S. Laban

[New aspects of current therapeutic strategies in oropharyngeal carcinoma: highlights of the 2012 ASCO meeting].

Beside the surgical treatment of head and neck cancer, the concept of organ and function preserving therapy of locally advanced HNSCC (head and neck squamous cell carcinoma) especially of oropharyngeal origin is becoming increasingly important. The comparison of induction chemotherapy plus chemoradiation and primary concomitant chemoradiation has recently been the subject of randomized clinical trials. New combinations of different (chemo)radiation regimens and targeted therapies are also under investigation for HNSCC. Molecular markers predicting treatment efficacy as well as new potential targets are also being evaluated in several clinical trials. The good prognosis of HPV-associated HNSCC has sparked efforts to deintensify treatment to minimize therapy-related toxicities. The impact of specific therapies is growing due to the increasing incidence of young patients with HPV-positive carcinomas.ZusammenfassungNeben der chirurgischen Therapie von Kopf-Hals-Tumoren wird heutzutage vor allem bei lokal fortgeschrittenen Stadien von Oropharynxkarzinomen eine organ- und funktionserhaltende Therapie angestrebt. Gegenstand aktueller prospektiver Studien ist der direkte Vergleich zwischen Induktionschemotherapie plus  Radiochemotherapie (RCT) und einer primär konkomitanten RCT. Neue Ansätze von Kombinationen aus Radio(chemo)therapie und Target-Therapeutika werden ebenfalls in klinischen Studien untersucht. Molekularbiologische Parameter und potenzielle neue therapeutische Targets werden in zahlreichen Studien evaluiert. Die günstige Prognose HPV-positiver Tumoren führt zu dem Wunsch, aktuelle Therapieregime zu deintensivieren, um den Patienten unnötige Toxizitäten zu ersparen. Die Bedeutung spezifischer Therapien nimmt aufgrund der stetig steigenden Inzidenz an HPV-positiven Karzinomen bei jungen Patienten zu.AbstractBeside the surgical treatment of head and neck cancer, the concept of organ and function preserving therapy of locally advanced HNSCC (head and neck squamous cell carcinoma) especially of oropharyngeal origin is becoming increasingly important. The comparison of induction chemotherapy plus chemoradiation and primary concomitant chemoradiation has recently been the subject of randomized clinical trials. New combinations of different (chemo)radiation regimens and targeted therapies are also under investigation for HNSCC. Molecular markers predicting treatment efficacy as well as new potential targets are also being evaluated in several clinical trials. The good prognosis of HPV-associated HNSCC has sparked efforts to deintensify treatment to minimize therapy-related toxicities. The impact of specific therapies is growing due to the increasing incidence of young patients with HPV-positive carcinomas.

Neue Therapieaspekte bei Rezidiv und Fernmetastase des Kopf- und Hals-Karzinoms

The majority of patients with a squamous cell carcinoma of the head and neck region (HNSCC) initially present in a locally advanced stage of the disease. Despite aggressive protocols in first-line treatment, some of these patients develop locoregional recurrences or metastases and are, in particular, extraordinarily challenging for the multidisciplinary treatment team. Therefore, among resectability and prior therapy, age, performance status and individual expectations of the patient have to be taken into account. Apart from surgical options like salvage surgery, chemotherapy and target therapy as well as reirradiation are possible treatment concepts. Unfortunately, most treatment options offer only little to no survival benefit.ZusammenfassungDer überwiegende Anteil von Patienten mit einem Plattenepithelkarzinom der Kopf- und Halsregion („head and neck squamous cell carcinoma“, HNSCC) präsentiert sich bereits bei der Erstvorstellung in einem regional sehr fortgeschrittenen Stadium der Erkrankung. Einige dieser Patienten entwickeln trotz mitunter sehr aggressiver Behandlungsprotokolle in der Erstlinientherapie ein lokoregionäres Rezidiv oder Metastasen. Dieses Patientengut stellt eine besondere Herausforderung an das multidisziplinäre Behandlungsteam dar. Neben Operabilität und vorangegangener Therapie müssen daher auch Patientenalter, der Leistungsstatus und die individuellen Wünsche des Patienten in die Entscheidungsfindung mit einbezogen werden. Abgesehen von chirurgischen Optionen wie der Salvage-Chirurgie stellen die Chemo- und die Target-Therapie sowie die Reradiatio mögliche Behandlungskonzepte dar. Leider bieten die meisten Behandlungsmöglichkeiten nur einen geringen bis keinen Überlebensvorteil.AbstractThe majority of patients with a squamous cell carcinoma of the head and neck region (HNSCC) initially present in a locally advanced stage of the disease. Despite aggressive protocols in first-line treatment, some of these patients develop locoregional recurrences or metastases and are, in particular, extraordinarily challenging for the multidisciplinary treatment team. Therefore, among resectability and prior therapy, age, performance status and individual expectations of the patient have to be taken into account. Apart from surgical options like salvage surgery, chemotherapy and target therapy as well as reirradiation are possible treatment concepts. Unfortunately, most treatment options offer only little to no survival benefit.

