Head & Neck Cancer

Cetuximab (Erbitux) added to standard first-line chemotherapy with cisplatin or carboplatin plus fluorouracil (5-FU) yielded a statistically and clinically significant 35% survival advantage over these regimens without cetuximab in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN)

A simple oral rinse could detect head and neck squamous cell carcinoma (HNSCC) by showing elevations in CD44, a protein that is a potential biomarker for HNSCC, and also CD44 hypermethylation

In contrast to other radiosensitizers, cetuximab (Erbitux) improves radiotherapy efficacy in patients with locoregionally advanced head and neck cancer without increasing mucositis or dysphagia, and this may translate into fewer treatment breaks and longer survival

Combining chemiluminescent examination with toluidine blue staining greatly improves the accuracy of visual screening for oral cancer and could reduce the number of noninformative biopsies

ImClone Systems Incorporated and Bristol-Myers Squibb Company announced that a first-line phase III study of cetuximab (Erbitux) combined with platinum-based chemotherapy met the primary endpoint of increasing overall survival in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck.

Updated Varian Brachytherapy Applicator Receives Clearance

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

Cetuximab (Erbitux) plus concurrent chemoradiotherapy (CRT) appears to be feasible and effective in many patients with locally advanced squamous-cell head and neck cancer, and may improve local-regional control

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.

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.

In RTOG 9111, a randomized phase III trial in locally advanced laryngeal cancer, there was no difference in overall survival between the three arms, but disease-free survival, locoregional control, and preservation of the larynx were better in patients receiving induction chemotherapy plus radiation or concurrent chemoradiation, compared with radiation therapy alone.

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 (docetaxelfor injection, Sanofi-Aventis), in combinationwith cisplatin and fluorouracil andadministered prior to radiotherapy, forthe treatment of patients with inoperable,locally advanced squamous cell carcinomaof 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.

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)

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.

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.

There is sufficient evidence to show that asbestos exposure can cause cancer of the larynx.

Cases of osteonecrosis of the jaw (ONJ) have been reported with an increasing frequency over the past few years. ONJ is most often identified in patients with cancer who are receiving intravenous bisphosphonate therapy but it has also been diagnosed in patients receiving oral bisphosphonates for nonmalignant conditions. The condition involves exposed bone of the maxilla or mandible. Although it is often associated with a recent dental surgical procedure, spontaneous ONJ can also occur. Patients commonly present with symptoms. Through case reporting and clinical experience, there is a suggestion that the incidence of ONJ in patients with cancer receiving intravenous bisphosphonates ranges between 1% and 10%. Management of ONJ focuses on maximizing oral health, conservative actions with mouth rinses, antibiotics, and avoidance of unnecessary invasive dental procedures. The currently available data on ONJ are reviewed here.

The TPF induction regimen-docetaxel (Taxotere), cisplatin, fluorouracil (5-FU)—followed by carboplatin-based chemoradiotherapy (CRT) is a "new acceptable standard of care" for locally advanced squamous cell carcinoma of the head and neck (SCCHN

Anti-EGFR (epidermal growth factor receptor) therapies, including tyrosine kinase inhibitors (TKIs) and monoclonal antibodies, demonstrate activity in a variety of tumor types. While both inhibit the EGFR pathway, they act via different mechanisms.

Since initial characterization over 40 years ago, strong preclinical and clinical data have clearly established the epidermal growth factor receptor (EGFR) as a worthy molecular target for intervention in cancer therapy. The receptor is expressed, overexpressed, or mutated in many human tumors, including head and neck, colorectal, pancreatic, non-small-cell lung, ovarian, esophageal, gastric, breast, prostate, bladder, and renal cancers. Experiments in several model systems have confirmed that EGFR signaling is involved in regulating several key biologic processes, including cell proliferation, epithelial development, organogenesis, apoptosis, angiogenesis, and differentiation. Furthermore, EGFR function has been shown to be altered and/or dysregulated in a variety of spontaneous tumors.

The FDA has approved the marketing of the first new drug for the treatment of head and neck cancer in nearly half a century and granted it two indications.

