Head and neck cancer is the seventh most common cancer in the world and the tumor covers the mouth, throat and nasal cavity, and symptoms and treatment vary by location 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 effectiveness can only last for about 2 to 3 months; and immunotherapy is only recently, PD-1 antibody therapy has successfully demonstrated efficacy and improved efficacy. prognosis.
It is a great honor for the online gene editing team to visit doctors who specialize in treating head and neck cancer, 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. ) doctor. As well as leading us to a deeper understanding of the current and latest treatment options for head and neck cancer, including photodynamic therapy (PDA) and photoimmunotherapy, the two doctors also shared with us their experience using treatments new and their prospects. • Future trends in head and neck cancer therapy.
Early diagnosis and early treatment has 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 means and difficulty of diagnosis and treatment also vary according to the location of the tumor. 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 recognize, they are often caused by the initial diagnosis Late stage, which increases the difficulty of subsequent treatment.
Dr Lou emphasized: “Because there are many tumor sites for head and neck cancer, the doctor’s treatment strategy will be determined by the tumor site, stage and degree of invasion.” The initial standard treatment for head and neck cancer is surgery and radiation therapy, but only about a 70% control rate. Dr Lou went on to explain that early stage oral cancer should be treated with surgery, while advanced stage patients should be treated with an additional combination of systemic chemotherapy and local radiotherapy after surgery. This treatment strategy is also seen in pharyngeal cancer. Early stage patients undergo surgical resection alone, while advanced or metastatic patients require combined chemotherapy and radiotherapy. It is worth noting that around 70-80% of head and neck cancers recur locally and are usually treated with local therapy.
Regarding local surgery, Dr. Ichiro Esaya, for advanced laryngeal cancer, that doctors often require patients to sacrifice vocal function; as for patients with oropharyngeal cancer, doctors will reconstruct the throat and intestines, and this major operation usually takes 7 -8 hours.
However, when head and neck cancer progresses to a recurrent or metastatic stage, treating the tumor becomes more difficult.
In addition to local surgical resection, radiation therapy is often used by doctors as local treatments for head and neck cancer. Radiation therapy includes photon therapy, proton therapy, neutron boron therapy, etc. , can improve the target Injury of tumor tissue. However, Dr Lou stressed that if patients with recurrent head and neck cancer have chosen to use radiotherapy in the first treatment, the effectiveness of later use of radiotherapy will not be as effective as first line treatment.
Dr said. Ichiro Trayaya: “When the treatment options for patients with recurrent head and neck cancer are limited because of this, photodynamic therapy will be a good alternative.”
Two-step local treatment (two-step local treatment) is a new type of treatment that combines non-toxic photosensitizer drugs and light wave sources. 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 head and neck cancer patients, Dr. Lou highly recommends the use of two-stage local therapy because of its relatively mild side effects and less damage to the surrounding tissue. The only possible limitation is that the energy of the light waves in the target tissue gradually decreases 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. the target tissue to eliminate the tumor.
To improve the effectiveness 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 produce fast speed. immune response to target cells with minimal damage to surrounding tissues.
After treating oral and throat cancer with the combined Alluminox™ drug ASP-1929 (Japanese trade name: Akalux), Dr. Ichiro Esuya is very happy to see that the tumors in his patients are effective within 2-4 months after follow-up. Clear treatment. Because this precise therapy can target cells and deliver high concentrations of drugs, it brings a good prognosis and very few 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 recurrent or metastatic 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 globally randomized, Phase 3 clinical trials are also in full swing, evaluating the drug’s Efficacy and safety in head and neck tumors.
Dr said. Ichiro Trayaya: “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 go. .”
Although the results of the Phase 3 clinical trial of Alluminox™ have not yet been published, both doctors remain confident in the treatment, and both agree that it has the potential to become the next immunotherapy on 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 treating head and neck cancer in the future,” added Dr. Lou, “and because head and neck cancer is associated with tumor suppression Gene defects are more related, not caused by overexpression of oncogenes. Defects in tumor gene suppression 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 cancers to treat, due to the limited effectiveness of systemic chemotherapy, and immunotherapy and radiation therapy are also looking for more breakthroughs. However, with the gradual accumulation of positive efficacy and safety data of emerging therapies such as photodynamic and photoimmune, more and more doctors now believe that they will become a trend in the treatment of head and neck cancer, and hope that they can be reduced treatment for patients. in the future, difficulty.
Further reading: New “Highlights” in Cancer Medicine! Photoimmunotherapy improves glioblastoma￼ treatment outcomes
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