Personalizing Head & Neck Cancer Therapy to minimize treatment-related toxicity

Head and Neck Cancers (HNC) remain a significant cause of morbidity worldwide. These cancers arise from the oral cavity, pharynx, larynx, salivary glands, nasal cavity and paranasal sinuses. They are characterized by distinct clinical, pathological and molecular features with different predisposing factors (e.g. smoking, viruses), presenting natural histories, and treatment outcomes. Fortunately, HNCs are rare in Canada. However, with more than 850 patients being referred annually to the Princess Margaret Cancer Centre for radiation oncology consultations, the Radiation Medicine Program (RMP) HNC program is one of the largest HNC programs in North America.

While delivering state-of-the-art radiation therapy (RT) and comprehensive care to our patients, the RMP HNC team appreciates the complexities and personal challenges of each patient’s cancer journey. The management of HNC with radiation and concurrent chemotherapy is one of the most challenging treatments any cancer patient can receive as an outpatient. Patients require a tremendous amount of support that can only be provided by a comprehensive multidisciplinary team, comprised of radiation oncologists, medical oncologists, surgical oncologists, physicists, radiation therapists, nurses, dietitians and speech pathologists. Some patients require psychosocial oncology support.

MICHAEL JOHN was diagnosed with oropharyngeal cancer (OPC) and was recommended curative radiation therapy and concurrent chemotherapy at the Princess Margaret. With the support of the HNC multidisciplinary team, he is now well on his way to recovery from his treatments. “I was still in shock from my diagnosis when I first met Dr. John Waldron and his team. His calmness and confidence were very reassuring. Nearly four months after starting my treatment, I still have uncomfortable dry mouth, and do not have all my sense of taste back (a big loss for someone who loves to cook!), but I am making progress. I am on the road to recovery.”

Michael’s story highlights the continued need to investigate improvements in cancer care for HNC through innovative research, with a particular emphasis on reducing treatment-related side effects while still maintaining excellent cancer control outcomes. The RMP HNC Program is at the forefront of high-impact transdisciplinary research, spanning from basic science to translational, clinical outcomes and clinical trials research.

A recent focus of the RMP HNC Site Group has been the investigation of treatment de-intensification in a subset of patients with virus-related HNCs, including human papillomavirus (HPV)-associated OPC and Epstein-Barr virus (EBV)-associated nasopharyngeal cancer (NPC). In landmark studies recently published in the Journal of Clinical Oncology, RMP investigators, in collaboration with multidisciplinary researchers at the University Health Network, reported pivotal findings elucidating the clinical differences between HPV-related and HPV-unrelated OPC, demonstrating that some HPV-positive OPC patients with a low risk of metastatic disease can be successfully treated with RT alone and spared chemotherapy. These results have provided key data supporting the development of an international multicentre randomized clinical trial (NRG-HN002) evaluating de-intensified therapy for this group of HPV-related OPC patients, which has been launched this year.

The RMP HNC team continues to make great strides towards advancing personalized radiation medicine with improved treatment outcomes and reduced side effects, ultimately to enhance the quality of life for our HNC patients. 
Written by Dr. John Waldron, Radiation Oncologist for Connexions published by the Radiation Medicine Department of Princess Margaret Cancer Centre. Photo of Michael John courtesy of Donna Santos Studios.