Neue Aspekte zur aktuellen Therapie von Oropharynxkarzinomen

Beside the surgical treatment of head and neck cancer, the concept of organ and function preserving therapy of locally advanced HNSCC (head and neck squamous cell carcinoma) especially of oropharyngeal origin is becoming increasingly important. The comparison of induction chemotherapy plus chemoradiation and primary concomitant chemoradiation has recently been the subject of randomized clinical trials. New combinations of different (chemo)radiation regimens and targeted therapies are also under investigation for HNSCC. Molecular markers predicting treatment efficacy as well as new potential targets are also being evaluated in several clinical trials. The good prognosis of HPV-associated HNSCC has sparked efforts to deintensify treatment to minimize therapy-related toxicities. The impact of specific therapies is growing due to the increasing incidence of young patients with HPV-positive carcinomas.ZusammenfassungNeben der chirurgischen Therapie von Kopf-Hals-Tumoren wird heutzutage vor allem bei lokal fortgeschrittenen Stadien von Oropharynxkarzinomen eine organ- und funktionserhaltende Therapie angestrebt. Gegenstand aktueller prospektiver Studien ist der direkte Vergleich zwischen Induktionschemotherapie plus  Radiochemotherapie (RCT) und einer primär konkomitanten RCT. Neue Ansätze von Kombinationen aus Radio(chemo)therapie und Target-Therapeutika werden ebenfalls in klinischen Studien untersucht. Molekularbiologische Parameter und potenzielle neue therapeutische Targets werden in zahlreichen Studien evaluiert. Die günstige Prognose HPV-positiver Tumoren führt zu dem Wunsch, aktuelle Therapieregime zu deintensivieren, um den Patienten unnötige Toxizitäten zu ersparen. Die Bedeutung spezifischer Therapien nimmt aufgrund der stetig steigenden Inzidenz an HPV-positiven Karzinomen bei jungen Patienten zu.AbstractBeside the surgical treatment of head and neck cancer, the concept of organ and function preserving therapy of locally advanced HNSCC (head and neck squamous cell carcinoma) especially of oropharyngeal origin is becoming increasingly important. The comparison of induction chemotherapy plus chemoradiation and primary concomitant chemoradiation has recently been the subject of randomized clinical trials. New combinations of different (chemo)radiation regimens and targeted therapies are also under investigation for HNSCC. Molecular markers predicting treatment efficacy as well as new potential targets are also being evaluated in several clinical trials. The good prognosis of HPV-associated HNSCC has sparked efforts to deintensify treatment to minimize therapy-related toxicities. The impact of specific therapies is growing due to the increasing incidence of young patients with HPV-positive carcinomas.

[Immunomodulation as innovative therapy for head and neck tumors : Current developments].

Head and neck squamous cell carcinoma (HNSCC) is characterized by its intense immune suppression and its elaborate immune escape mechanisms. Due to the fact that survival rates remain low, the role of immunotherapy has become more important and the focus of current clinical studies has shifted toward antibody-based immune checkpoint modulation. Application of immunotherapy in curative settings or for prevention of recurrent disease would be desirable.ZusammenfassungDas Plattenepithelkarzinom des Kopf-Hals-Bereichs (PKH) ist durch seine starke Immunsuppression und ausgeprägte Immune-escape-Mechanismen gekennzeichnet. Die immuntherapeutischen Ansätze gewinnen weiter an Bedeutung, wobei sich die Studienlandschaft deutlich in Richtung antikörperbasierter Immuncheckpointmodulation verschoben hat. Der Einsatz der Immuntherapie als kurativer Ansatz oder als Rezidivprophylaxe ist anzustreben.AbstractHead and neck squamous cell carcinoma (HNSCC) is characterized by its intense immune suppression and its elaborate immune escape mechanisms. Due to the fact that survival rates remain low, the role of immunotherapy has become more important and the focus of current clinical studies has shifted toward antibody-based immune checkpoint modulation. Application of immunotherapy in curative settings or for prevention of recurrent disease would be desirable.

