Emerging patient-specific treatment modalities in head and neck cancer – a systematic review

ABSTRACT

Introduction: Head and neck cancer (HNC) is an immunosuppressive disease that demonstrates heterogeneous molecular characteristics and features of tumor–host interaction. Beside radiotherapy and surgery, the current standard of care in systemic treatment involves the use of cytotoxic chemotherapy, monoclonal antibodies (mAbs), and tyrosine kinase inhibitors (TKIs). There are also other modalities being developed under the category of immunotherapy, but they are overshadowed by the recent advancements of immune checkpoint inhibitors.

Areas covered: This systematic review covers recent advancements in ‘patient-specific’ treatment modalities, which can be only administered to a given patient.

Expert opinion: Currently, patient-specific treatment modalities in HNC mainly consist of active immunotherapy using adoptive cell therapies and/or gene engineered vectors. Despite the slow pace of development, the interest continues in these treatment modalities. The future of HNC treatment is expected to be guided by biomarkers and personalized approaches with tailored combinations of local treatments (radiotherapy, surgery), systemic agents and immune system modulation. Systematic research is required to generate robust data and obtain a high-level of evidence for the effectiveness of such treatment modalities.

KEYWORDS:

• Adoptive cell therapy
• cancer vaccine
• CAR T-cells
• clinical trials
• CRISPR
• gene editing
• head and neck cancer
• squamous-cell carcinoma
• targeted therapy

Article Highlights

• HNC is caused by exposure to carcinogenic substances (tobacco, alcohol, industrial chemicals) or oncogenic viruses (HPV, EBV) with distinct pathophysiology, biologic, and immune profiles.

• The head and neck squamous-cell carcinoma tumor microenvironment is strongly immunosuppressive

• Currently, all patient-specific treatment modalities in HNC are under development and mainly consist of active immunotherapy using adoptive cell therapies and/or gene engineered vectors.

• Despite of the emergence of advanced techniques, the current data suggest, that it is unlikely to find the ultimate cure for HNC using off-the-shelf or patient-specific immunotherapy in the coming years.

• The future of HNC treatment is expected to be guided by biomarkers and personalized with tailored combinations of local treatments (radiotherapy, surgery), systemic agents, and modulation of patients’ immune system.

• An ideal personalized and patient-specific treatment with 100% on-target action, efficacy and reproducibility, but 0% off-target action and toxicity is not expected in the near future.

This box summarizes the key points contained in the article.

Declaration of interest

O Elicin has received consultation fees from Merck Group, MSD and AstraZeneca and M Ozsahin has received consultation fees from AstraZeneca. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.