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Wang Z, Chen H, Chen Q, Zhu Y, Li M, Zhou J. The incidence and predictive factors of secondary epilepsy in patients with supratentorial brain metastases (st-BMs) after stereotactic radiosurgery: A multicenter retrospective study. Epilepsy Behav 2024; 157:109870. [PMID: 38870867 DOI: 10.1016/j.yebeh.2024.109870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/19/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To evaluate the incidence and the independent risk factors of SRS-related epilepsy in patients with supratentorial brain metastases (st-BMs), providing evidences for prevention or reduction secondary epilepsy after SRS. METHODS Patients with st-BMs from four gamma knife centers who developed secondary epilepsy after SRS were retrospectively studied between January 1, 2017 and June 31, 2023. The incidence and clinical characteristics of the patients with secondary epilepsy were analyzed. The predictive role of baseline clinical-demographic variables was evaluated according to univariate and multivariate logistic regression model. The impact of secondary epilepsy on patients' OS was evaluated as well by log-rank test. RESULTS 11.3 % (126/1120) of the patients with totally 158 st-BMs experienced secondary epilepsy after SRS in median 21 days. 61.9 % (78/126) of the patients experienced simple partial seizures. 91.3 % (115/126) patients achieved good seizure control after received 1-2 kinds of AEDs for median 90 days, while 7.1 % (9/126) of the patients suffered from refractory epilepsy. Patients had higher risk of secondary epilepsy if the tumor located in cortex and/or hippocampus, peri-tumor edema larger than 20.3 cm3 before SRS, had epilepsy history, and failed to receive bevacizumab prior to SRS. There was no difference in the OS of patients who experience secondary epilepsy or not after SRS. CONCLUSIONS The incidence of SRS-related secondary epilepsy is 11.3 % in patients with st-BMs in this retrospective study. The risk of secondary epilepsy is higher in patients with st-BM located in cortex and/or hippocampus area, peri-tumor edema larger than 20.3 cm3 before SRS, and epilepsy history. Bevacizumab is suggested prior to SRS therapy, as it could be used for the control of peri-tumor edema and SRS-related damage, hence reduce the risk of secondary epilepsy. However, whether or not patients suffered from secondary epilepsy after SRS does not affect their OS.
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Affiliation(s)
- Zheng Wang
- Cancer Center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China.
| | - Haining Chen
- Gamma Knife Treatment Center, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China.
| | - Qun Chen
- Gamma Knife Treatment Center. Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University Nanjing 210029, China.
| | - Yucun Zhu
- Gamma Knife Treatment Center, Ming Ji Hospital, Affiliated to Nanjing Medical University, Nanjing 210009, China.
| | - Min Li
- Cancer Center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China.
| | - Jia Zhou
- Cancer Center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China.
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Liu S, Wang R, Fang J. Exploring the frontiers: tumor immune microenvironment and immunotherapy in head and neck squamous cell carcinoma. Discov Oncol 2024; 15:22. [PMID: 38294629 PMCID: PMC10830966 DOI: 10.1007/s12672-024-00870-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
The global prevalence of head and neck malignancies positions them as the sixth most common form of cancer, with the head and neck squamous cell carcinoma (HNSCC) representing the predominant histological subtype. Despite advancements in multidisciplinary approaches and molecular targeted therapies, the therapeutic outcomes for HNSCC have only marginally improved, particularly in cases of recurrent or metastatic HNSCC (R/MHNSCC). This situation underscores the critical necessity for the development of innovative therapeutic strategies. Such strategies are essential not only to enhance the efficacy of HNSCC treatment but also to minimize the incidence of associated complications, thus improving overall patient prognosis. Cancer immunotherapy represents a cutting-edge cancer treatment that leverages the immune system for targeting and destroying cancer cells. It's applied to multiple cancers, including melanoma and lung cancer, offering precision, adaptability, and the potential for long-lasting remission through immune memory. It is observed that while HNSCC patients responsive to immunotherapy often experience prolonged therapeutic benefits, only a limited subset demonstrates such responsiveness. Additionally, significant clinical challenges remain, including the development of resistance to immunotherapy. The biological characteristics, dynamic inhibitory changes, and heterogeneity of the tumor microenvironment (TME) in HNSCC play critical roles in its pathogenesis, immune evasion, and therapeutic resistance. This review aims to elucidate the functions and mechanisms of anti-tumor immune cells and extracellular components within the HNSCC TME. It also introduces several immunosuppressive agents commonly utilized in HNSCC immunotherapy, examines factors influencing the effectiveness of these treatments, and provides a comprehensive summary of immunotherapeutic strategies relevant to HNSCC.