[The most important results on primary chemoradiation for head and neck squamous cell carcinoma: highlights from the 2012 ASCO meeting].

ZusammenfassungDie primäre Radiochemotherapie wird in konkomitanter und sequenzieller Form in der Therapie von Kopf-Hals-Tumoren zunehmend verwendet. Beim jährlichen Meeting der American Society of Clinical Oncology 2012 wurden zahlreiche Studien zu diesem Thema vorgestellt. Eine Auswahl dieser Studien wird in diesem Artikel vorgestellt. Unter anderem werden Ergebnisse mehrerer Phase-III-Studien – auch über den lang erwarteten Vergleich von Induktionschemotherapie und konkomitanter Radiochemotherapie – präsentiert.AbstractPrimary concomitant and sequential chemoradiation is a commonly used therapeutic strategy for head and neck squamous cell carcinoma. At the annual meeting of the 2012 American Society of Clinical Oncology numerous trial results were presented. A selection of the most important trials will be summarized in this article. This year, several important results from phase III trials—including the long awaited comparison of sequential and concomitant chemoradiation—were demonstrated.Primary concomitant and sequential chemoradiation is a commonly used therapeutic strategy for head and neck squamous cell carcinoma. At the annual meeting of the 2012 American Society of Clinical Oncology numerous trial results were presented. A selection of the most important trials will be summarized in this article. This year, several important results from phase III trials-including the long awaited comparison of sequential and concomitant chemoradiation-were demonstrated.

[New aspects in the therapy of recurrence and metastasis of head and neck cancer: highlights from the 2012 ASCO meeting].

The majority of patients with a squamous cell carcinoma of the head and neck region (HNSCC) initially present in a locally advanced stage of the disease. Despite aggressive protocols in first-line treatment, some of these patients develop locoregional recurrences or metastases and are, in particular, extraordinarily challenging for the multidisciplinary treatment team. Therefore, among resectability and prior therapy, age, performance status and individual expectations of the patient have to be taken into account. Apart from surgical options like salvage surgery, chemotherapy and target therapy as well as reirradiation are possible treatment concepts. Unfortunately, most treatment options offer only little to no survival benefit.ZusammenfassungDer überwiegende Anteil von Patienten mit einem Plattenepithelkarzinom der Kopf- und Halsregion („head and neck squamous cell carcinoma“, HNSCC) präsentiert sich bereits bei der Erstvorstellung in einem regional sehr fortgeschrittenen Stadium der Erkrankung. Einige dieser Patienten entwickeln trotz mitunter sehr aggressiver Behandlungsprotokolle in der Erstlinientherapie ein lokoregionäres Rezidiv oder Metastasen. Dieses Patientengut stellt eine besondere Herausforderung an das multidisziplinäre Behandlungsteam dar. Neben Operabilität und vorangegangener Therapie müssen daher auch Patientenalter, der Leistungsstatus und die individuellen Wünsche des Patienten in die Entscheidungsfindung mit einbezogen werden. Abgesehen von chirurgischen Optionen wie der Salvage-Chirurgie stellen die Chemo- und die Target-Therapie sowie die Reradiatio mögliche Behandlungskonzepte dar. Leider bieten die meisten Behandlungsmöglichkeiten nur einen geringen bis keinen Überlebensvorteil.AbstractThe majority of patients with a squamous cell carcinoma of the head and neck region (HNSCC) initially present in a locally advanced stage of the disease. Despite aggressive protocols in first-line treatment, some of these patients develop locoregional recurrences or metastases and are, in particular, extraordinarily challenging for the multidisciplinary treatment team. Therefore, among resectability and prior therapy, age, performance status and individual expectations of the patient have to be taken into account. Apart from surgical options like salvage surgery, chemotherapy and target therapy as well as reirradiation are possible treatment concepts. Unfortunately, most treatment options offer only little to no survival benefit.

