“There’s a lot of good work on developing genomic signatures,” said Dr Hashemi Sadraei. “But at this point there’s a lot to be done before we can exclude any subgroup of patients based on their biomarkers in head and neck cancer.”
“I think we should walk away from older designs where we open and close a phase 2 trial with a large number of patients,” she said. “We probably should incorporate more biologic endpoints in our studies as opposed to more traditional endpoints, which require many years of follow up. I think the key would be designing smarter clinical trials and more fluid trials where we can introduce combinations and look at multiple cohorts.”
The article also identified several additional immune therapy strategies for head and neck cancer that are being investigated. These include the activation of positive stimulatory pathways in combination with chemotherapy, combining cetuximab with different checkpoint inhibitors, and the use of HPV-specific vaccine.
“The biggest difference with these drugs is not so much the rate of response in the patients; it’s the durability and the depth of response that we’re seeing, and the fact that we’re coming out now with survival advantage,” said Dr Hashemi Sadraei. “Moving forward, I think our focus should be more on durability and survival, and then teasing out the subgroups that could benefit from less drug for shorter periods of time, and maintaining their immune stability.
“We are very optimistic, especially when you factor in historical data,” she said. “It’s very exciting to be able to offer patients something that even those with certain comorbidities can tolerate well, and from which they can eventually derive a very durable response rate.”
- Sadraei NH, Sikora AG, Brizel DM. Immunotherapy and checkpoint inhibitors in recurrent and metastatic head and neck cancer. Am Soc Clin Oncol Educ Book. 2016;35:e277-282.