highlights in Head and Neck Cancer. JAMA Oncol. Published online November 23, 2016. doi:10.1001/jamaoncol.2016.3648