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Affiliation(s)
- Shaokun Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ru Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Jugao Fang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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3
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Xu M, Gu X, Yang L, Ge S, Zhao P. Publication Trends of Research on Head and Neck Squamous Cell Carcinoma During 2002 to 2022: A 20-Year Bibliometric Study. J Craniofac Surg 2023; 34:2379-2383. [PMID: 37639658 PMCID: PMC10597449 DOI: 10.1097/scs.0000000000009666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. Our study attempted to analyze the research trends in HNSCC and compare contributions from different countries, institutions, journals, and authors. MATERIALS AND METHODS The authors extracted publications in this field from 2002 to 2022 from the Web of Science database. Microsoft Excel and VOSviewer were performed to collect data on publication numbers, analyze publication trends, and visualize relevant results. RESULTS A total of 1903 publications were screened. In the past 20 years, the United States contributed the most publications and citations in the HNSCC research. China ranked second in the number of publications. The Ophthalmic Plastic and Reconstructive Surgery was the most productive journal concerning HNSCC. ESMAELIB of the University of Texas System and ROSENTHAL EL of Stanford University had published the most publications in this field. Keywords were categorized into 3 clusters: basic study, clinical feature study, and treatment-related study. The keywords "reflectance confocal microscopy", "raman-spectroscopy", and "confocal laser endomicroscopy" were most frequently emerged in the recent years. Management-related research has been recognized as a potential focus in the HNSCC.
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Affiliation(s)
- Mingpeng Xu
- Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine
| | - Xiang Gu
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ludi Yang
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine
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4
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Wei C, Lan X, Qiu M, Cui R, Fu Q, Shinge SAU, Muluh TA, Jiang O. Expanding the role of combined immunochemotherapy and immunoradiotherapy in the management of head and neck cancer (Review). Oncol Lett 2023; 26:372. [PMID: 37965160 PMCID: PMC10641411 DOI: 10.3892/ol.2023.13958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/13/2023] [Indexed: 11/16/2023] Open
Abstract
Immunotherapy has become one of the most promising approaches in tumor therapy, and there are numerous associated clinical trials in China. As an immunosuppressive tumor, head and neck squamous cell carcinoma (HNSCC) carries a high mutation burden, making immune checkpoint inhibitors promising candidates in this field due to their unique mechanism of action. The present review outlines a comprehensive multidisciplinary cancer treatment approach and elaborates on how combining immunochemotherapy and immunoradiotherapy guidelines could enhance clinical efficacy in patients with HNSCC. Furthermore, the present review explores the immunology of HNSCC, current immunotherapeutic strategies to enhance antitumor activity, ongoing clinical trials and the future direction of the current immune landscape in HNSCC. Advanced-stage HNSCC presents with a poor prognosis, low survival rates and minimal improvement in patient survival trends over time. Understanding the potential of immunotherapy and ways to combine it with surgery, chemotherapy and radiotherapy confers good prospects for the management of human papillomavirus (HPV)-positive HNSCC, as well as other HPV-positive malignancies. Understanding the immune system and its effect on HNSCC progression and metastasis will help to uncover novel biomarkers for the selection of patients and to enhance the efficacy of treatments. Further research on why current immune checkpoint inhibitors and targeted drugs are only effective for some patients in the clinic is needed; therefore, further research is required to improve the overall survival of affected patients.
