Research Highlights from the 2022 Multidisciplinary Head and Neck Cancers Symposium, with Kedar Kirtane, MD

ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests’ statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this podcast, Dr. Kedar Kirtane discusses new research from the 2022 Multidisciplinary Head and Neck Cancers Symposium, held February 24-26 in Phoenix, Arizona, including research on disparities in head and neck cancer, treatment for HPV-positive oropharyngeal cancer, and strategies for reducing side effects from treatment while still keeping high effectiveness. Dr. Kirtane is an assistant member and medical oncologist at Moffitt Cancer Center in Tampa, Florida, with a focused interest in the treatment of head, neck, and endocrine malignancies. He is also the 2022 Cancer.Net Specialty Editor for Head and Neck Cancers. View Dr. Kirtane’s disclosures at Cancer.Net. Dr. Kirtane: My name is Kedar Kirtane. I am an assistant member at Moffitt Cancer Center in Tampa, Florida. And today, I'm going to discuss some of the highlights from the recent 2022 Multidisciplinary Head and Neck Cancers Symposium held in late February in Phoenix, Arizona. For many of us, it was the first in-person meeting being attended in the last few years due to the pandemic. The talks were truly fantastic, and above all, it was nice to see colleagues, friends, and collaborators from all over. There is no way I can go over every incredible talk that was presented, but I wanted to highlight a few of the talks that I found most compelling and interesting. So the first was the first keynote discussions by Dr. Sharon Spencer at the University of Alabama at Birmingham and Dr. Charles Moore at Emory University. They had a wonderful discussion on cancer disparities and head and neck cancers. It is unfortunately very well documented that African Americans with head and neck cancer have worse outcomes. They discussed efforts made in both Alabama and Georgia to help combat disparities in head and neck cancer outcomes for African Americans. Dr. Moore described the evolution of his interest in tackling disparities in his local communities in the Atlanta Metropolitan area, where he first held cancer screenings out of the back of his car and seeing firsthand the poverty and lack of infrastructure that contributes to the daily disparities he encounters in his clinic. Both speakers discussed that it is imperative to increase representation of underrepresented communities into head and neck cancer clinical trials to ensure generalizability of results. And though this is very certainly easier said than done, as both speakers acknowledged, this is still an interesting aspect of clinical care that many of us encounter, where it is difficult for a variety of reasons to increase the representation of diverse communities under clinical trials. And I think this is one strong way of really doubling down and trying to combat disparities and outcomes, but I think a lot more is needed. In addition to increasing clinical trial participation, there are ways to combat implicit biases, improve local infrastructures to provide care, and engage key stakeholders for standard of care in clinical trials to minimize racial and ethnic bias. So both of these talks were really wonderful and talked about all of these things and how to incorporate them into your daily practice. As advances in the cancer world grow at exponential rates, it's really important that people from all walks of life are involved, and Doctors Spencer and Moore are doing wonderful work in their local communities and beyond to make sure this happens. The second topic I wanted to discuss today comes from my own institution, Moffitt Cancer Center, and my colleague, Dr. Michelle Echevarria. I was not directly involved with this study, but I am obviously a colleague of Dr. Echevarria, and this study was done at my center at Moffitt. So she discussed the study that she conducted on the kinetics of circulating human papillomavirus DNA, or HPV DNA, in plasma and oral gargles from patients with HPV-positive oropharynx cancers that are treated with definitive radiation therapy. HPV, or human papillomavirus, is a sexually transmitted virus that can cause cancer. It is the same virus that causes the majority of cervical cancer, and it is actually now believed that in America, this represents the major cause for oropharynx cancers. This is in direct contrast to 20, 30 years ago where HPV as a cause for oropharynx cancers was not even known, and most of the disease was thought to be related to tobacco or alcohol. Now, there are ways to check for circulating HPV DNA in the bloodstream and also in oral gargles for patients with HPV-related head and neck cancers. This is by no means considered a standard of care, but the goal from many institutions is to try to figure out how to incorporate these blood tests in sorting out how to treat patients and potentially how to detect