The World Health Organization’s Globocan Project ranked head and neck cancer (HNC) as the 6th most common cancer worldwide. There are an estimated 650,000 cases across the world, with 200,000 deaths annually. It may not be as popular as breast or lung cancer, however, the burden of having HNC has escalated over the years and the need for better and more responsive treatment has been the focus of recent clinical trials and medical research.
If detected early, HNC is often curable. But in many cases, patients ignore the early signs and symptoms. Many are diagnosed in the later stages and doctors will be in a race to save the patient’s life.
“HNC interrupts the social functioning of an individual. Patients most often suffer pain from swallowing and rely on feeding tubes, which could lead to significant weight loss. There may be deformity in the face and neck due to treatments. Further, they also experience speech and communication problems which impact their quality of life,” explained Dr. Margaret Louise McGrath, senior staff specialist at the Medical Oncology Division of Cancer Services at Princess Alexandra Hospital, Queensland, in describing how HNC affects a person’s life.
HNC includes cancer of the lip, tongue, salivary glands, gums and other oral cavity tissues such as the inner lining of the cheeks, floor of the mouth, tonsils, throat or pharynx, voice box or larynx, lymph nodes in the neck, nasal cavity, sinuses and ears.
Since HNC involves organs of the digestive and respiratory tract, tumors often affect patient’s social and personal life. It can also affect eating, and breathing. If left undetected and untreated, HNC becomes more life-threatening.
Clinical Trials Bring Hope
One of the breakthrough findings of these clinical trials is the efficacy of immunotherapy treatment which is considered the new hope against lung cancer and melanoma, and now, also for those with head and neck cancer.
Immunotherapy is the use of antibody treatment drug like pembrolizumab to activate a patient’s immune system and fight off cancer without killing the healthy cells. Immunotherapy is already used as first line treatment against lung cancer and melanoma.
For HNC patients, immunotherapy clinical trials have shown a positive response rate and bring better hope for remission and recovery. This was elaborated by Dr. McGrath in her tea symposium held at the annual gathering of the Philippine Society of Medical Oncology, wherein she cited that there is 20 percent overall response rate for HNC patients treated with immunotherapy.
In the Philippines, immunotherapy is usually given as second or further line of treatment of head and neck cancers, as healthcare practitioners wait for more favourable trial results before administering immunotherapy for first-line treatment.
Immunotherapy vs Chemotherapy
According to McGrath, chemotherapy is generally used for recurrent HNC cases, showing 10 to 15 percent response rate in 5 to 6 months of chemotherapy treatment duration. She also added that nausea, appetite loss, alopecia and renal problems are associated with chemotherapy.
Compared to the traditional standard of care treatment of chemotherapy, Dr. McGrath observed that patients given immunotherapy had less toxicity levels and side effects which are more manageable and easily treated. Effect on the patient’s appetite is less in immunotherapy. There is better pain control and social functioning. It won’t have the same detrimental effect. Potential related side effects are very low, very manageable and can be reversed”, noted McGrath.
Importance of Screening and Patient Education
Despite the new hope offered by immunotherapy, Dr. McGrath reiterated the importance of screening and early diagnosis. “If you have symptoms like sore throat, lesions, sores that do not away, get checked”, McGrath said. Chances of cure are higher when the cancer is treated in the early stages, as the patient’s body is more receptive to treatment.
“Immunotherapy can make a big difference in patients’ quality of life in their fight against HNC, but they need to better understand their condition first, and learn if they can be given immunotherapy or combination treatment of immunotherapy paired with chemotherapy or radiation,” she emphasized.
Screening and testing are necessary to determine the suitability of a patient for immunotherapy. The tumour, the patient’s biology, and current medical status, each play an important role in coming up with diagnosis and tailor-fitting treatments for patients.
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