Innovative Strategies in Locally Advanced Head and Neck Cancer:
Focus on Targeting Inhibitor of Apoptosis Proteins
CPC Release: 10-06-2022
Valid for credit through: 09-06-2023
Duration: 1 hour
The management of locally advanced small cell carcinoma of the head and neck (LA SCCHN) is complex, and selecting the most appropriate treatment strategy for an individual patient requires a multidisciplinary team approach. Chemoradiotherapy (CRT) is the current gold standard for fit patients with LA SCCHN; however, despite treatment, many patients experience relapse. Research with new agents and combination strategies that may enhance the activity of CRT, and thereby lead to improved locoregional control and patient survival, is promising. In this Expert Review, leading experts in the field will discuss the current standard of care, the role of immunotherapy, and the rationale for targeting inhibitors of apoptosis proteins (IAPs), along with the clinical evidence of clinical activity of antagonists of IAPs, in SCCHN. An accompanying slide set will summarize the key data and treatment recommendations for the optimal management of patients with LA SCCHN.
Based on Expert Review recorded on April 28, 2022.
This program is available with subtitles in the following languages:
Ezra Cohen, MD
University of California San Diego
San Diego, California, US
Ezra Cohen is Chief of the Division of Hematology-Oncology and Co-Director of the San Diego Center for Precision Immunotherapy, California, US. A physician-scientist, Dr. Cohen led an independently funded laboratory interested in mechanisms of action of novel therapeutics. He has made major contributions to targeted and immunotherapy. His research has received peer-reviewed funding in the study of epidermal growth factor receptor inhibitors, cell therapy, and immunotherapy in head and neck cancer. He has made major contributions to the understanding of critical signaling pathways, integration of novel agents into standard of care, and definition of mechanisms to overcome resistance to drug therapy. He has also recently co-developed a personalized neoantigen vaccine using unique cancer mutations to boost an anti-tumor immune response.
Dr. Cohen is Associate Director for Clinical Science, Co-Leader of the Solid Tumor Therapeutics research program and Co-Director of the Hanna and Mark Gleiberman Head and Neck Cancer Center at Moores Cancer Center. Among other roles, he serves as a member of the Protocol Review and Monitoring Committee (PRMC), the Cancer Council, and the Cancer Center’s Executive Committee.
Jonathan D. Schoenfeld, MD, MPH
Dana-Farber Cancer Institute
Boston, Massachusetts, US
Jonathan Schoenfeld is an Associate Professor at Harvard Medical School in the Department of Radiation Oncology at Brigham and Women’s Hospital and a Senior Physician at Dana-Farber Cancer Institute, Massachusetts, US. He is a member of the Head and Neck Disease Center at the Dana-Farber Cancer Institute and the Cancer Immunology Program at the Dana-Farber / Harvard Cancer Center. He also serves as the Associate Director of Clinical Research within the Department of Radiation Oncology. He received his medical degree from the Harvard-MIT Division of Health Sciences and Technology at Harvard Medical School after completing a research fellowship as a Gates Scholar at the University of Cambridge in the UK. He performed his medical internship at Memorial Sloan Kettering Cancer Center, then completed residency in radiation oncology in the Harvard Radiation Program. He received a Master of Public Health in Clinical Effectiveness from the Harvard T.H. Chan School of Public Health. He serves on the NCI Radiation and Immune Modulation Working Group and the Radiation Developmental Therapeutics Subcommittee for NRG Oncology. His research focuses on clinical trials evaluating the use of novel agents and technology to improve the care of head and neck patients, and translational investigations related to immunotherapy and radiation.
Yungan Tao, MD, PhD
Yungan Tao is Chief Radiation Oncologist of head and neck / dermatology / endocrinology in the Department of Radiation Oncology at Institut Gustave-Roussy, Villejuif, France. Dr. Tao is Principal Investigator (PI) or co-PI of several international / European and French national clinical phase II/III studies, utilizing new radiotherapy technology, and investigating the association of targeted therapy or immunotherapy with chemoradiotherapy, for example. He is also interested in translational research, particularly regarding the radiosensitivity of head and neck cancer related to new targeted therapy and immuno-biomarkers. Dr. Tao’s recent publications as first/co-first/last author include JCO, Lancet Oncol, and Nature Reviews Clinical Oncology.
Dr. Tao is Vice-President and member of the executive committee and scientific committee of the French head and neck oncology radiotherapy group (GORTEC). He is also a member of the Scientific Committee of French Head and Neck Intergroup and a Radiation Oncology Expert in Unicancer Head and Neck Group. He is the key investigator/radiation oncologist in the Head and Neck Group of European Organisation for Research and Treatment of Cancer (EORTC) and Expert Panelist for the nasopharyngeal cancer project in the International Atomic Energy Agency (IAEA). Dr. Tao is also a board member at Head and Neck Cancer International Group (HNCIG).