for recurrence. So by noninvasively being able to measure this DNA in the bloodstream, this offers potential opportunities to personalize radiation dose, i.e. for people whose HPV DNA does not go to zero initially after treatment, and also as a potential biomarker for recurrent disease. Dr. Echevarria and her team analyzed circulating HPV in blood and in oral gargle samples from patients enrolled on a clinical trial of radiation alone for the treatment of HPV-related oropharynx cancer. And in this study, plasma and oral gargles were collected prior to the initiation of treatment. So they had a baseline HPV level in their oral gargle and/or their plasma. And they also checked it during week 4 of treatment, at the end of treatment, and then at 2 to 3 months after treatment. That latter endpoint is a clinically relevant one because many times, this is when providers are getting imaging and checking to see if the treatment that was given to the patient actually worked. And what this study found, briefly, was that a clearance of plasma HPV levels was associated with a reduction in cancer size as seen on CT imaging. And this suggests that there are future avenues for research where potentially one could study a subset of patients who immediately clear the HPV in their bloodstream early and then potentially de-escalate those therapies. So really, the question is whether those patients need the full gamut of radiation or whether they can safely avoid toxicity and at the same time maintain those high cure rates. So this was a really interesting study, and I think these sorts of studies checking for HPV in the bloodstream are going to become more and more prolific as we figure out how to incorporate this into standard of care and whether it actually ends up changing clinical practice. Speaking of HPV and de-escalation, there was certainly a lot of discussion regarding de-escalation of therapies. Now for people who don't know what that means, what that means is that, as I mentioned earlier, HPV is a known cause of oropharynx cancers in America and abroad. And what we know now is that HPV-related head and neck cancers actually just have a better prognosis, a better cure rate, a better survival rate compared to cancers of the head and neck that are related to tobacco or alcohol. So really, the question has come up as to whether the treatment paradigm that we have, which is 6, 7 weeks of radiation, sometimes adding chemotherapy, do we really need to throw the proverbial kitchen sink at treating these patients when they already do so well? Dr. Chera from University of North Carolina and Dr. Hayes from University of Tennessee discussed radiation and chemotherapy, respectively, in de-escalation strategies. I will say that Dr. Hayes said something really thoughtful, which is that the greatest toxicity is treatment failure, so there has to be clinical equipoise in how we choose the patients that we are safely deeming to de-escalate therapy. The last thing we want to do is decrease toxicity in the short term for patients if we don't at the same time maintain those high cure rates that are seen in HPV-related cancer patients. Dr. Chera discussed a variety of studies regarding reduced radiation dose, either after primary surgical management of head and neck cancers or as part of definitive therapy. And he conceded that while some of his treatments for his patients have changed as a result of phase 2 studies, that he acknowledged that there was a need for larger phase 3 studies to really definitively conclude that de-escalation of radiation dose is okay to do. Dr. Hayes discussed a variety of clinical trials that have been done with different chemotherapy regimens. Now the standard of care that we use is something called cisplatin. And while most of the randomized control trials have shown inferiority of non-cisplatin-based chemotherapy regimens, there's still a large future out there to figure out which subset of patients could safely either avoid chemotherapy, get a chemotherapy that is perhaps less toxic, or give a chemotherapy just with less dose. And while none of these have become yet standard of care, obviously, just like I mentioned earlier with checking HPV in the bloodstream, this is going to be a really significant part of the clinical trial landscape moving forward over the next 5 or 10 years. So, in summary, this was a really great conference, one that focused on disparities, one that focused on HPV-circulating tumor DNA in the bloodstream and also de-escalation strategies for HPV head and neck cancer patients. So thank you for listening to this brief summary of new research in head and neck cancers. ASCO: Thank you, Dr. Kirtane. You can find more research from recent scientific meetings at www.cancer.net. And if this podcast was useful, please take a minute to subscribe, rate, and review the show wherever you listen to podcasts. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.