Head & Neck Cancer

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Among the most exciting new anticancer products presented at the 2001 ASCO meeting were new drugs that block the epidermal growth factor receptor (EGFR). About 30% to 90% of carcinomas express high levels of EGFR. These include, among others, head and neck cancer, lung cancer, pancreatic cancer, colon cancer, breast cancer, ovarian cancer, and bladder cancer.

CHICAGO-Radio- and chemotherapy delivered concurrently produced greater overall and disease-free survival than radiotherapy alone in RTOG 9703, a phase II randomized trial of patients with advanced squamous cell carcinoma of the head and neck. The RTOG 9703 trial compared three treatment approaches using different chemotherapeutic agents, integration strategies, and timing sequences against the results of clinical studies involving radiotherapy alone.

Fenretinide (N-4-hydroxyphenyl-retinamide, or 4-HPR) is a semisynthetic retinoid that was initially developed as a low-dose chemopreventative agent.[1-3] Unlike other naturally occurring retinoids such as all-trans, 13-cis, and 9-cis retinoic acids, fenretinide does not induce systemic catabolism that interferes with the maintenance of effective plasma levels during long-term use. This characteristic, combined with the agent’s low toxicity and its ability to block aspects of carcinogenesis, provided the rationale for the development of fenretinide in lower doses as a chemoprevention agent for breast, prostate, and bladder cancer.

ZUHL, Germany-Amifostine (Ethyol) used as cytoprotective therapy can reduce the occurrence of xerostomia, loss of taste, and fibrosis associated with radiochemotherapy for head and neck cancer. Jens Buentzel, MD, PhD, reported results of three studies at The First Investigators’ Congress on Radio-protection, held at the Kimmel Cancer Center at Jefferson University, Philadelphia. Dr. Buentzel is vice chairman of the Department of Otolaryngology, Head and Neck Oncology, Zentralklinikum Zuhl, Germany.

TORONTO, Canada-The combination of positron emission tomography (PET) and computed tomography (CT) has proved particularly advantageous in the diagnosis and treatment of cancer of the head and neck, Carolyn Cidis Meltzer, MD, said at the 48th Annual Meeting of the Society of Nuclear Medicine (abstract 133).

SAN FRANCISCO-Interim analysis of a clinical trial of patients with inoperable head and neck cancer (locally advanced or metastatic) showed superior response rates for the combination of cisplatin (Platinol), raltitrexed (Tomudex, investigational in the United States), levofolinic acid, and 5-fluorouracil (5-FU), compared with cisplatin, methotrexate, levofolinic acid, and 5-FU.

BETHESDA, Maryland-The FDA’s Oncologic Drugs Advisory Committee (ODAC) has voted not to recommend that the agency approve IntraDose (injectable cisplatin/epinephrine gel, Matrix Pharmaceuticals). Matrix is seeking to market the drug for the treatment of recurrent or refractory squamous cell carcinoma of the head and neck in patients not considered curable with surgery or radiotherapy.

A conventional course of radiation for squamous cell carcinoma in the United States is generally 70 Gy in 7 weeks, with a once-daily dose of 1.8 to 2 Gy. This schedule has a modest success rate in curing head and neck cancer. The

ZUHL, Germany-Amifostine (Ethyol) used as cytoprotective therapy can reduce the occurrence of xero-stomia, loss of taste, and fibrosis associated with radiochemotherapy for head and neck cancer. Results of three studies were reported by Jens Buentzel, MD, PhD, vice chairman of the Department of Otolaryngology, Head and Neck Oncology, Zentralklinikum Zuhl, Germany.

ST. LOUIS-To determine whether cytoprotective amifostine (Ethyol) can reduce the incidence of hypothyroidism in patients with head and neck cancer treated with radiotherapy, a trial is set to begin at Washington University in St. Louis. The proposed trial is currently undergoing institutional review board (IRB) consideration and has not yet enrolled patients.

PHILADELPHIA-For head and neck cancer patients, subcutaneous (SC) amifostine (Ethyol) provides equal protection against radiation-induced grade 2 acute xerostomia compared to intravenous (IV) amifostine, Pramila Rani Anné, MD, reported. She cautioned, however, that SC amifostine should be used only in clinical trials until ways to prevent cutaneous toxicities are worked out.

ST. LOUIS-Intensity modulated radiation therapy (IMRT) and use of radioprotectant agents may help reduce late-appearing radiation side effects, reported K. S. Clifford Chao, MD. Dr. Chao is associated radiation oncologist, Department of Radiation Oncology at the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis.

BOSTON-By reducing radiation to the parotid glands, intensity modulated radiation therapy (IMRT) allows head and neck cancer patients to maintain more saliva flow after therapy. Clifford K.S. Chao, MD, of Washington University School of Medicine, St. Louis, reported the study results at the 42nd Annual Meeting of the American Society for Therapeutic Radiology and Oncology.