Head and Neck Cancer

Head and Neck Cancer

Since the 1970s, advances in therapies and surgical approaches to treating head and neck cancers have improved patients' survival and quality of life enormously. In the 2000s, the introduction of the first molecularly targeted drug brought additional hope for patients with certain advanced head and neck cancers. The ability to identify and effectively target more of the genetic drivers of head and neck cancers remains an urgent challenge for researchers.

Recent years have seen an increase in the number of head and neck cancers caused by the human papillomavirus (HPV). Research shows that HPV-driven tumors typically respond better to treatment, and the availability of an effective HPV vaccine offers the hope of eventually reducing the number of people affected by head and neck cancers worldwide.

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2015

More extensive surgery helps patients with early oral cancer live longer

More extensive surgery helps patients with early oral cancer live longer

A large study resolves a decades-long debate, confirming that for patients with certain types of early oral cancers, it’s better to remove both the primary tumor and nearby lymph nodes during initial surgery for oral cancer, rather than postponing lymph node removal until the cancer comes back. The study finds that performing more extensive surgery initially lowers the risk of cancer returning and extends survival. However, the study also noted this surgical approach has a higher risk of health complications, including difficulty moving the neck and shoulders and problems with talking and swallowing.

2010

HPV status and smoking affect prognosis for oropharyngeal cancer

2008

Adding cetuximab to initial chemotherapy extends survival for advanced cancers

Adding cetuximab to initial chemotherapy extends survival for advanced cancers

For the first time in nearly three decades (see 1991), researchers introduce a new initial ("induction") treatment strategy that extends survival for patients with advanced head and neck cancers. This strategy includes a combination of the targeted drug cetuximab (Erbitux) plus the previous standard treatment regimen, involving the chemotherapy drugs cisplatin or carboplatin with fluorouracil. Cetuximab – already available for patients with advanced disease receiving radiation therapy or whose disease progresses despite standard chemotherapy – is approved by the FDA for this broader use in 2011.

New research highlights role of HPV infection in head and neck

New research highlights role of HPV infection in head and neck

While studies over the prior decade had suggested a connection between HPV infection and oropharyngeal cancers, several studies offer important new insight. The first finds that DNA from HPV-16, one of the strains of HPV most commonly associated with cervical cancer, is present in nearly three-quarters of oropharyngeal tumor samples. These findings help spur research to determine if HPV vaccination could help prevent these cancers.

A second study finds that patients with certain squamous cell carcinomas of the oropharynx or larynx whose tumors test positive for the HPV virus have a better prognosis than patients with HPV-negative tumors treated with the same therapy. This is the first major study suggesting that HPV-related head and neck cancers are biologically different, and in some cases more treatable, than non-HPV-related cancers.

Around the same time, researchers report that U.S. cases of HPV-related head and neck cancers have risen nearly 1 percent each year since 1973.

Taxane therapy improves survival for several types of advanced head and neck cancers

Taxane therapy improves survival for several types of advanced head and neck cancers

Two large studies show that patients with advanced head and neck cancers who receive initial chemotherapy with docetaxel (Taxotere), together with the drugs cisplatin and fluorouracil, have substantially longer survival than patients who receive two-drug therapy. All patients in these studies had squamous cell carcinomas, which represent approximately 90 percent of head and neck cancers.

2006

Treatment with new targeted drug cetuximab prolongs life

Treatment with new targeted drug cetuximab prolongs life

Important data emerge on the value of the targeted drug cetuximab (Erbitux), showing this therapy extends survival and improves quality of life for patients with head and neck cancers.

One large trial shows that adding cetuximab to standard radiation therapy significantly extends the lives of patients with head and neck cancer that has not spread beyond this region of the body. Notably, the addition of cetuximab does not carry significant added side effects. Soon after, the FDA approves cetuximab for this use and in patients with advanced disease who have not responded to previous chemotherapy. Since the value of cetuximab has not yet been confirmed by additional positive trials, however, many researchers remain cautious about the drug's benefits.

1999

Chemoradiation shown conclusively to benefit patients with advanced disease

Chemoradiation shown conclusively to benefit patients with advanced disease

A major clinical trial confirms the value of giving carboplatin chemotherapy and standard radiation therapy together to patients with advanced oropharynx cancer. While the approach, called concurrent chemotherapy, causes more side effects than radiation treatment alone, patients receiving the concurrent therapy lived almost twice as long as the patients receiving radiation alone.

1994

Drug approved to help with saliva production

Drug approved to help with saliva production

Patients with head and neck cancers frequently experience chronic dry mouth, due to the effects of radiation therapy on the salivary glands. In 1994, the drug pilocarpine (Salagen), which can increase saliva production, is approved by the FDA for patients with head and neck cancer.

1992

Cigarette smoking and alcohol are conclusively linked to certain pharyngeal cancers

1991

Better organ preservation with initial chemotherapy and radiation

Better organ preservation with initial chemotherapy and radiation

A Phase III randomized trial shows that induction therapy, involving initial treatment with chemotherapy followed by radiation, is as effective as standard treatment but allows many patients with advanced laryngeal cancer to avoid surgical removal of their larynx and vocal cords. Until this time, such surgery, followed by radiation, was the only proven treatment for these patients.

This regimen – called induction therapy – remains the standard for more than a decade, until researchers discover that giving radiation and chemotherapy at the same time is more effective.

1990

Combination chemoradiation first emerges

Combination chemoradiation first emerges

Researchers report successful results of a new approach for head and neck cancer therapy – so-called "chemoradiation." This approach involves giving cisplatin chemotherapy and radiation together (concurrently), rather than one after the other (sequentially). The two-pronged approach helps prevent the spread of advanced squamous cell cancers of the head and neck to other parts of the body and causes greater tumor shrinkage, compared to radiation therapy alone.

Several years later, another trial finds that a similar approach – combining radiation with both cisplatin and fluorouracil chemotherapy – helps reduce the size of tumors enough so that patients can eventually undergo surgery to remove them. This approach is proven to significantly extend survival and reduce the risk of recurrence.

1985

Effective, less toxic two-drug therapy is introduced

Effective, less toxic two-drug therapy is introduced

Researchers first show that initial ("induction") chemotherapy with a combination of the drugs cisplatin and 5-fluorouracil results in high rates of tumor shrinkage in patients with advanced head and neck cancers. In 2007, larger trials show induction therapy also extends survival, firmly establishing this strategy as a standard treatment.

1970

High-dose methotrexate therapy results in significant tumor shrinkage

High-dose methotrexate therapy results in significant tumor shrinkage

Researchers discover that giving high doses of methotrexate – a chemotherapy drug already used to treat leukemia – followed by "leucovorin rescue" can shrink the majority of head and neck tumors by as much as 50 to 75 percent. Such shrinkage makes it possible for more patients to have their tumors surgically removed, offering some a chance of cure.

Around this time, researchers explore the benefits of giving increasingly large doses of methotrexate for a range of cancers, finding that it is safe and effective as long as patients receive carefully timed supportive treatment with leucovorin, which helps protect the bone marrow and other healthy cells from the otherwise damaging effects of methotrexate.