A recent study explored a new way to treat certain patients with head and neck cancer. The researchers tested whether combining radiation therapy with a drug called cetuximab could improve patient outcomes compared to radiation therapy alone.
The focus was on people who had squamous cell cancer of the head and neck (SCCHN), specifically those who had surgery but still needed additional treatment to reduce the risk of cancer returning.
The study, known as the NRG-RTOG 0920 trial, included 577 patients with cancer in areas like the oral cavity, throat, or voice box. These patients had intermediate-risk factors, meaning they needed radiation after surgery but were not suitable for stronger treatments like high-dose cisplatin chemotherapy.
Most of the patients (85%) had tumors with high levels of a protein called EGFR, which plays a role in cancer growth.
In the study, patients were randomly divided into two groups. One group received only radiation therapy (RT), while the other group received radiation therapy combined with weekly doses of cetuximab (C+RT). Cetuximab is a drug that targets EGFR and is designed to stop cancer cells from growing.
The researchers wanted to see if this combination could help patients live longer (overall survival) and if it could reduce the risk of cancer returning (disease-free survival). They also examined whether adding cetuximab would increase side effects.
After following the patients for more than seven years, the researchers found mixed results. Adding cetuximab did not significantly improve how long patients lived overall.
The five-year survival rate was slightly better for those who received cetuximab (76.5%) compared to those who had only radiation (68.7%), but the difference was not large enough to be considered statistically significant.
However, the study did show that cetuximab improved disease-free survival, meaning it helped reduce the risk of cancer returning or spreading. At five years, 71.7% of patients who received cetuximab were disease-free, compared to 63.6% of those who had only radiation.
This benefit was seen mainly in patients whose cancers were not caused by HPV (human papillomavirus). About 80% of the study participants had HPV-negative cancer, which tends to have worse outcomes compared to HPV-positive cancer.
In terms of side effects, there were some differences between the two groups. Patients who received cetuximab had higher rates of severe short-term side effects (70.3%) compared to those who had only radiation (39.7%).
These side effects included issues like skin reactions and mouth sores. However, there was no significant increase in long-term side effects, and no patients in either group experienced life-threatening toxicity.
Dr. Mitchell Machtay, the lead researcher, emphasized that the study provides a new option for treating certain patients with HPV-negative head and neck cancer.
For those who cannot tolerate cisplatin-based chemotherapy, adding cetuximab to radiation therapy could be a suitable alternative. He noted that the treatment needs to be carefully tailored to individual patients to balance the benefits and risks.
Analysis of the Study Findings
This study highlights the challenges of improving outcomes for patients with head and neck cancer. While the addition of cetuximab to radiation therapy did not significantly extend overall survival, it did reduce the risk of cancer returning, particularly for HPV-negative patients.
This finding is important because these patients often have worse outcomes and fewer effective treatment options.
The increase in short-term side effects with cetuximab suggests that the treatment may not be suitable for everyone.
Doctors need to carefully assess each patient’s situation, considering factors like overall health, cancer type, and ability to handle side effects. For patients who cannot receive stronger chemotherapy, this approach offers a promising alternative.
Overall, the study provides valuable insights into the treatment of head and neck cancer. While it does not offer a complete solution, it adds an important option for patients who need additional therapies after surgery.
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The research findings can be found in the Journal of Clinical Oncology.
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