Immunmodulation als innovative Therapie bei Kopf-Hals-Tumoren@@@Immunomodulation as innovative therapy for head and neck tumors: Aktuelle Entwicklungen@@@Current developments

Head and neck squamous cell carcinoma (HNSCC) is characterized by its intense immune suppression and its elaborate immune escape mechanisms. Due to the fact that survival rates remain low, the role of immunotherapy has become more important and the focus of current clinical studies has shifted toward antibody-based immune checkpoint modulation. Application of immunotherapy in curative settings or for prevention of recurrent disease would be desirable.ZusammenfassungDas Plattenepithelkarzinom des Kopf-Hals-Bereichs (PKH) ist durch seine starke Immunsuppression und ausgeprägte Immune-escape-Mechanismen gekennzeichnet. Die immuntherapeutischen Ansätze gewinnen weiter an Bedeutung, wobei sich die Studienlandschaft deutlich in Richtung antikörperbasierter Immuncheckpointmodulation verschoben hat. Der Einsatz der Immuntherapie als kurativer Ansatz oder als Rezidivprophylaxe ist anzustreben.AbstractHead and neck squamous cell carcinoma (HNSCC) is characterized by its intense immune suppression and its elaborate immune escape mechanisms. Due to the fact that survival rates remain low, the role of immunotherapy has become more important and the focus of current clinical studies has shifted toward antibody-based immune checkpoint modulation. Application of immunotherapy in curative settings or for prevention of recurrent disease would be desirable.

Neue Aspekte der primären Radiochemotherapie bei Kopf-Hals-Tumoren@@@New aspects of primary radiochemotherapy in head and neck cancer: Highlights vom ASCO-Kongress 2011@@@Highlights from the 2011 ASCO Congress

ZusammenfassungDie primäre Radiochemotherapie ist vor allem bei Patienten zu erwägen, deren Organfunktion postoperativ nicht erhalten werden kann oder bei nichtresektablen Tumoren. Die intensitätsmodulierte Radiotherapie (IMRT) scheint zu einer geringeren Spättoxizität und damit zu einer Verbesserung der Lebensqualität zu führen. Ob die IMRT im Vergleich zu einer konventionellen Radiotherapie zu einer Verbesserung der lokalen Kontrolle führt, bleibt weiterhin offen. Die Langzeittoxizitäten der jeweiligen Therapie sind mit dem Patienten abzuwägen, um eine optimale Therapie mit minimalen Risiken zu erreichen. Neuere Ansätze mit einer Kombination aus Bestrahlung und biologischen Targettherapeutika sind ebenfalls eine Option. Diese Substanzen werden vermehrt in Therapieprotokolle integriert. Die prätherapeutischen Selektionskriterien für ein gutes Ansprechen auf eine sog. Targettherapie fehlen bislang.AbstractPrimary radiochemotherapy is a treatment option for patients with locally advanced or unresectable head and neck cancer. Compared to conventional radiotherapy, intensity-modulated radiotherapy (IMRT) is associated with fewer long-term toxicities and better quality of life. Whether IMRT improves local control in these patients needs to be further investigated. The risk factors and treatment toxicities must be taken into consideration and discussed with the patients. New approaches combining radiotherapy and biological targets are a treatment option. The implementation of these substances in treatment protocols is increasing. Sensitive and specific prognostic biomarkers for patient identification to optimize treatment selection are important, but reliable parameters are still missing.Primary radiochemotherapy is a treatment option for patients with locally advanced or unresectable head and neck cancer. Compared to conventional radiotherapy, intensity-modulated radiotherapy (IMRT) is associated with fewer long-term toxicities and better quality of life. Whether IMRT improves local control in these patients needs to be further investigated. The risk factors and treatment toxicities must be taken into consideration and discussed with the patients. New approaches combining radiotherapy and biological targets are a treatment option. The implementation of these substances in treatment protocols is increasing. Sensitive and specific prognostic biomarkers for patient identification to optimize treatment selection are important, but reliable parameters are still missing.

