The approval of Pembrolizumab drug for head and neck squamous cell carcinoma after progression of platinum based chemotherapy is an indicative advancement for treatment of the disease.
Barbara A Burtness, MD Professor of Medicine, Clinical research program leader, Head and Neck Cancers Program at Yale Cancer Center said that "Immunotherapy is a big change for head and neck cancer and there seems to be no doubt that there is activity for immunotherapies with pembrolizumab as well as nivolumab [Opdivo]"
‘Approval of Pembrolizumab for head and neck cancer might indicate significant potential of cancer immunotherapy.’
"But one question that still remains is, 'Will there be a role for these agents in first-line therapy for patients with metastatic recurrent disease who have not previously failed a platinum-based approach?' she added.
In an interview with Onc Live, Barbara A Burtness said that there are three ongoing clinical trials for the use of immunotherapy in the first- line treatment of head and neck cancer. Two trials focused on combinations of CTLA-4 with a PD-1 drug being compared with standard cetuximab. While the other trial focused on combining chemotherapy with immunotherapy.
The trial mainly studied the use of pembrolizumab monotherapy with pembrolizumab chemotherapy using an FDA standard chemotherapy with cetuximab. And was also able to produce modest response rates for about 18% .
Regarding the independent benefits of immunotherapy and chemotherapy, pembrolizumab with chemotherapy may produce positive effects of chemotherapy along with durability of immune response.
Burtness also said that, tolerability of immunotherapies are found to be pleasing and the trial would help to prove the tolerability of integrated chemotherapy with immunotherapy. This could also be synergistic as chemotherapy could kill the cells due to DNA damage and release antigens.
To combine standard therapy with immunotherapy, burtness said that it can be either given first, during radiation or after radiation therapy.
And administration of radiation therapy can produce more tumor - infiltrating lymphocytes and upregulation of PD-1 expression.
On going trial can produce upregulation of PD-1 and augmentation of TILs for immunotherapy. And may produce results on the response rate after radiation.