J.B. Vermorken MD, PhD

Recurrent and metastatic non-nasopharyngeal head and neck cancer: state of the art of systemic treatment

Summary

The majority of patients diagnosed with recurrent and/or metastatic squamous cell carcinoma of the head and neck are deemed ineligible for surgery or irradiation. Their management prioritise symptom control and quality-of-life improvement. According to patient’s performance status, medical comorbidities and symptoms, recommended treatment options include supportive care only, mono- or multi-drug chemotherapy or cetuximab (epidermal growth factor receptor inhibitor) either alone or as an adjunct to cytotoxic drugs. Despite achieving response rates superior to single-agents, doublet and triplet regimens incorporating cisplatin and/or taxanes did not increase overall survival and were often difficult to tolerate. The platinum (cisplatin or carboplatin)/5-fluorouracil/cetuximab regimen is the only regimen showing significant survival improvement over PF alone in a large randomised trial, and therefore is the only approved new standard systemic treatment today. However, the very poor overall survival of six to ten months expected in this patient population, remains a continuous challenge and novel anticancer therapies are urgently needed. The potential to induce durable responses with manageable toxicity has propelled immunotherapy to the forefront of cancer research, yet its validation in phase III clinical trials is pending. Another crucial task is the identification of reliable, prospectively confirmed prognostic and predictive biomarkers. Mounting evidence from retrospective analyses suggests that human papillomavirus status with p16 immunohistochemical positivity as its surrogate represent promising candidates for this role.

(BELG J MED ONCOL 2016;10(6):207–214)

Targeted therapy for the treatment of head and neck squamous cell carcinomas: hopes and pitfalls

Targeted therapy is a promising strategy for the treatment of head and neck squamous cell carcinoma and other cancers, which has been developed as a result of breakthroughs in molecular characterisation of carcinogenesis. It is thought to offer a higher therapeutic index and, therefore, to be associated with less toxicity than cytotoxic drugs. Unfortunately this kind of therapy also has weaknesses; in particular the long-term response rate is disappointing. This review will not only focus on the benefits of EGFR targeted agents in head and neck squamous cell carcinoma, but will also summarise its weaknesses.

(BELG J MED ONCOL 2015;9(5):175–78)

Biomarkers for an effective and cost-effective use of anti-EGFR biotherapeutics for the treatment of head and neck cancer

As the epidermal growth factor receptor is expressed in up to 90% of all head and neck squamous cell carcinomas and initiates important signalling pathways in carcinogenesis, this receptor has emerged as a promising therapeutic target. Nevertheless, the challenge of drug resistance alongside treatment with epidermal growth factor receptor inhibitors remains. New results from our research group provide evidence that the RAS-MAPK signalling pathway is still activated despite upstream epidermal growth factor receptor blocking by cetuximab, an epidermal growth factor receptor targeting monoclonal antibody. DUSP5, DUSP6, AURKB, HB-EGF, IL8 and the transcription factor AP-1 were among the genes identified by us as likely contributing to cetuximab resistance. These novel findings provide new insights in the underlying mechanisms of anti-epidermal growth factor receptor therapeutic resistance in head and neck squamous cell carcinomas. Furthermore, these observations can form a solid basis for further in vivo and clinical studies on this topic, making advances in the treatment of head and neck squamous cell carcinomas.

(BELG J MED ONCOL 2015;9(2):74–6)

The role of immunotherapy in colorectal cancer

Colorectal cancer is one of the most prevalent types of cancer worldwide and a leading cause of cancer related mortality. Although chemo- and radiation therapy can improve survival rates, it is imperative to integrate more advanced treatment options; therefore, rationally designed immunotherapeutic strategies are being explored as adjuvant treatment. In this review, we will discuss the study design and results of the clinical trials that have been conducted in colorectal cancer patients using autologous and allogeneic tumour cell vaccines, peptide vaccines, viral vector based vaccines, dendritic cell based vaccines, and antibody-based immunotherapy as well as some future recommendations.

(BELG J MED ONCOL 2015;9(1):25–30)