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Affiliation(s)
- Chun Wei
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Xiaojun Lan
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Maona Qiu
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Ran Cui
- Department of Oncology, The First People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Qiuxia Fu
- Department of General Medicine, The People's Hospital of Luzhou City, Luzhou, Sichuan 646000, P.R. China
| | - Shafiu A. Umar Shinge
- Department of Cardiothoracic Surgery, Sun Yat Sen Memorial Hospital, Sun Yat Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Tobias Achu Muluh
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong 518060, P.R. China
| | - Ou Jiang
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
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Rink M, Jung EM, Künzel J. The Use of Contrast-Enhanced Sonography for Therapy Monitoring of Metastatic Lymph Nodes: A Systematic Review. Curr Oncol 2023; 30:6734-6743. [PMID: 37504354 PMCID: PMC10378161 DOI: 10.3390/curroncol30070494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
Metastatic cervical lymph nodes are a frequent finding in head and neck squamous cell carcinoma (HNSCC). If a non-surgical approach is primarily chosen, a therapy response evaluation of the primary tumor and the affected lymph nodes is necessary in the follow-up. Supplementary contrast-enhanced ultrasound (CEUS) can be used to precisely visualize the microcirculation of the target lesion in the neck, whereby malignant and benign findings differ in their uptake behavior. The same applies to many other solid tumors. For various tumor entities, it has already been shown that therapy monitoring is possible through regular contrast-enhanced sonography of the primary tumor or the affected lymph nodes. Thus, in some cases, maybe in the future, a change in therapy strategy can be achieved at an early stage in the case of non-response or, in the case of therapy success, a de-escalation of subsequent (surgical) measures can be achieved. In this paper, a systematic review of the available studies and a discussion of the potential of therapy monitoring by means of CEUS in HNSCC are presented.
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Affiliation(s)
- Maximilian Rink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
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Iancu DCE, Fulga A, Vesa D, Stan C, Zenovia A, Bujoreanu F, Piraianu AI, Sarbu MI, Tatu AL. Insight on common forms of cutaneous head and neck carcinoma (Review). Mol Clin Oncol 2023; 18:28. [PMID: 36908978 PMCID: PMC9995598 DOI: 10.3892/mco.2023.2624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/05/2023] [Indexed: 02/19/2023] Open
Abstract
To improve the outcome and quality of life for patients with head and neck carcinoma, an increasing amount of research has been performed on the particularities of this type of cancer and its treatment methods. Starting from clinical aspects, including histology and imaging features, up-to-date studies from different parts of the world have determined new data leading to a better understanding of the mechanisms behind the disease and proposed new treatment protocols. The head and neck areas are predisposed to almost all skin neoplasms, most commonly those related to ultraviolet exposure. Squamous cell carcinoma and basal cell carcinoma account for almost 90% of non-melanoma skin cancers in this region; therefore, reviewing the literature on cutaneous carcinomas of the head and neck area and sharing particular aspects of their physiopathology are beneficial for a great number of patients.
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Affiliation(s)
- Doriana Cristea-Ene Iancu
- Department of Otorhinolaryngology, 'Sfantul Andrei' Emergency Clinical Hospital of Galati, 800578 Galati, Romania.,Clinical Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galati, 800010 Galati, Romania
| | - Ana Fulga
- Department of Otorhinolaryngology, 'Sfantul Andrei' Emergency Clinical Hospital of Galati, 800578 Galati, Romania.,Clinical Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galati, 800010 Galati, Romania
| | - Doina Vesa
- Department of Otorhinolaryngology, 'Sfantul Andrei' Emergency Clinical Hospital of Galati, 800578 Galati, Romania.,Clinical Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galati, 800010 Galati, Romania
| | - Constantin Stan
- Department of Otorhinolaryngology, 'Sfantul Andrei' Emergency Clinical Hospital of Galati, 800578 Galati, Romania.,Clinical Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galati, 800010 Galati, Romania
| | - Andrei Zenovia
- Department of Otorhinolaryngology, 'Cai Ferate' General Hospital, 800223 Galati, Romania
| | - Florin Bujoreanu
- Department of Dermatology, 'Sfanta Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galati, Romania.,Multidisciplinary Integrative Center for Dermatologic Interface Research (MIC-DIR), 800179 Galati, Romania
| | - Alin Ionut Piraianu
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galati, 800010 Galati, Romania.,Department of Forensic Medicine, 'Sfantul Andrei' Emergency Clinical Hospital of Galati, 800578 Galati, Romania
| | - Mihaela Ionela Sarbu
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galati, 800010 Galati, Romania
| | - Alin Laurentiu Tatu
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galati, 800010 Galati, Romania.,Department of Otorhinolaryngology, 'Cai Ferate' General Hospital, 800223 Galati, Romania.,Department of Dermatology, 'Sfanta Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galati, Romania.,Multidisciplinary Integrative Center for Dermatologic Interface Research (MIC-DIR), 800179 Galati, Romania
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7
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8
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Chemo- immunotherapy and radiation in locally advanced head and neck cancer: Where do we stand? Oral Oncol 2022; 127:105773. [PMID: 35217401 DOI: 10.1016/j.oraloncology.2022.105773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/20/2022] [Accepted: 02/13/2022] [Indexed: 11/21/2022]
Abstract
Immunotherapy represents an effective therapeutic option in the management of recurrent/metastatic head and neck squamous cell carcinoma, along with chemotherapy in metastatic disease or radiotherapy/re-irradiation for (locoregionally confined) recurrent disease. On the other hand, concomitant chemo-radiation remains the primary treatment modality in many patients with locally advanced disease. In spite of promising preclinical, it is difficult to clearly establish the role of immunotherapy in the upfront management of locally advanced head and neck squamous cell carcinoma and its integration with the standard of care. In this paper, we discuss/review the main results thus far available and outline some unanswered questions that might help design future clinical trials.
