Zusammenfassung
Hintergrund
In den letzten Jahren zeigt sich auch bei den speziellen Tumorentitäten im Kopf-Hals-Bereich eine zunehmende Studiendynamik. Bei den onkologischen Tagungen der American Society of Clinical Oncology (ASCO) und European Society for Medical Oncology (ESMO) 2021 wurden einige Studien vorgestellt, welche Änderungen im klinischen Alltag von Nasopharynxkarzinom, Speicheldrüsenkarzinom und Schilddrüsenkarzinom erwarten lassen.
Ziel der Arbeit
Zukünftige Therapieneuerungen spezieller HNO-Tumorentitäten wurden nach Sichtung der auf den Tagungen ASCO 2021 und ESMO 2021 präsentierten klinischen Studien abgeschätzt.
Material und Methoden
Es erfolgte eine systematische Analyse der präsentierten klinischen Phase-II- und -III-Studien zur Behandlung von Nasopharynx‑, Speicheldrüsen- und Schilddrüsenkarzinomen. Unter Berücksichtigung der aktuellen Therapiestandards wurden die Ergebnisse bezüglich ihrer potenziell klinischen Bedeutung eingeordnet.
Ergebnisse und Diskussion
In der kurativen Therapie von fortgeschrittenen Nasopharynxkarzinomen ist eine adjuvante Therapie mit Capecitabin nach primärer Radiochemotherapie als neuer Standard zu diskutieren. In der palliativen Therapie von Nasopharynxkarzinomen ist eine zunehmende Rolle von Immuntherapien zu prognostizieren. Rezidivierte/metastasierte Speicheldrüsenkarzinome werden bei Vorliegen molekularer angreifbarer Zielläsionen mit zielgerichteten Substanzen teilweise sehr effektiv behandelt. Immuntherapien spielen aktuell eine untergeordnete Rolle, scheinen sie nur bei wenigen Patienten mit Speicheldrüsenkarzinomen effektiv zu sein, die sich aktuell durch prädiktive Marker nicht verlässlich identifizieren lassen. Patienten mit radioiodrefraktären differenzierten Schilddrüsenkarzinom profitieren nach Versagen einer VEGFR-TKI-Therapie („vascular endothelial growth factor receptor“, Tyrosinkinaseinhibitor) von einer Therapie mit dem Multi-TKI Cabozantinib.
Abstract
Background
In recent years the number of studies on special tumor entities in the head and neck region has increased. During the 2021 meetings of the American Society of Clinical Oncology (ASMO) and the European Society for Medical Oncology (ESMO), several studies were presented which predict changes in clinical treatment algorithms for nasopharyngeal carcinoma, salivary gland, and thyroid cancer.
Objective
Future treatment alterations in specific head and neck tumor entities were evaluated after screening clinical studies presented at the 2021 ASCO and ESMO meetings.
Materials and methods
A systematic analysis of the phase II and III clinical trials for nasopharyngeal carcinoma, salivary gland, and thyroid cancer treatment presented at ASCO and ESMO 2021 was performed. Taking into account current treatment standards, the results are structured in terms of their potential clinical significance.
Results and conclusion
In curative treatment of advanced nasopharyngeal carcinoma, adjuvant therapy with capecitabine after primary chemoradiation should be discussed as a new standard. In the palliative treatment of nasopharyngeal carcinoma, an increasing role of immunotherapy can be predicted. Recurrent or metastatic salivary gland cancer can often be treated very effectively with targeted substances if molecular target lesions are present. Immunotherapies currently play a subordinate role; they only seem to be effective in a few patients with salivary gland cancer, who cannot currently be reliably identified using predictive markers. Patients with radioiodine-refractory differentiated thyroid cancer benefit from treatment with the multi-tyrosine kinase inhibitor cabozantinib after failure of vascular endothelial growth factor receptor–tyrosine kinase inhibitor (VEGFR-TKI) therapy.
