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Oncology Pharmacy Consults
Targeting the Immune System in Head and Neck Squamous-Cell Carcinoma
Head and neck cancer is recognized worldwide as the seventh most common type of cancer. In the United States, head and neck squamous-cell carcinoma (HNSCC) is responsible for 3% of diagnosed cancers annually.1Despite marked progress in the development of conventional therapy options, survival rates for patients with HNSCC have failed to improve. Surgery and radiotherapy are currently the standard treatment options for patients with HNSCC.2 Patients with early stage disease are usually treated with surgery and/or radiation alone; combined-modality treatment approaches, including surgery, radiation, and chemotherapy, are used in patients with locally advanced disease.1-3 Exploitation of aberrant epidermal growth-factor receptor (EGFR) signaling led to the development of the first and only targeted therapy – EGFR monoclonal antibody (mAB) cetuximab. However, cetuximab resistance represents a major challenge in treatment, and the benefits of this mAB in the recurrent setting are modest at best.4-5
Despite these treatment paradigms, 30% to 60% of patients develop local recurrences, and 20% develop distant metastases.1 The immune system plays a key role in the regulation of patients with HNSCC, and recent advances in our understanding of the immune system have accelerated the development of immunotherapies for treating patients with cancer overall, including HNSCC. Novel immunotherapies that target the programmed death-ligand 1 (PD-LI)/programmed death receptor-1 (PD-1) pathway have shown promise in treating patients with recurrent and metastatic HNSCC, and recent approvals of the PD-1 inhibitors nivolumab and pembrolizumab represent a new era in the treatment of HNSCC.6-8
As a part of the patient's healthcare team, pharmacists need to ensure the appropriate selection of medications, monitor treatment, evaluate the efficacy of the treatment, manage adverse effects, and educate patients. Pharmacists are also uniquely positioned to provide guidance and education to patients and other healthcare providers about changing oncology treatment paradigms, adverse event management, adherence monitoring, and therapeutic effectiveness related to new and emerging targeted therapies. This activity will enable pharmacists to better understand the prevailing challenges in HNSCC treatment, and in so doing, pharmacists will learn about the limitations of current cytotoxic and targeted therapies and be better able to evaluate the mechanisms of current and emerging immunotherapies, their unique response patterns, and strategies to manage immune-related adverse events (irAEs).
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