ImClone Systems Incorporated and Bristol-Myers Squibb Company recently announced that the US Food and Drug Administration (FDA) has approved cetuximab (Erbitux), an immunoglobulin (Ig)G1 monoclonal antibody, for use in the treatment of squamous cell carcinoma of the head and neck.

The epidermal growth factor receptor (EGFR) promotes the growth of different cell types and has been implicated in tumorigenesis. The EGFR comprises a family of four structurally similar tyrosine kinases with a complex link to downstream signaling molecules that ultimately regulate key cell processes. Anti-EGFR agents have been developed as promising therapeutic anticancer targets, and some have been recently approved for the treatment of non-small-cell lung cancer and colon cancer. The two anti-EGFR therapies with the greatest clinical application are monoclonal antibodies that block the binding of ligands to EGFR and small-molecule tyrosine kinase inhibitors that inhibit the binding of adenosine triphosphate to the internal tyrosine kinase receptor of EGFR. We attempt to give an overview of the EGFR function and biology, focusing on the most important clinical findings and applications of EGFR inhibitors in lung and head and neck cancer.

The epidermal growth factor receptor (EGFR) promotes the growth of different cell types and has been implicated in tumorigenesis. The EGFR comprises a family of four structurally similar tyrosine kinases with a complex link to downstream signaling molecules that ultimately regulate key cell processes. Anti-EGFR agents have been developed as promising therapeutic anticancer targets, and some have been recently approved for the treatment of non-small-cell lung cancer and colon cancer. The two anti-EGFR therapies with the greatest clinical application are monoclonal antibodies that block the binding of ligands to EGFR and small-molecule tyrosine kinase inhibitors that inhibit the binding of adenosine triphosphate to the internal tyrosine kinase receptor of EGFR. We attempt to give an overview of the EGFR function and biology, focusing on the most important clinical findings and applications of EGFR inhibitors in lung and head and neck cancer.

The epidermal growth factor receptor (EGFR) promotes the growth of different cell types and has been implicated in tumorigenesis. The EGFR comprises a family of four structurally similar tyrosine kinases with a complex link to downstream signaling molecules that ultimately regulate key cell processes. Anti-EGFR agents have been developed as promising therapeutic anticancer targets, and some have been recently approved for the treatment of non-small-cell lung cancer and colon cancer. The two anti-EGFR therapies with the greatest clinical application are monoclonal antibodies that block the binding of ligands to EGFR and small-molecule tyrosine kinase inhibitors that inhibit the binding of adenosine triphosphate to the internal tyrosine kinase receptor of EGFR. We attempt to give an overview of the EGFR function and biology, focusing on the most important clinical findings and applications of EGFR inhibitors in lung and head and neck cancer.

PHOENIX-Zila, Inc. has enrolled the first patients in its phase III clinical trial of OraTest, a rinse for detecting severe dysplasia and cancer in patients at elevated risk for oral cancer. Its active ingredient is Zila Tolonium Chloride (pharmaceutical grade toluidine blue). The trial is expected to require fewer than 4,000 high-risk patients, generally requiring a single visit; it will be conducted at approximately 13 investigative sites.

The epidermal growth factor receptor (EGFR) promotes the growth of different cell types and has been implicated in tumorigenesis. The EGFR comprises a family of four structurally similar tyrosine kinases with a complex link to downstream signaling molecules that ultimately regulate key cell processes. Anti-EGFR agents have been developed as promising therapeutic anticancer targets, and some have been recently approved for the treatment of non-small-cell lung cancer and colon cancer. The two anti-EGFR therapies with the greatest clinical application are monoclonal antibodies that block the binding of ligands to EGFR and small-molecule tyrosine kinase inhibitors that inhibit the binding of adenosine triphosphate to the internal tyrosine kinase receptor of EGFR. We attempt to give an overview of the EGFR function and biology, focusing on the most important clinical findings and applications of EGFR inhibitors in lung and head and neck cancer.

PHILADELPHIA-In a phase III randomized trial, the addition of cetuximab (Erbitux) to standard radiotherapy resulted in improved locoregional disease control and enhanced survival in patients with advanced squamous cell carcinoma of the head and neck, according to a poster presentation (poster B106) at the annual AACR/NCI/EORTC International Conference on Molecular Targets and Cancer Therapeutics.