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9
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Sun C, Zhang M, Qiao Q, Wang Y. Integrating Intrinsic Radiosensitivity and Immune Status for Predicting Benefits of Radiotherapy in Head and Neck Squamous Cell Carcinoma. Med Sci Monit 2021; 27:e932126. [PMID: 34670999 PMCID: PMC8547194 DOI: 10.12659/msm.932126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background HNSCC (head and neck squamous cell carcinoma) is a heterogeneous disease for which radiotherapy is a main treatment. As intrinsic radiosensitivity and immune status affect the initial and effective stage of the radiation-induced cancer immunity cycle, respectively, it is important to consider both of them when we select patients who can benefit from radiotherapy. Material/Methods Our study included all HNSCC patients with complete survival and radiotherapy information in TCGA database. Patients were divided into RS (radiosensitive), RR (radioresistant), immune, and non-immune groups according to their RSI (radiosensitivity index) and immune score calculated by the ESTIMATE algorithm. Survival analysis was performed to compare OS (overall survival) between patients receiving and not receiving radiotherapy. GO and KEGG pathway enrichment analysis was performed for functional analysis. Univariate Cox and ridge regression analysis were performed to construct a predictive gene signature based on the combined stratification. Results Only patients in the RS-immune group could benefit from radiotherapy, and the survival analysis results remained consistent after we performed propensity score matching between patients receiving and not receiving radiotherapy. The differentially expressed genes between the RS-immune and non-RS-immune groups were mainly enriched in pathways related to immune process. The 3-gene signature we built exhibited predictive value in training and validation cohorts when treated as a binary or continuous variable. Conclusions The combined stratification of intrinsic radiosensitivity and immune status was superior to considering intrinsic radiosensitivity or immune status alone and could be used in preclinical evaluation to select patients or to decide whether radiotherapy sensitizers and immunotherapy should be used at the same time.
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Affiliation(s)
- Chuyao Sun
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Department of Radiation Oncology, The Fourth Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Miao Zhang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Qiao Qiao
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yanli Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
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10
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Masarwy R, Kampel L, Horowitz G, Gutfeld O, Muhanna N. Neoadjuvant PD-1/PD-L1 Inhibitors for Resectable Head and Neck Cancer: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147:871-878. [PMID: 34473219 DOI: 10.1001/jamaoto.2021.2191] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The emerging approach of neoadjuvant immunotherapy for solid cancers has set the ground for the integration of programmed cell death 1 (PD-1)/PD-1 ligand 1 (PD-L1) inhibitors into the neoadjuvant setting of head and neck squamous cell carcinoma (HNSCC) treatment. Objective To assess the reported efficacy and safety of neoadjuvant immunotherapy for resectable HNSCC. Data Sources and Study Selection Electronic databases, including PubMed (MEDLINE), Embase, the Cochrane Library, and ClinicalTrials.gov were systematically searched for published and ongoing cohort studies and randomized clinical trials that evaluate neoadjuvant immunotherapy for resectable HNSCC. The search results generated studies from 2015 to July 2021. Data Extraction and Synthesis Two investigators (R.M. and L.K.) independently identified and extracted articles for potential inclusion. Random and fixed models were used to achieve pooled odds ratios. All results are presented with 95% CIs. Data quality was assessed by means of the Cochrane Collaboration's risk of bias tool. Main Outcomes and Measures The primary outcomes were reported efficacy, evaluated by major pathological response and pathological complete response in the primary tumors and lymph nodes separately, and safety, assessed by preoperative grade 3 to 4 treatment-related adverse events and surgical delay rate. Results A total of 344 patients from 10 studies were included. In 8 studies, neoadjuvant immunotherapy only was administered, and the other 2 studies combined immunotherapy with neoadjuvant chemotherapy and/or radiotherapy. The overall major pathological response rate in the primary tumor sites from studies reporting on neoadjuvant immunotherapy only was 9.7% (95% CI, 3.1%-18.9%) and the pathological complete response rate was 2.9% (95% CI, 0%-9.5%). Preoperative grade 3 to 4 treatment-related adverse events were reported at a rate of 8.4% (95% CI, 0.2%-23.2%) and surgical delay at a rate of 0% (95% CI, 0%-0.9%). There was a favorable association of neoadjuvant immunotherapy with all outcome measures. The subgroup analyses did not find one specific anti-PD-1/PD-L1 agent to be superior to another, and the favorable association was demonstrated by either immunotherapy alone or in combination with anti-CTLA-4. Conclusions and Relevance In this systematic review and meta-analysis, neoadjuvant anti-PD-1/PD-L1 immunotherapy for resectable HNSCC was well tolerated and may confer therapeutic advantages implied by histopathological response. Long-term outcomes are awaited.
