Patients with head and neck cancer usually present with locally advanced disease and often require more than one type of treatment, which may include surgery, radiotherapy, and chemotherapy. Traditional treatments may result in many acute and late complications, and their success is rather limited. The introduction of epidermal growth factor receptor inhibitors about 10 years ago was a milestone in head and neck cancer therapy.
A monoclonal antibody against EGFR, was the first targeted agent to show survival benefit either in combination with radiotherapy in locally advanced disease or in combination with chemotherapy for recurrent/metastatic disease. Very recently, the immune checkpoint inhibitors, a class of drugs that stimulate the immune system against cancer, produced very encouraging antitumor activity.
In a recently presented phase III randomized trial that enrolled patients with recurrent/metastatic head and neck cancer who previously received a PD-1 inhibitor demonstrated the survival benefit over standard treatment.This is another milestone for head and neck cancer therapy.
Curing the patient is a priority but is currently feasible in about half of the patients with locally advanced disease and very rarely in patients with recurrence. Hopefully, with new therapies long-term survival may be achievable even for patients with recurrent/metastatic head and neck cancer.
There is still a lot to be learned about the biology of head and neck cancer. Future studies in the laboratory and the clinic will explore mechanisms of resistance to targeted agents and most likely lead to a new generation of active therapies. Head and neck cancer treatment must be personalized.
It is foreseeable that better patient selection will be critical in maximizing benefit and minimizing risk. Harnessing the immune system and use it to a patient’s advantage is a very important task ahead. Other important molecular targets and novel agents are being identified and studied in the clinic. As a physician, I am particularly happy to be able to offer new treatment options to my patients.