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Thursday, July 21, 2016

Immunotherapy in head and neck squamous cell carcinoma

Head and neck squamous cell carcinoma has been found to be an immuno-suppressive malignancy, with many defects in the host immune system contributing to the progression of disease, as cancer cells evade immune-surveillance due to accumulation of genetic mutations and tumor heterogeneity. Improved understanding of the role of the immune system in cancer has led to the identification of novel therapeutic targets, which are being investigated for their potential to provide durable responses. A greater understanding of these defects has led to the identification and investigation of new therapeutic strategies, targeting immune system dysfunction in an effort to improve the outcomes of this disease.

Improved understanding of the role of the immune system in cancer has led to the identification of a range of novel therapeutic targets. Immuno-oncology is an evolving field of investigation that includes active immunotherapies that are designed to target and harness the patient’s own immune system directly to fight cancer. More specifically, it is designed to leverage the unique properties of the immune system (specificity, adaptability, and memory).The primary goal of immunotherapy is to shift the balance in favor of an immune response against the tumor, allowing tumor eradication or long-term suppression of tumor growth, and the generation of immunological memory. Therapeutic approaches include: Monoclonal antibodies, Immune checkpoint inhibitors, Dendritic cells vaccines, and Adoptive T cell therapy.  The better understanding of the mechanisms of immune escape has led to the development of novel immunotherapies that has shown initial promising results in many solid tumors including Head and neck squamous cell carcinoma.

History of smoking and long term outcome in head and neck cancer patients.

new study by Peterson and colleagues investigated associations between a history of tobacco use and survival outcomes. The researchers from  the Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan surveyed 687 previously untreated patients with cancer of the oral cavity (n = 271), oropharynx (n = 257), larynx (n = 135), or hypopharynx (n = 24). They explored the associations of tobacco use intensity (packs/day), duration (years of use), and timing before diagnosis with overall survival, disease-specific survival, and recurrence-free survival.

The study showed that cigarette use duration, timing, and intensity were significant predictors for all adverse outcomes. Never smoking and pack-years were not significantly associated with outcomes after adjustment for prognostic factors, such as stage, comorbidities, and human papillomavirus (HPV) status, which were strongly associated with clinical outcomes.

The authors concluded that their findings confirm the association between smoking history and survival and the importance of clinical variables in evaluating smoking as a prognostic factor. They also stated that timing, intensity, and duration of cigarette use should be considered with other prognostic factors when considering risk stratification for treatment planning.