Robert Coleman MBBS, MD, FRCP, FRCPE, FACP | Moderator
University of Sheffield
Robert (Rob) Coleman is Emeritus Professor of Medical Oncology in the Department of Oncology and Metabolism at the University of Sheffield, UK. He graduated in medicine from King’s College Hospital Medical School in 1978 and trained in London and Edinburgh before moving to Sheffield in 1991; he was instrumental in developing clinical cancer research in Sheffield and established an internationally respected bone oncology research team in the city. Professor Coleman has held many leadership roles within the university and the National Institute for Health Research (NIHR) Cancer Research Network. He has published over 450 peer-reviewed manuscripts and numerous book chapters, and is a Past-President of the Cancer and Bone Society and the founding editor of Journal of Bone Oncology.
During 2014–2019, Professor Coleman was a part-time Medical Director for the global independent medical education provider, prIME Oncology, developing and delivering both live and online educational activities for oncologists and other providers of cancer care. Since retiring from his formal position at the university in 2017, he remains active in research, lectures on his areas of expertise around the world, and provides consultancy to a medical education company as well as a range of pharma and biotech companies developing new oncology treatments.
Current Standard of Care for LA SCCHN
More than half of patients with head and neck cancer present with locally advanced disease, and high-risk patients continue to have a poor prognosis. The treatment of locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) is complex and requires a multidisciplinary team approach. Dr. Jonathan Schoenfeld, Dr. Ezra Cohen, and Dr. Yungan Tao discuss the current treatment strategies for these patients and challenges in achieving cure while preserving function and quality of life.
The Role of Immunotherapy in LA SCCHN
Based on improved survival, PD-1 immune checkpoint inhibitors (± chemotherapy) have become the standard of care for patients with recurrent/metastatic SCCHN. However, in patients with locally advanced disease, the results of several clinical trials evaluating the addition of PD-(L)1 inhibitors to conventional chemoradiotherapy have been disappointing. The expert panel discuss the potential reasons for immunotherapy failure, promising neoadjuvant immunotherapy approaches, and some ongoing, eagerly awaited trials that will hopefully help to define the role of immunotherapy in LA SCCHN.
Promising Strategies to Enhance Efficacy of (Chemo)radiotherapy in LA SCCHN
Novel strategies are needed to improve outcomes for patients with LA SCCHN. Enhancing chemoradiation by targeting Inhibitor of Apoptosis Proteins (IAPs), a class of proteins that regulate apoptosis and modulate immune responses, is currently the most promising strategy, and a phase III clinical trial is underway. Alternative targeted therapies in combination with (chemo)radiation are also being investigated. The expert panel review the available data for targeting IAPs and consider the future treatment landscape for patients with LA SCCHN.
This program is specifically designed for radiation oncologists, medical oncologists, and other members of the head and neck multidisciplinary team involved in the treatment of patients with head and neck cancer.
Upon completion of this educational activity, participants should be able to:
- Evaluate current treatment options for patients with unresectable LA SCCHN (HPV+ and HPV-)
- Explain whether immune checkpoint inhibitors have a role in the LA setting
- Identify and assess potential strategies to enhance CRT efficacy, including targeting inhibitors of apoptosis proteins (IAPs) in LA SCCHN
This activity is jointly provided by USF Health and ACE Oncology.
The information provided by this CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
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This educational activity is supported by an independent medical education grant from Merck KGaA, Darmstadt, Germany.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and ACE Oncology. USF Health is accredited by the ACCME to provide continuing medical education for physicians.
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Physician Assistants may claim a maximum of 1 hour Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.
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Date of original release: June 10, 2022. Date credit expired: June 9, 2023
Estimated time to complete activity: 1 hour
In order to receive credit for this activity, participants must:
- Read the information provided on this page regarding the target audience, learning objectives, and disclosures. Read and study the activity content, complete the post-test questions and the evaluation form.
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USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant financial relationships are listed below. All individuals not listed have no relevant financial relationships.
USF Health Office of Continuing Professional Development and ACE Oncology staff have no relevant financial interests/relationships or affiliations in relation to this activity.
Ezra Cohen, MD has served on the advisory board for Psioxus Therapuetics, Ayala, Kura, and Kinnate Biopharma. He has served as a consultant for Cel Sci, Eisai, Hoopika, Istari, Janssen, Kahr Medical, Mana Therapeutics, Mirati, Merck & Co (MSD), Nectin Tx, Pangea Therapeutics and Roche. He has stocks/shares with Kinnate Biopharma and Primmune Therapeutics.
Jonathan Schoenfeld, MD has served on the advisory board for Castle Biosciences, Genentech, Immunitas and Merck KGA. He has served as a consultant for Astellas and Stimit. He has received grants for clinical research from Bristol Myers Squibb, Regeneron, Debiopharm and Merck KGA. He has stocks/shares with Immunitas.
Yungan Tao, MD has served on the advisory board for Ipsen and Merck & Co.
Robert Coleman, MD has no financial interests/relationships or affiliations in relation to this activity.