Top advances of the year: Head and neck cancer

Abstract

AbstractAdvances in treatment deintensification for human papillomavirus‐associated oropharyngeal cancer include use of transoral surgery to permit reduction in pathologic risk‐based postoperative therapy after transoral resection. The E3311 cooperative group trial demonstrated 3‐year progression‐free survival (PFS) of 95% for intermediate risk patients treated with 50 Gy radiation alone, with no decrement for those with a smoking history. Favorable risk patients could be observed, with a 3‐year PFS of 93%. Reduction in radiation dose is also feasible for favorable risk patients (low or no smoking history and low stage) treated with chemoradiation on the NRG HN002 trial, where 2‐year PFS was 90.7%. For those favorable risk patients treated with radiation alone, 2‐year PFS was 87.7% and this arm did not meet criteria for further testing. Important phase 3 trials of immunotherapy in first‐line treatment of recurrent and/or metastatic head and neck cancer were also reported in 2022. For patients with nonnasopharyngeal sites of disease, the combination of the programmed death‐1–directed antibody nivolumab plus the anti–CTLA‐4 agent ipilimumab was not superior to chemotherapy plus cetuximab in the Checkmate 651 trial. However, in an important breakthrough for patients with nasopharyngeal cancer, the JUPITER‐02 trial, conducted in China, Singapore, and Taiwan among patients with predominantly Epstein‐Barr virus‐related cancers, demonstrated a significant improvement in PFS (hazard ratio, 0.52) when toripalimab was added to gemcitabine/cisplatin chemotherapy. Immature survival data indicate overall survival will likely also be impacted.