Head and neck cancer is the seventh most common cancer in the world. The tumor covers the mouth, throat, and nasal cavity, and the symptoms and treatment vary according to the location of the tumor. However, due to the unique nature of this cancer, head and neck cancer is one of the most difficult cancers to treat with only one approved targeted therapy, Cetuximab. In terms of chemotherapy, Cisplatin has been the main drug for head and neck cancer since the 1970s, but the efficacy can only last for regarding 2 to 3 months; and immunotherapy is only recently, PD-1 antibody therapy has successfully shown better efficacy and prognosis .
It is a great honor for the online gene editing team to visit physicians specializing in the treatment of head and neck cancer, namely Dr. Lou Pei-ren, Vice President of National Taiwan University Hospital, and Ichiro Tateya, Director of Head and Neck Surgery at Fujita Health University in Japan. ) physician. In addition to leading us to have a deeper understanding of the current and latest treatment options for head and neck cancer, including photodynamic therapy (PDA) and photoimmunotherapy, the two physicians also shared with us their experience in the use of new treatments and their prospects. Future trends in head and neck cancer therapy.
Current head and neck cancer treatment options
Early diagnosis and early treatment have always been the best way to improve the prognosis of cancer therapy, and head and neck cancer is no exception. However, due to the variety of cancer types in head and neck cancer, the mode and difficulty of diagnosis and treatment also vary according to the tumor site. Taking oral cancer as an example, the early symptoms are oral ulcers that cannot heal for more than two weeks; and the early symptoms of laryngeal tumors are hoarseness. Because the symptoms are relatively mild and difficult to identify, it is often caused by the initial diagnosis. Late stage, which increases the difficulty of subsequent treatment.
Dr. Lou emphasized: “Because there are several tumor sites for head and neck cancer, the physician’s treatment strategy will be determined according to the tumor site, stage and degree of invasion.” The initial standard treatment for head and neck cancer is surgery and radiation therapy, but only regarding 70% control rate. Dr. Lou went on to explain that early-stage oral cancer cases should be treated with surgery, while advanced-stage patients should be treated with additional combination of systemic chemotherapy and local radiotherapy following surgery. This treatment strategy can also be seen in pharyngeal cancer. Early-stage patients simply undergo surgical resection, while advanced or metastatic patients require combined chemotherapy and radiotherapy. It is worth mentioning that regarding 70-80% of head and neck cancer recurrences are localized and are usually treated with local therapy.
In terms of local surgery, Dr. Ichiro Esaya said that for advanced laryngeal cancer, doctors often require patients to sacrifice vocal function; as for patients with oropharyngeal cancer, doctors will reconstruct the throat and intestines, and this major surgery usually takes 7 -8 hours.
However, when head and neck cancer progresses to a recurrent or metastatic stage, the treatment of the tumor becomes more difficult.
Topical, two-stage therapy will be a therapeutic turnaround
In addition to local surgical resection, radiation therapy is often used by physicians as local treatments for head and neck cancer. Radiation therapy covers photon therapy, proton therapy, boron neutron therapy, etc. Its curative effect and prognosis are getting better and better with the advancement of science and technology; the side effects are much smaller than that of systemic therapy, but at the same time, it can improve the target Injury of tumor tissue. However, Dr. Lou emphasized that if patients with recurrent head and neck cancer have chosen to use radiotherapy in the first treatment, the efficacy of later use of radiotherapy will not be as effective as that of first-line treatment.
Dr. Ichiro Trayaya said: “When the treatment options for patients with recurrent, advanced head and neck cancer are limited due to this, photodynamic therapy will be a good alternative.”
Two-stage localized treatment (two-stage localized treatment) is a new type of treatment that combines non-toxic photosensitizer drugs and light wave sources. Toxic. Photodynamic therapy and more recently photoimmunotherapy fall into this category, and have been widely used to treat a variety of cancers, such as pancreatic, bladder, and lung cancers.
For patients with head and neck cancer, Dr. Lou highly recommends the use of two-stage local therapy because of its relatively weak side effects and less damage to the surrounding tissue. The only potential limitation is that the energy of the light waves in the target tissue gradually diminishes with the depth of the tissue; therefore, it is important to design the therapy so that the energy of the light waves can be distributed as evenly as possible to the target tissue to eliminate the tumor.
The Alluminox™ Platform: New Potential Therapies Targeting Cancer Cells
To enhance the efficacy of photoimmunotherapy, Lotte Pharma has developed the Alluminox™ therapeutic platform, which contains an antibody-dye conjugate that selectively binds to the surface of target cells and activates the drug through non-thermal light waves , which in turn produces a rapid immune response to target cells with minimal damage to surrounding tissues.
After treating oral cancer and throat cancer with Alluminox™ drug conjugate ASP-1929 (Japanese trade name: Akalux), Dr. Ichiro Esuya was very happy to see that the tumors in his patients were effective within 2-4 months of follow-up following treatment Clear. Because this precision therapy can target cells and deliver high concentrations of drugs, it brings good prognosis and minimal side effects to patients. Allluminox™ also brings a good impression to Dr. Lou.
Akalux is now conditionally approved in Japan for the treatment of locally metastatic or recurrent head and neck cancer. However, this drug is still in Phase 2 clinical trials in Taiwan to evaluate the efficacy of combination therapy with PD1 antibody therapy; and global randomized, Phase 3 clinical trials are also in full swing, evaluating the drug Efficacy and safety in head and neck tumors.
Dr. Ichiro Trayaya said: “Our ultimate goal is to make this drug a standard treatment for head and neck cancer, but this needs to pass a Phase 3 clinical trial. In other words, Alluminox™ has a long way to go. to go.”
Looking to the future of head and neck cancer therapy
Although the results of the Phase 3 clinical trial of Alluminox™ have not yet been announced, both physicians remain confident in the treatment, and both agree that it has the potential to become the next immunotherapy for head and neck cancer.
“Compared to other treatment options in use today, Alluminox™ is very effective, and I personally think it will be one of the important options for the treatment of head and neck cancer in the future,” added Dr. Lou, “and because head and neck cancer is associated with tumor suppression Defects of genes are more related, not caused by over-expression of oncogenes. Defects in inhibiting tumor genes often cause DNA damage. Therefore, targeted therapy for DNA damage repair may also be an area of great potential. “
Head and neck cancer has always been one of the most difficult and difficult to treat cancers, because of the limited efficacy of systemic chemotherapy, and immunotherapy and radiation therapy are also seeking more breakthroughs. However, with the gradual accumulation of positive efficacy and safety data of emerging therapies such as photodynamic and photoimmune, more and more physicians now believe that they will become the treatment trend of head and neck cancer, and hope that they can be reduced treatment for patients in the future. difficulty.
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