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ASCO 2022 | Head and neck cancer at ASCO 2022

Paolo Bossi, MD, University of Brescia, Brescia, Italy, provides an overview of key updates in the field of head and neck cancers presented at this year’s American Society of Clinical Oncology (ASCO) 2022 Annual Meeting, including the de-escalation of treatment in patients with nasopharyngeal cancer based on low plasma EBV DNA allowing for the avoidance of concurrent chemotherapy and radiation. Radiosensitization with docetaxel is also discussed by Dr Bossi as a potential approach in patients with nasopharyngeal cancer. Finally, Dr Bossi highlights the results of a Phase II trial (NCT03468218), which investigated the safety and efficacy of pembrolizumab and cabozantinib in patients with recurrent head and neck squamous cell cancer. This interview took place at the American Society of Clinical Oncology (ASCO) 2022 Annual Meeting in Chicago, IL.

Transcript (edited for clarity)

This year at ASCO, there were some interesting results that have been presented, in particular, in the oral lab sessions regarding nasopharyngeal cancer. Last year was the year of nasopharyngeal cancer with many novelties and also this year, we learned that is possible to deescalate treatment in some group of patients in particular, there was a good work presented by Chinese investigators, showing that in stage two or stage three and zero with a low EBV Barr in the plasma, we can reduce the intensity of the treatment avoiding concurrent chemotherapy, this is good for the patient and for their quality of life...

This year at ASCO, there were some interesting results that have been presented, in particular, in the oral lab sessions regarding nasopharyngeal cancer. Last year was the year of nasopharyngeal cancer with many novelties and also this year, we learned that is possible to deescalate treatment in some group of patients in particular, there was a good work presented by Chinese investigators, showing that in stage two or stage three and zero with a low EBV Barr in the plasma, we can reduce the intensity of the treatment avoiding concurrent chemotherapy, this is good for the patient and for their quality of life.

Another way of deescalating treatment that has been shown is a dynamic way because patient treated with induction chemotherapy, TPF chemotherapy, that had a partial complete response and the drop in the EBV DNA load in the blood could receive a lower dose of radiation and this also has an interesting consequence on quality of life of our patients. This for nasopharyngeal cancer.

Then we learned something about radiosensitization. There was a trial showing that docetaxel can be added to radiation, in patient suitable for cisplatin. It’s not the trial with many patient because it was prematurely closed because of the COVID pandemic, but it’s something that should be explored for the future.

And then also we had interesting trial evaluating something that we missed in the past that is an unanswered question. If also in the setting of locally advanced neck cancer, treated with concurrent chemoradiation, with a definitive treatment and not cost-comparative, but with a definitive treatment, if a weekly cisplatin can be the same, then over three weekly cisplatin. And this was shown as a possible, another way in which we can use cisplatin as radiosensitizer so this is another intriguing bit.

And then I would say the other trial for which I have been very interested. It was the trial presented by Nabil Saba regarding the combination of pembrolizumab and cabozantinib in recurring metastatic head and neck squamous cell carcinoma. And we know that this multi-kinase targeted drug can be added to immunotherapy, can increase the immunogenicity and this was true because in this small trial, this small trial, but the overall response rate was very interesting, 54% of the patient obtained a response. So in conclusion], small trial, but useful for the future.

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