New aspects of primary radiochemotherapy in head and neck cancer. Highlights from the 2011 ASCO Congress

ZusammenfassungDie primäre Radiochemotherapie ist vor allem bei Patienten zu erwägen, deren Organfunktion postoperativ nicht erhalten werden kann oder bei nichtresektablen Tumoren. Die intensitätsmodulierte Radiotherapie (IMRT) scheint zu einer geringeren Spättoxizität und damit zu einer Verbesserung der Lebensqualität zu führen. Ob die IMRT im Vergleich zu einer konventionellen Radiotherapie zu einer Verbesserung der lokalen Kontrolle führt, bleibt weiterhin offen. Die Langzeittoxizitäten der jeweiligen Therapie sind mit dem Patienten abzuwägen, um eine optimale Therapie mit minimalen Risiken zu erreichen. Neuere Ansätze mit einer Kombination aus Bestrahlung und biologischen Targettherapeutika sind ebenfalls eine Option. Diese Substanzen werden vermehrt in Therapieprotokolle integriert. Die prätherapeutischen Selektionskriterien für ein gutes Ansprechen auf eine sog. Targettherapie fehlen bislang.AbstractPrimary radiochemotherapy is a treatment option for patients with locally advanced or unresectable head and neck cancer. Compared to conventional radiotherapy, intensity-modulated radiotherapy (IMRT) is associated with fewer long-term toxicities and better quality of life. Whether IMRT improves local control in these patients needs to be further investigated. The risk factors and treatment toxicities must be taken into consideration and discussed with the patients. New approaches combining radiotherapy and biological targets are a treatment option. The implementation of these substances in treatment protocols is increasing. Sensitive and specific prognostic biomarkers for patient identification to optimize treatment selection are important, but reliable parameters are still missing.Primary radiochemotherapy is a treatment option for patients with locally advanced or unresectable head and neck cancer. Compared to conventional radiotherapy, intensity-modulated radiotherapy (IMRT) is associated with fewer long-term toxicities and better quality of life. Whether IMRT improves local control in these patients needs to be further investigated. The risk factors and treatment toxicities must be taken into consideration and discussed with the patients. New approaches combining radiotherapy and biological targets are a treatment option. The implementation of these substances in treatment protocols is increasing. Sensitive and specific prognostic biomarkers for patient identification to optimize treatment selection are important, but reliable parameters are still missing.

Neue Aspekte der primären Radiochemotherapie bei Kopf-Hals-Tumoren

ZusammenfassungDie primäre Radiochemotherapie ist vor allem bei Patienten zu erwägen, deren Organfunktion postoperativ nicht erhalten werden kann oder bei nichtresektablen Tumoren. Die intensitätsmodulierte Radiotherapie (IMRT) scheint zu einer geringeren Spättoxizität und damit zu einer Verbesserung der Lebensqualität zu führen. Ob die IMRT im Vergleich zu einer konventionellen Radiotherapie zu einer Verbesserung der lokalen Kontrolle führt, bleibt weiterhin offen. Die Langzeittoxizitäten der jeweiligen Therapie sind mit dem Patienten abzuwägen, um eine optimale Therapie mit minimalen Risiken zu erreichen. Neuere Ansätze mit einer Kombination aus Bestrahlung und biologischen Targettherapeutika sind ebenfalls eine Option. Diese Substanzen werden vermehrt in Therapieprotokolle integriert. Die prätherapeutischen Selektionskriterien für ein gutes Ansprechen auf eine sog. Targettherapie fehlen bislang.AbstractPrimary radiochemotherapy is a treatment option for patients with locally advanced or unresectable head and neck cancer. Compared to conventional radiotherapy, intensity-modulated radiotherapy (IMRT) is associated with fewer long-term toxicities and better quality of life. Whether IMRT improves local control in these patients needs to be further investigated. The risk factors and treatment toxicities must be taken into consideration and discussed with the patients. New approaches combining radiotherapy and biological targets are a treatment option. The implementation of these substances in treatment protocols is increasing. Sensitive and specific prognostic biomarkers for patient identification to optimize treatment selection are important, but reliable parameters are still missing.Primary radiochemotherapy is a treatment option for patients with locally advanced or unresectable head and neck cancer. Compared to conventional radiotherapy, intensity-modulated radiotherapy (IMRT) is associated with fewer long-term toxicities and better quality of life. Whether IMRT improves local control in these patients needs to be further investigated. The risk factors and treatment toxicities must be taken into consideration and discussed with the patients. New approaches combining radiotherapy and biological targets are a treatment option. The implementation of these substances in treatment protocols is increasing. Sensitive and specific prognostic biomarkers for patient identification to optimize treatment selection are important, but reliable parameters are still missing.