Notes on ESMO17: Head and neck cancer

Clinical Brief – September 15th

ESMO, or the European Society of Medical Oncology Congress, is an annual gathering of cancer experts and patient advocates. Here are some studies from this year’s ESMO that may be of use.

EBV viral load may be used to assess the risk of relapse and worse disease outcomes for non-metastatic nasopharyngeal carcinoma (a rare type of head and neck cancer).

Researchers from Taiwan looked through records of about 350 patients newly diagnosed with stage III nasopharyngeal carcinoma. All patients were treated with chemo and radiation.

Of patients with EBV viral load above 1,000 copies/mL, 33% experienced tumor relapse; vs 12% for those whose viral load was under 1,000 copies/mL.

Fewer patients with EBV viral load above 1,000 copies/mL survived beyond 5 years vs those with viral load under 1,000 copies/mL (79% vs 93%).

Abstract #1094P

Does hyper-progression after immunotherapy exist among patients with head and neck cancer?

Researchers from two cancer centers in Spain looked through the records of 46 patients in immunotherapy trials between 2014 and 2016.

They did not detect hyper-progression in their limited patient sample, but they did find nine patients they call “early progressors” (about 20%). These patients experienced cancer progression within 2 months of their immunotherapy treatment and rapid deterioration in their overall health.

It’s hard to tell how to identify early progressors though, based on such a small patient sample.

Abstract #1058P

Collaboration between oncologists and geriatricians may help optimize treatment for elderly patients with head and neck cancer.

In a study lead by Gustave Roussy, France, researchers gave oncologist a suited geriatric evaluation to assess their patients’ physical fitness for treatment. The evaluation covers physical function, comorbidity, cognition, mental health status, social status, and nutrition.

After using the evaluation, 8% of patients had their treatments changed. The rate of patients needing multidisciplinary interventions was significantly higher when the assessment was also performed by a geriatrician (71% vs 51%).

Abstract #1050PD

Radiation with high-dose chemo isn’t necessarily better than with low-dose chemo for head and neck cancer.

In an analysis of data from the Veteran’s Administration Corporate Data Warehouse, researchers found that radiation with high-dose chemo was not associated with better survival over low-dose chemo, after adjusting for physical fitness.

In sub-analyses based on where the cancer was initially found, they noted that radiation with high-dose chemo was linked to some survival benefit for those with cancers of the oropharynx (mouth and voice box).

High-dose chemo was associated with more renal failure, neutropenia, dehydration or electrolyte disturbances, and hearing loss.

Abstract #1064P

For more presentations from #ESMO17, take a look at my hand-curated Twitter moment 🤓.

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