Researchers discover less invasive treatment for some head and neck cancers

A new study by researchers at the University of Colorado’s Anschutz Medical Campus has identified a less invasive way to treat a subset of head and neck cancers that might potentially change the standard of care for patients .

Non-HPV-related head and neck squamous cell carcinomas (HNSCC) generally do not elicit immune responses and have not responded well to immunotherapies. The current standard of care for these tumors begins with surgery that may require removal of the tongue or jaw and other facial and oral complications, followed by six weeks of radiation therapy with or without chemotherapy.

In a new study, just published in nature cancerAnschutz researchers detail a different approach to treating these tumors that uses radiation therapy combined with immunotherapy to invigorate the patient’s immune response and reduce immune exhaustion.

This approach, combined with a single cycle of the drug Durvalumab within a specific preoperative timeframe, prepares the immune system to kill most or all of the cancer before surgery. The level of success observed in this preoperative marriage of treatments is remarkable.

Of the 21 HNSCC patients in the Phase I/Ib dose escalation study, major pathological responses or complete responses were 75%, and 89% for those in the expansion cohort who received the optimal radiation dose. And for those in the expansion cohort with MPR/CR, none of them received radiation therapy or adjuvant chemotherapy despite having large tumors at presentation and none have recurred to date. The time to surgery was also critical to allow observation of the response and priming of the immune system.

“Our patients’ response to this dual treatment protocol has exceeded our expectations,” says Sana Karam, MD, PhD, corresponding author and member of the CU Cancer Center. “By combining treatment modalities, we were able to spare our patients’ lymph nodes and prime their immune systems, ultimately resulting in a less morbid treatment regimen.”

In translational analysis, Anschutz MD and PhD student Laurel Darragh observed a significant increase in T cell infiltration into the tumor and several biomarkers in the blood. Blood correlates might be detected preoperatively so it was clear prior to surgery who was going to respond to treatment. All patients then received 4 additional cycles of postoperative Durvalumab, but those who failed treatment did so despite adjuvant therapy.

“Our biggest lesson from these results is hope for our patients,” says Karam. “The response rates here are truly unprecedented, so we hope this work will lead to a significantly improved standard of care in how we treat these types of cancers.”

The researchers hope to move forward with these results to validate potential biomarkers in a larger, ongoing phase II trial.

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Material provided by University of Colorado Anschutz Medical Campus. Original written by Kelsea Pieters. Note: Content may be edited for style and length.