Literatur
Chen YP, Chan ATC, Le QT et al (2019) Nasopharyngeal carcinoma. Lancet 394(10192):64–80. https://doi.org/10.1016/S0140-6736(19)30956-0
Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492
Petit C, Lee A, Carmel A et al (2020) Network-meta-analysis of chemotherapy in nasopharyngeal carcinoma (MAC-NPC): An update on 8,221 patients. J Clin Oncol 38(15):6523. https://doi.org/10.1200/jco.2014.32.15_suppl.6022
Cao SM, Yang Q, Guo L et al (2017) Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A phase III multicentre randomised controlled trial. Eur J Cancer 75:14–23. https://doi.org/10.1016/j.ejca.2016.12.039
Empfehlungen des National Comprehensive Cancer Network NCCN. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437. Zugegriffen: 6. Nov. 2021
Chen L, Hu CS, Chen XZ et al (2012) Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol 13(2):163–171. https://doi.org/10.1016/S1470-2045(11)70320-5
Miao J, Wang L, Tan SH et al (2021) Adjuvant capecitabine in locoregionally advanced nasopharyngeal carcinoma: A multicenter randomized controlled phase III trial. J Clin Oncol 39(15):6005–6600
Ma J, Chen Y, Sun Y et al (2020) Metronomic capecitabine as adjuvant therapyin locoregionally advanced nasopharyngeal carcinoma: A phase 3, multicenter, randomized controlled trial. J Clin Oncol 39(15):6003
Zhang L, Huang Y, Hong S et al (2016) Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma: a multicentre, randomised, open-label, phase 3 trial. Lancet 388(10054):1883–1892. https://doi.org/10.1016/S0140-6736(16)31388-5
Cohen EEW, Soulieres D, Le Tourneau C et al (2019) Pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma (KEYNOTE-040): a randomised, open-label, phase 3 study. Lancet 393(10167):156–167. https://doi.org/10.1016/S0140-6736(18)31999-8
Hsu C, Lee SH, Ejadi S et al (2017) Safety and antitumor activity of pembrolizumab in patients with programmed death-Ligand 1‑positive Nasopharyngeal carcinoma: results of the KEYNOTE-028 study. J Clin Oncol 35(36):4050–4056. https://doi.org/10.1200/JCO.2017.73.3675
Chan ATC, Lee V, Hong R‑L et al (2021) Results of KEYNOTE-122: A phase III study of pembrolizumab (pembro) monotherapy vs chemotherapy (chemo) for platinum-pretreated, recurrent or metastatic (R/M) nasopharyngeal carcinoma (NPC). In: ESMO Congress 2021, 858O
Xu R, Mai H‑Q, Chen Q‑Y et al (2021) JUPITER-02: Randomized, double-blind, phase III study of toripalimab or placebo plus gemcitabine and cisplatin as first-line treatment for recurrent or metastatic nasopharyngeal carcinoma (NPC). J Clin Oncol 39(18_suppl):LBA2-LBA2. https://doi.org/10.1200/JCO.2021.39.15_suppl.LBA2
Zhang L, Yang Y, Qu S et al (2021) Camrelizumab versus placebo combined with gemcitabine and cisplatin for recurrent or metastatic nasopharyngeal carcinoma: A randomized, double-blind, phase 3 trial. J Clin Oncol 39(15_suppl):6000–6000. https://doi.org/10.1200/JCO.2021.39.15_suppl.6000
Markham A, Keam SJ (2019) Camrelizumab: first global approval. Drugs 79(12):1355–1361. https://doi.org/10.1007/s40265-019-01167-0
Keller G, Steinmann D, Quaas A et al (2017) New concepts of personalized therapy in salivary gland carcinomas. Oral Oncol 68:103–113. https://doi.org/10.1016/j.oraloncology.2017.02.018
Hong DS, Shen L, v. Tilburg CM et al (2021) Long-term efficacy and safety of larotrectinib in an integrated dataset of patients with TRK fusion cancer. J Clin Oncol 39(15_suppl):3108–3108. https://doi.org/10.1200/JCO.2021.39.15_suppl.3108
Hernando-Calvo A, Rezqalla A, Malona ER et al (2021) Molecular profiling and targeted agents in recurrent, metastatic salivary gland tumor (R/M SGT) patients (pts) treated at two academic centers. J Clin Oncol 39(15_suppl):6081. https://doi.org/10.1200/JCO.2021.39.15_suppl.6081
Swiecicki P, Tang Y, Pearson AT et al (2021) Trial in progress: A phase I/II trial of novel MDM2 inhibitor alrizomadlin (APG-115), with or without platinum chemotherapy, in patients with p53 wild-type salivary gland carcinoma. J Clin Oncol 39(15_suppl):TPS6094-TPS6094. https://doi.org/10.1200/JCO.2021.39.15_suppl.TPS6094
Rodriguez CP, Wu QV, Voutsinas J et al (2020) A phase II trial of pembrolizumab and vorinostat in recurrent metastatic head and neck squamous cell carcinomas and salivary gland cancer. Clin Cancer Res 26(4):837–845. https://doi.org/10.1158/1078-0432.CCR-19-2214
Burman B, Sherman EJ, Dunn L et al (2021) A phase II trial cohort of nivolumab plus ipilimumab in patients (Pts) with recurrent/metastatic salivary gland cancers (R/M SGCs). J Clin Oncol 39(15_suppl):6002–6002. https://doi.org/10.1200/JCO.2021.39.15_suppl.6002
Tchekmedyian V, Sherman EJ, Dunn L et al (2019) A phase II trial cohort of nivolumab plus ipilimumab in patients (Pts) with recurrent/metastatic adenoid cystic carcinoma (R/M ACC). J Clin Oncol 37(15_suppl):6084–6084. https://doi.org/10.1200/JCO.2019.37.15_suppl.6084
Okamura R, Kato S, Lee S et al (2020) ARID1A alterations function as a biomarker for longer progression-free survival after anti-PD-1/PD-L1 immunotherapy. J Immunother Cancer. https://doi.org/10.1136/jitc-2019-000438
Brose MS, Nutting CM, Jarzab B et al (2014) Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet 384(9940):319–328. https://doi.org/10.1016/S0140-6736(14)60421-9
Durante C, Haddy N, Baudin E et al (2006) Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab 91(8):2892–2899. https://doi.org/10.1210/jc.2005-2838
Singh A, Ham J, Po JW et al (2021) The genomic landscape of thyroid cancer tumourigenesis and implications for immunotherapy. Cells. https://doi.org/10.3390/cells10051082
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
H.B. Zech und C.S. Betz geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Additional information
QR-Code scannen & Beitrag online lesen
Rights and permissions
About this article
Cite this article
Zech, H.B., Betz, C.S. Spezielle Tumorentitäten im Kopf-Hals-Bereich. HNO 70, 278–286 (2022). https://doi.org/10.1007/s00106-022-01157-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00106-022-01157-x