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Affiliation(s)
- Razan Masarwy
- Department of Otolaryngology-Head and Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liyona Kampel
- Department of Otolaryngology-Head and Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology-Head and Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Gutfeld
- Institute of Radiation Therapy, Division of Oncology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology-Head and Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sellami S, Leclere JC, Lucia F, Gobel Y, Uguen A, Rousset J, Gouders D, Pradier O, Marianowski R, Abgral R, Schick U. N3 (> 6 cm) squamous cell carcinoma of the head and neck: outcomes and predictive factors in 104 patients. ACTA ACUST UNITED AC 2021; 41:221-229. [PMID: 34264915 PMCID: PMC8283407 DOI: 10.14639/0392-100x-n1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022]
Abstract
Objective To report outcome and predictive factors in patients with N3 (> 6 cm) non-metastatic locally advanced head and neck squamous cell carcinoma (LAHNSCC) treated with a conservative approach or with initial surgery. Methods 104 patients were included: 69 treated with radiotherapy (RT) ± chemotherapy (CT) and 35 with nodal surgery with or without primary tumour resection, which was completed in 30 patients by adjuvant RT ± CT. Positron-emission tomography-computed tomography (PET-CT) guided surveillance after RT ± CT was standard. Results Two-year overall survival (OS) and locoregional control (LRC) were 39.4% and 37.5%, respectively. In univariate analysis, body mass index (BMI), performance status (PS), p16 status and haemoglobin value influenced OS and disease-free survival (DFS). In multivariate analysis, p16 positive status and BMI ≥ 25 remained independent prognostic factors for better OS (p = 0.023) and DFS (p = 0.002). Only under/normal weight remained an independent and adverse significant prognostic factor in multivariate analysis for regional control (RC). Patients treated with primary RT ± CT had slightly better 2-year OS (43.5% versus 33.3%, p = 0.31). Conclusions Patients with N3 LAHNSCC have poor prognosis, but long term LRC is achievable, especially in overweight patients and those with a good PS.
