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Thursday, November 10, 2016
Recent advances in targeted treatment for oral cavity and oropharyngeal cancer
With greater understanding of the cellular changes that cause cancer, newer drugs that specifically target these changes have been developed. Targeted drugs work in a different way than regular chemotherapy agents. They also often have different (and usually less severe) side effects.
Nivolumab (Opdivo®) injection, for intravenous use, was approved by the FDA for the treatment of patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) with disease progression on or after platinum-based therapy. Nivolumab is a human immunoglobulin G4 (IgG4) monoclonal antibody that binds to the PD-1 receptor and blocks its interaction with PD-L1 and PD-L2, releasing PD-1 pathway-mediated inhibition of the immune response, including the anti-tumor immune response. Nivolumab treatment was proven in a phase 3 trial to significantly extend overall survival for patients with SCCHN.
Side effects include: fatigue, rash, itching, cough, upper respiratory tract infection, swelling of the extremities, shortness of breath, and muscle pain.
Cetuximab (Erbitux®) is a monoclonal antibody (which is a manufactured version of an immune system protein) that targets epidermal growth factor receptor (EGFR), a protein on the surface of certain cells that helps them grow and divide. Oral cavity and oropharyngeal cancer cells often have more than normal amounts of EGFR. By blocking EGFR, cetuximab can slow or entirely stop cell growth.
Cetuximab can be administered in combination with radiation therapy for some earlier stage cancers. For more advanced cancers, it can be combined with standard chemotherapeutic drugs such as cisplatin, or it may be used by itself.
Cetuximab is administered by infusion into a vein (IV), generally once a week. Side effect of cetuximab include allergic reaction during the first infusion and skin problems such as an acne-like rash on the face and chest, headache, tiredness, fever, and diarrhea.
Several other drugs that target EGFR are now being studied as well, some of which are already being used to treat other types of cancers.