Treating Head and Neck Cancer: The Power of a Multi-Specialty Team and Staying Informed

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Topics include: Living Well and Understanding

At the 2017 ASCO meeting in Chicago, Host Andrew Schorr chats with head and neck cancer expert Dr. Ezra Cohen about updates for patients at this year's conference. Dr. Cohen is the Associate Director of the Moores Cancer Center and is also a Professor of Medicine at UC San Diego Health. Dr. Cohen says that researchers have realized that there are two types of head and neck cancer, one that is associated with tobacco primarily and the other being associated with human papillomavirus (HPV), which is a discovery that will help create better defined treatments for both types of head and neck cancer. Dr. Cohen relays encouraging news from the meeting such as newly approved immunotherapy treatments for patients with head and neck cancer, prevention through vaccination, refining therapies, and the benefits of working with a multi-disciplinary team for treatment.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Hello and welcome to Patient Power.  On location in Chicago at the ASCO, American Society of Clinical Oncology, meeting, I'm Andrew Schorr.  I'm with a noted expert in head and neck cancer.  That's Dr. Ezra Cohen, who is the Associate Director of the Moores Cancer Center at UC San Diego.  That's where I get treatment as well for cancer.  Thank you so much for being with us.  

Dr. Cohen:

Thank you, Andrew.  It's a pleasure.  

Andrew Schorr:

Dr. Cohen, so head and neck cancer is pretty scary when people are diagnosed, and there are different types, of course.  And there have been fears depending on what it is, oh, my God, am I going to be disfigured by surgery, or are there medications that can maybe help get at the cancer and help me live longer and live better?  Any updates from this meeting?  And how are we doing generally, too?  

Dr. Cohen:

Yeah, a few things to make note of for sure, Andrew.  You're absolutely right.  A diagnosis of head and neck cancer comes with a lot of other baggage, if you will, around how am I going to live with this disease, how am I going to be cured of this disease, and what are the long?term impacts?  Because if you think about what we do on a day-to-day basis, how we communicate with each other, how we interact with each other, so much of it goes on above the clavicle. 

Andrew Schorr:

Eating, swallowing. 

Dr. Cohen:

Everything—almost everything that defines us human beings, and so head and neck cancer has a profound effect on all of those.  And the treatment, of course, has some long-term consequences.  So you're absolutely right, right on when you say it's one that's associated with a lot of anxiety. 

Now, what about what's going on, what's exciting?  First of all, we now realize that there are really two types of head and neck cancer, one that's associated with tobacco primarily, and another one that's associated with a virus called human papillomavirus. And we're beginning to understand that those behave differently and just starting to define how we should maybe treat those differently. 

For the HPV positive, for the viral cancers, we're actually beginning to scale back on therapy with the realization that we could affect a cure just as well but with less radiation and less chemotherapy or minimally invasive surgery.  And so that specter of that debilitating, long-term effect is just beginning to go away, which of course is wonderful for patients.  

The other thing that's happening in head and neck cancer, as with many other cancers, that's very exciting is immunotherapy.  And in that regard we have actually approved agents now in head and neck cancer, immunotherapy drugs.  One of them is called pembrolizumab (Keytruda).  The other one is called nivolumab (Opdivo).  These are patients with a recurrent or metastatic disease, but we're quickly beginning to move those into the upfront setting, combining them with radiation, combining them with surgical approaches with the hope that again not only could we cure more patients, but maybe we can do it in a much more gentle way. 

Andrew Schorr:

Okay. That sounds like real progress.  Now, there are specific studies that come out here.  Anything you'd want to comment about news?  I know you have meetings throughout the year and worldwide, any news or update here? 

Dr. Cohen:

A number of things I think are worth noting.  I talked about the viral etiology of some of these cancers.  There is going to be a paper presented on Monday at this meeting that demonstrates that people who get the preventative vaccine, and we're talking preteens, really. 

Andrew Schorr:

HPV vaccine. 

Dr. Cohen:

The HPV preventative vaccine, so these are people who have never been exposed to the virus. But if you give them the preventative vaccine, believe it or not their chance of getting an HPV infection goes down tenfold.  Tenfold.  And we think that should eventually translate in a dramatic reduction in the incidence of HPV-related cancers including head and neck cancers, cervical cancer, anal and penile cancer, if we can vaccinate the population.  So those are the first data that are coming out to show that for head and neck cancer the risk reduction with a preventative vaccine should be pretty tremendous. 

From prevention we can begin to talk about refining therapy a little bit.  Some of the papers that are coming out of this meeting are beginning to tell us how we should better use chemotherapy, especially a drug called cisplatin (Platinol), and unfortunately a large negative study trying to improve the cure rates in very high?risk patients using a drug called afatinib (Gilotrif).  A great idea, good rationale but did not make a difference compared to placebo.  So the biggest implications for practice are how to better use or refine the use of chemotherapy. 

And then lastly I talked about chemotherapy, and there are some very interesting preliminary data now beginning to combine immunotherapy drugs—that’s very exciting, looks like we can double or maybe even more than double the response rate to single-agent immunotherapy with many of those responses being complete responses.  And, of course, that generates a lot of interest and a lot of excitement. 

Andrew Schorr:

Okay. So it sounds like there is some encouraging news.  People can be told which group they fit into, the HPV group, do they have a history of smoking, can they be treated one way or another, and that's a discussion with a specialist such as yourself.  

Dr. Cohen:

And hopefully a multi-specialty team, because now we realize conclusively that patients do better when they're treated at centers that have high volumes, or experienced centers, and when they're treated by a multidisciplinary team that includes not only surgeons, radiation oncologists, medical oncologists but nutritionists, dieticians, pharmacists… 

Andrew Schorr:

Pathologists.

Dr. Cohen:

…pathologists, psychiatrists, social workers, and of course speech and swallow experts.  So absolutely that's the—those are the people to talk to.  It's a nuanced therapy, and the approach is going to be different for every person, and so really talking with a specialist is the best way to go.  

Andrew Schorr:

Okay. Dr. Ezra Cohen from UC San Diego, the Moores Cancer Center, thank you for being with us. 

Dr. Cohen:

Thank you very much. 

Andrew Schorr:

Okay. So the message to patients as the news continues on head and neck cancer, as you heard, get with a multispecialty team so that you have all the support that you need, and be plugged into these new developments, see how it applies to you, and we always recommend inquire about clinical trials.  Does that give you a chance to have tomorrow's medicine today? 

On location in Chicago, I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on June 21, 2017