HEAD AND NECK: Edited by Joël Guigay
Things are changing for head and neck squamous cell carcinomas (HNSCC)!
Progress in cancer care are always eagerly awaited for our patients but the analysis of the successful stories in cancer research shows that we need to go step by step, and unfortunately, giant steps are rare. However, major changes have occurred for HNSCC within the past few years, casting in light the importance of clinical and translational researches to improve the results of therapies in this setting.
First, the increasing incidence of human papilloma virus (HPV)-related oropharyngeal cancers, widely covered in the media and social networks, has caused many physicians, labs and pharma to work on these cancers, which were not so popular before, as related to alcohol and tobacco consumption. If the prognosis of HPV-positive non-smokers patients seems better whatever the primary treatment to search for reducing its toxicity (de-escalate strategies), however, there is a clear need to improve the therapeutics of HPV-negative and HPV-positive smoker patients.
The knowledge of molecular alterations that may be new therapeutic targets has increased, and two reviews published in this volume focus on these new aspects and prospects, including the potential role of CDK4/6 inhibitors.
The second upheaval was the irruption of new immunotherapies, such as the check-point inhibitors. We have waited more than 10 years for new drugs, since the approval of cetuximab, which remains the only approved targeted therapy to provide a benefit in overall survival in combination with radiotherapy or chemotherapy. Nivolumab and pembrolizumab are now approved in second-line for recurrent and/or metastatic HNSCC patients, and the standards of care are changing very fast, with new options arising in first-line R/M setting. For the first time, new guidelines evoke the possibility of third-line treatment and more, and we can observe in daily practice more prolonged responses and long survivors among R/M HNSCC patients than before. Selecting patients who could benefit more from immunotherapy seems the best approach to avoid local failure and life-threatening fast progression, and to allow long-time control disease. Two updated reviews focus on these important points.
Next steps of improvement should be brought by the introduction of immunotherapies in early stages, in curative situation, associated with radiotherapy and surgery. The respective places of surgery and radiotherapy, two actual pillars of the curative intent treatment of HNSCC, remain controversial, and are also reviewed in this volume.
The number of elderly HNSCC patients is increasing, as for the whole cancer population, and we wanted to summarize the current approaches and prospects for this population, as there is no clear standard treatment at the present time.
Finally, the management of care of patients with recurrent salivary gland cancer, is always a challenge in daily practice, and Even et al. (pp. 169–174) review the different options and perspectives in this setting.
We sincerely thank all experts in the field who accepted to contribute to these reviews.
Acknowledgements to Cecile Michel for her help in writing.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.