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Affiliation(s)
| | - Jean Christophe Leclere
- Oncology Department, University Hospital, Brest, France.,Head and Neck Surgery Unit, University Hospital, Brest, France
| | - François Lucia
- Oncology Department, University Hospital, Brest, France.,INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
| | - Yves Gobel
- Head and Neck Surgery Unit, University Hospital, Brest, France
| | - Arnaud Uguen
- Pathology Unit, University Hospital, Brest, France
| | - Jean Rousset
- Department of Radiology, University Hospital of Brest and Military Hospital, Brest, France
| | - Dominique Gouders
- Radiation Oncology Department, Hospital de Cornouaille, Quimper, France
| | - Olivier Pradier
- Oncology Department, University Hospital, Brest, France.,INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
| | | | - Ronan Abgral
- Nuclear Medicine, University Hospital, Brest, France
| | - Ulrike Schick
- Oncology Department, University Hospital, Brest, France.,INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
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12
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Chitsike L, Duerksen-Hughes PJ. Targeted Therapy as a Potential De-Escalation Strategy in Locally Advanced HPV-Associated Oropharyngeal Cancer: A Literature Review. Front Oncol 2021; 11:730412. [PMID: 34490123 PMCID: PMC8418093 DOI: 10.3389/fonc.2021.730412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
The treatment landscape of locally advanced HPV-oropharyngeal squamous cell carcinoma (OPSCC) is undergoing transformation. This is because the high cures rates observed in OPSCC are paired with severe treatment-related, long-term toxicities. These significant adverse effects have led some to conclude that the current standard of care is over-treating patients, and that de-intensifying the regimens may achieve comparable survival outcomes with lower toxicities. Consequently, several de-escalation approaches involving locally advanced OPSCC are underway. These include the reduction of dosage and volume of intensive cytotoxic regimens, as well as elimination of invasive surgical procedures. Such de-intensifying treatments have the potential to achieve efficacy and concurrently alleviate morbidity. Targeted therapies, given their overall safer toxicity profiles, also make excellent candidates for de-escalation, either alone or alongside standard treatments. However, their role in these endeavors is currently limited, because few targeted therapies are currently in clinical use for head and neck cancers. Unfortunately, cetuximab, the only FDA-approved targeted therapy, has shown inferior outcomes when paired with radiation as compared to cisplatin, the standard radio-sensitizer, in recent de-escalation trials. These findings indicate the need for a better understanding of OPSCC biology in the design of rational therapeutic strategies and the development of novel, OPSCC-targeted therapies that are safe and can improve the therapeutic index of standard therapies. In this review, we summarize ongoing research on mechanism-based inhibitors in OPSCC, beginning with the salient molecular features that modulate tumorigenic processes and response, then exploring pharmacological inhibition and pre-clinical validation studies of candidate targeted agents, and finally, summarizing the progression of those candidates in the clinic.
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Farlow JL, Brenner JC, Lei YL, Chinn SB. Immune deserts in head and neck squamous cell carcinoma: A review of challenges and opportunities for modulating the tumor immune microenvironment. Oral Oncol 2021; 120:105420. [PMID: 34218062 DOI: 10.1016/j.oraloncology.2021.105420] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/03/2021] [Accepted: 06/17/2021] [Indexed: 01/02/2023]
Abstract
Immunotherapy revolutionized cancer treatment but has yet to elicit durable responses in the majority of patients with head and neck squamous cell carcinoma (HNSCC). HNSCC is generally characterized by a high tumor mutational burden, which has translated to a large neoantigen load that could prime the immune system to recognize and eliminate malignant cells. Studies are increasingly showing, however, that HNSCC is an "immune desert" tumor that can hijack multiple parts of the tumor immunity cycle in order to evade immune recognition and suppress immune system activation. Herein we will review how HNSCC tumors modulate their architecture, cellular composition, and cytokine milieu to maximize immunosuppression; as well as relevant therapeutic opportunities and emerging issues facing the field of HNSCC immuno-oncology.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA; Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA
| | - Yu L Lei
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA; Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA; Department of Periodontics and Oral Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA; Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA.
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Altay-Langguth A, Balermpas P, Brandts C, Balster S, Ghanaati S, Winkelmann R, Burck I, Rödel F, Martin D, Rödel C, von der Grün J. Re-irradiation with concurrent and maintenance nivolumab in locally recurrent and inoperable squamous cell carcinoma of the head and neck: A single-center cohort study. Clin Transl Radiat Oncol 2021; 28:71-78. [PMID: 33889760 PMCID: PMC8050105 DOI: 10.1016/j.ctro.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 12/21/2022] Open
Abstract
Combination of in-field ReRT and nivolumab for locally recurrent HNSCC is feasible. No unexpected radiation-related toxicity occurred. CRP-, hemoglobin-levels, and neutrophil/lymphocyte ratio were associated with LPFS.
