Head and neck cancers account for 3 to 5 percent of all cancers in the United States and can occur in the oral and nasal cavities, the sinuses, the throat, the larynx, the salivary glands, and the thyroid. When diagnosed early, many head and neck cancers can be cured with combinations of surgery, radiation, and chemotherapy.
Researchers in the Head and Neck Cancer Treatment Center at Dana-Farber/Brigham and Women’s Cancer Center have shown that carefully tailored regimens involving surgery and combined chemotherapy/radiation can often save tissues and structures like the larynx and vocal cords, which are vital to good quality of life.
Advanced cases can be difficult to treat, and much of the current research focuses on testing combinations of medications – including a number of new drugs – with the aim of prolonging survival. Several clinical trials involving surgical techniques and novel drugs are available through Dana-Farber’s Head and Neck Oncology Program. One trial is looking at a procedure called cryoablation – using instruments that remove cancerous tissues by freezing them– to treat head, neck and spine tumors.
Until the past decade or two, most head and neck cancers occurred in people who drank or smoked heavily, or were exposed to industrial chemicals. Now, a greater proportion of cases are associated with infection with the human papilloma virus (HPV) through sexual transmission.
Studies have revealed that head and neck cancers caused by HPV infection respond better to treatment and patients have a better outlook than those linked to alcohol, tobacco and chemical exposure. It’s been suggested that patients with HPV-caused cancer might be successfully treated with lower doses of radiation and have less severe side effects. Trials are underway to determine if reduced doses can be safely given to these patients.
Other trials are comparing the effectiveness of new drugs against standard therapies. Among them are nivolumab, an immunotherapy drug, and afitinib, a tyrosine kinase inhibitor.
Jochen Lorch, MD, MS, a specialist in thyroid cancers, says thyroid cancer therapy has seen major developments in treatment options. For example, researchers are carrying out a number of trials of new drugs, including molecularly targeted agents, for patients with advanced thyroid cancer.
Many studies have also focused on using tyrosine kinase inhibitors, which have shown to be quite active in treating thyroid cancer. “At Dana Farber, we have also explored the use of a entirely different type of drug, targeting the mTOR molecule. We found that efficacy was very high, especially in patients with certain types of genetic abnormalities,” Lorch says.
“We are currently exploring this strategy in different types of thyroid cancer and are seeing remarkable level of activity,” Lorch adds. “We are envisioning a future where patients with a specific set of genetic markers are matched with the optimal drug to ensure the best possible outcome.”