Updates in head and neck cancers

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Published: 22 Oct 2018
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Prof Jean-Pascal Machiels - University Clinic Saint-Luc, Brussels, Belgium

We have two very important presentations today that will have an impact on the treatment of the patient. The first study, performed by Professor Mehanna, was performed in the curative setting in a subgroup of patients with HPV positive disease. So we know that some of these patients have a very good prognosis when they are treated with chemoradiation. We had a study performed with radiotherapy plus cetuximab that showed also activity, superiority to radiation therapy, and the comment believed was that this treatment could be used maybe instead of chemoradiation in this group of patients because also we believe that this may decrease toxicity.

So he has clearly showed that the toxicity is the same between chemoradiation and radiation plus cetuximab, even if there are more serious adverse events in chemoradiation. But clearly we have a signal that the chemoradiation has more activity in this setting and it should remain the standard of care.

We cannot extrapolate this result to the HPV negative disease, so the disease induced by alcohol and tobacco but clearly we should remain careful for this group of patients and maintain chemoradiation with cisplatin high dose as a standard of care.

The second presentation in the recurrent and metastatic setting is also a very important one because this is the first time since ten years that we showed an improvement in survival for this group of patients. What is extremely important also is that for a subgroup of patients with high expression of PD-L1 we can probably remove the cisplatin and have a good outcome with immunotherapy alone. We have still some work to do to better characterise the group of patients that will benefit and also we have to see how we can now bring this active drug to the curative treatment of the patients in combination with chemoradiation to try to cure more patients. Thank you.