New therapeutic strategies for the treatment of nasopharyngeal cancer and squamous cell carcinoma of the head and neck, malignancies associated with poor survival outcomes, were presented at the first European Society for Medical Oncology (ESMO) Asia Congress, held in Singapore in December 2015.
Nasopharyngeal cancer, a type of head and neck cancer, is considered endemic in Asia, and people there with exposure to the Epstein-Barr virus are thought to be at particular risk. According to the American Cancer Society, nasopharyngeal cancer is considered rare in America, with 3,200 cases diagnosed in 2015. However, in Asia, especially in Southern China, it is a major health issue.
During the congress, results from the Phase 1b trial KEYNOTE-028 were presented, evaluating the immunotherapy agent pembrolizumab in the treatment of patients with pretreated nasopharyngeal cancer, who currently have no other treatment options. The trial showed promising safety, tolerability, and efficacy results in people with PD-L1 positive advanced solid tumors, including 27 study participants with nasopharyngeal cancer. The study’s author, Professor Chiun Hsu from the Department of Oncology, National Taiwan University Hospital, reported a response rate of 22.2 percent and a median duration of response of 10.8 months, with a manageable safety profile.
“Immunotherapy is a very promising strategy for head and neck cancer and we are awaiting the results of pivotal studies in second-line treatment for recurrent and metastatic patients. To date we only have promising response rate and PFS data from non-comparative studies,” ESMO spokesperson, Dr Lisa Licitra, chief of the Head and Neck Cancer Medical Oncology Department at the Istituto Nazionale Tumori, in Italy, said in a press release. “For nasopharyngeal cancer a Phase III study is still to be developed. The development of these drugs in second line might obscure the real impact of these drugs in the disease as patients at advanced stage are highly immunocompromised irrespective of the previous treatment they have received.”
Afatinib is an oral irreversible drug that blocks the ErbB family of receptors, whose over-expression is associated with poor prognosis in head and neck squamous cell carcinoma (HNSCC). The results from a Phase 3 study (LUX-Head & Neck 1 trial) showed that afatinib significantly reduced the risk of disease progression by 20 percent, delaying tumor growth versus chemotherapy in patients following previous treatment failure. Benefit varied according to different subgroups of patients, with greater clinical benefit observed in those who did not receive prior EGFR-targeted therapy for recurrent or metastatic disease, for example.
First author Dr. Makoto Tahara, department of Head and Neck Medical Oncology, National Cancer Center Hospital East, in Japan, added, “These data provide important new insights into the efficacy outcomes in selected patient subgroups and may help to identify those who may achieve the most benefit from the targeted therapy. Three additional Phase III trials are ongoing, LUX-Head & Neck 3, LUX-Head & Neck 2 (global) and LUX-Head & Neck 4 (Asia), to further investigate the potential benefits of afatinib in patients with recurrent HNSCC progressing on/after platinum-based therapy and primary unresected locoregionally advanced HNSCC.”