Head & Neck Cancer

Preliminary findings show that the addition of cetuximab (Erbitux) to radiation therapy and chemotherapy may help some patients with head and neck cancer live longer, according to a study presented at the plenary session of the recent Multidisciplinary Head and Neck Cancer Symposium, held in Rancho Mirage, Calif, and cosponsored by the American Society for Therapeutic Radiology and Oncology, the American Society for Clinical Oncology, and the American Head and Neck Society. Researchers are recommending a larger trial to prove definitively if cetuximab combined with radiation helps improve survival for these patients.

Patients with advanced head and neck cancer who have a clinical complete response (CCR) to chemoradiotherapy (CRT) are at low risk for recurrence in the neck, and most can be spared laryngectomy

In its second annual "Clinical Cancer Advances" report, the American Society of Clinical Oncology (ASCO) selected six notable developments in clinical cancer research as most important in 2006.

A device that displays a holograph-like 3-dimensional (3D) image, created from a CT, MRI, or PET dataset, holds promise for more accurate radiotherapy treatment planning (see image on page 1). James C. H. Chu, PhD, professor of radiation oncology, Rush University Medical Center, presented results of a pilot study of the Perspecta Spatial 3D System, developed by Actuality Systems, Inc. (Bedford, Massachusetts), at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology

The FDA has approved Taxotere (docetaxel for injection, Sanofi-Aventis), in combination with cisplatin and fluorouracil and administered prior to radiotherapy, for the treatment of patients with inoperable, locally advanced squamous cell carcinoma of the head and neck (SCCHN).

The science supporting molecularly targeted therapies for the treatment of patients with solid tumors continues to evolve. Nurses are challenged to understand cell signaling, molecular targeting, and the mechanism of action of targeted agents. Two cell signal transduction pathways regulate the development, proliferation, and metastasis of solid tumors: the human epidermal growth factor (HER) receptor pathway and the vascular endothelial growth factor (VEGF) receptor pathway. Several novel pharmacologic agents with distinct indications and methods of administration target the HER and VEGF molecular pathways.

Cetuximab (Erbitux), a chimeric antiepidermal growth factor receptor monoclonal antibody currently used to treat metastatic colorectal cancer, is in clinical development for several other solid tumors. Although cutaneous manifestations are the most common toxicities associated with cetuximab, they are rarely life-threatening. Cetuximab-related infusion reactions are less common, but they may become severe and cause fatal outcomes if not managed appropriately. Little about the specific etiology of these events is known; however, an overview of infusion reactions observed with other compounds may shed some light and help characterize cetuximab-related reactions. For physicians administering cetuximab, familiarity with acute reaction treatment protocols and preparedness to identify and manage symptoms promptly and effectively are most important to minimize potential risks.

xAdvaxis, Inc. has conducted a pre-IND meeting with the FDA regarding its two planned phase II studies for its lead product Lovaxin C, a live Listeria vaccine for the treatment of cervical and head and neck cancers. The IND will be filed once phase I/II studies have been completed. In a separate news release, Advaxis announced that its breast cancer vaccine Lovaxin B, Listeria monocytogenes modified to deliver HER2/neu to immune cells, is in preclinical testing.

A systematic approach to early treatment of skin toxicity in patients on erlotinib (Tarceva)-based therapy can reduce the need for dose modification or delay in patients with head and neck cancer or non-small-cell lung cancer (NSCLC)

Jeff is a 47-year-old white male who presented to his primary care provider complaining of having had swollen lymph nodes in the right neck for 2 months. He also complained of nasal stuffiness and sore throat. Physical exam found lymphadenopathy in the left cervical triangle less than 2 cm in diameter. He smokes about 2 packs of cigarettes a day and has a 60 pack-year history of smoking. He has been a cabinet-maker for almost 20 years. He has no other significant medical history and is not on any regular medications. He is a social drinker and denies any illicit drug use. He was treated with an antibiotic for 10 days, but on return the lymphadenopathy appeared slightly enlarged. He was sent to an ear, nose, and throat specialist who biopsied the nodal mass. Following an extensive workup, he was diagnosed with stage III (T2, N1, M0) squamous cell carcinoma of the nasopharynx.