Background The rate of loco-regional recurrences for locally advanced head and neck squamous cell carcinoma (HNSCC) following standard treatment reaches up to 50%, accompanied by a probability of 20% to develop a second primary tumor in the head and neck region. Methods Ten patients with inoperable, in-field recurrence of HNSCC following previous primary or adjuvant radiotherapy (RT) in combination with concurrent platinum-based chemotherapy were re-irradiated with 60 Gray in 30 fractions between December 2017 and January 2020 with concurrent and maintenance nivolumab administration. Data were retrospectively collected and compared with patients who underwent re-irradiation (ReRT) with concurrent cisplatin following propensity score matching (PSM). Local progression-free survival (LPFS) and overall survival (OS) were visualized using Kaplan-Meier method (log-rank test). Results All patients completed ReRT. Median number of applied courses of nivolumab was 12 (range, 3–38). OS rate was 50% at 12 months and the median OS was 11 (range, 2–23) months. Six and 12 month LPFS rates were 60% and 30%, respectively. Median LPFS was 8 (range, 2–19) months. OS and LPFS rates were not inferior to those of patients treated with concurrent cisplatin. No unexpected radiation-related toxicity occurred. A total of four patients developed any-grade immune-related adverse events of which two presented with grade 3 toxicities. One patient died within 3 weeks after ReRT. Higher blood levels of CRP (p = 0.004), lower levels of hemoglobin (p = 0.029) and higher neutrophil/lymphocyte ratio (p = 0.004) were associated with impaired LPFS. Higher recursive portioning analysis (RPA) class was associated with impaired LPFS (p = 0.022) and OS (p = 0.024). Conclusion The combination of ReRT and nivolumab for locally recurrent HNSCC was feasible without occurrence of unexpected toxicities. Combined radioimmunotherapy might offer an effective treatment option for carefully selected pre-irradiated patients ineligible for salvage surgery.
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Affiliation(s)
- Alev Altay-Langguth
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Panagiotis Balermpas
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Christian Brandts
- Department of Medicine, Hematology and Oncology, University Hospital, Goethe University, 60590 Frankfurt am Main, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg and German Cancer Consortium (DKTK), Partner Site Frankfurt am Main/Mainz, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Sven Balster
- Department of Otorhinolaryngology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Shahram Ghanaati
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Ria Winkelmann
- Senckenberg Institute of Pathology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Iris Burck
- Department of Diagnostic and Interventional Radiology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Franz Rödel
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg and German Cancer Consortium (DKTK), Partner Site Frankfurt am Main/Mainz, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Daniel Martin
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg and German Cancer Consortium (DKTK), Partner Site Frankfurt am Main/Mainz, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg and German Cancer Consortium (DKTK), Partner Site Frankfurt am Main/Mainz, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Jens von der Grün
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg and German Cancer Consortium (DKTK), Partner Site Frankfurt am Main/Mainz, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- Corresponding author at: Department of Radiotherapy and Oncology, University Hospital, Goethe University, 60590 Frankfurt am Main, Germany.
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Bozic T, Sersa G, Kranjc Brezar S, Cemazar M, Markelc B. Gene electrotransfer of proinflammatory chemokines CCL5 and CCL17 as a novel approach of modifying cytokine expression profile in the tumor microenvironment. Bioelectrochemistry 2021; 140:107795. [PMID: 33789177 DOI: 10.1016/j.bioelechem.2021.107795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/19/2022]
Abstract
The effectiveness of immunotherapy highly correlates with the degree and the type of infiltrated immune cells in the tumor tissue. Treatments based on modifying the immune cell infiltrate of the tumor microenvironment are thus gaining momentum. Therefore, the aim of our study was to investigate the effects of gene therapy with two proinflammatory chemokines CCL5 and CCL17 on inflammatory cytokine expression profile and immune cell infiltrate in two murine breast tumor models, 4T1 and E0771, and two murine colon tumor models, CT26 and MC38. In vitro, lipofection of plasmid DNA encoding CCL5 or CCL17 resulted in changes in the cytokine expression profile similar to control plasmid DNA, implying that the main driver of these changes was the entry of foreign DNA into the cell's cytosol. In vivo, gene electrotransfer resulted in high expression levels of both Ccl5 and Ccl17 transgenes in the 4T1 and CT26 tumor models. Besides a minor increase in the survival of the treated mice, the therapy also resulted in increased expression of Cxcl9 and Ifnγ, potent activators of the immune system, in CT26 tumors. However, this was not recapitulated in changes of TME, implying that a further refinement of the dosing schedule is needed.
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Affiliation(s)
- T Bozic
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000 Ljubljana, Slovenia
| | - G Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia; Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, SI-1000 Ljubljana, Slovenia
| | - S Kranjc Brezar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia
| | - M Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia; Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia.
| | - B Markelc
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia; Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, SI-1000 Ljubljana, Slovenia.
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