DR. KUNJAHARI MEDHI, SENIOR DIRECTOR, CANCER CARE, MEDANTA – THE MEDICITY
The International Agency for Research on Cancer (IARC) estimates that 20% of the global population will develop cancer during their lifetime. Head and Neck Cancers are a significant burden on India, accounting for around 30% of all cancer incidents recorded in the country, and in the North Eastern states, the incidence rate is as high as 54.48%, likely due to the widespread habit of chewing tobacco.
The settled practice for treating patients suffering from Head and Neck Cancer is to carry out surgery, followed by radiation therapy and chemotherapy. However, this course of action often has serious repercussions in the patient’s post-op quality of life: side effects include significant impediments for the patient on a day-to-day basis, including ramifications with regards to their ability to speak, swallow, and/or breathe.
However, the established procedure may soon be a relic of the past: targeted therapy and immunotherapy are emerging as driving forces in a revolution that is underway in the treatment of Head and Neck Cancers. These innovative approaches are moving beyond the blunt force of traditional methods: clinicians are now able to tailor therapies based on a patient’s specific tumour characteristics, moving away from a one-size-fits-all approach. These techniques not only promise better efficacy but also aims to minimise the debilitating side effects that have long plagued survivors of Head and Neck Cancers.
Targeted Therapy: Precision Strikes against Cancer
Targeted therapies focus on the specific molecular vulnerabilities within cancer cells. Instead of broadly attacking rapidly dividing cells like chemotherapy, these drugs are designed to interfere with the proteins and pathways that drive cancer growth and survival. For instance, in Head and Neck Cancers, a significant proportion of squamous cell carcinomas (the most common type) are linked to the human papillomavirus (HPV). Researchers are actively exploring targeted therapies that exploit these HPV-driven mechanisms, potentially offering more effective and less toxic treatments for this specific subset of patients.
Beyond HPV, other molecular targets are being identified. For example, some Head and Neck Cancers exhibit overexpression of the epidermal growth factor receptor (EGFR). Drugs that block EGFR signalling, such as cetuximab, have already been incorporated into Head and Neck Cancer treatment, often in combination with radiation or chemotherapy. While not a cure-all, these agents can improve outcomes and, in some cases, offer a less aggressive alternative to traditional chemotherapy, reducing systemic toxicity. The ongoing research into identifying new, actionable mutations and developing corresponding targeted therapies promises an increasingly personalised approach to Head and Neck Cancer care.
Immunotherapy: Unleashing the Body’s Own Defence System
Even more transformative for Head and Neck Cancers is the rise of immunotherapy. This groundbreaking approach doesn’t directly attack cancer cells; instead, it harnesses the body’s own immune system to recognise and destroy them. Cancer cells often employ clever tricks to evade immune surveillance, such as expressing proteins that “turn off” immune cells. Immunotherapy drugs, particularly checkpoint inhibitors, block these inhibitory signals, essentially “releasing the brakes” on the immune system.
In Head and Neck Cancers, checkpoint inhibitors such as pembrolizumab and nivolumab have proven to be remarkably successful, particularly in recurrent or metastatic disease where traditional treatments have limited efficacy. For some patients, these therapies have led to durable responses, even complete remission, offering a quality of life previously unimaginable. While not every patient responds, the potential for long-term control and improved survival has made immunotherapy a cornerstone of modern Head and Neck Cancers management.
The Road Ahead
While challenges remain, including identifying reliable biomarkers to predict treatment response and managing potential immune-related adverse events, the future of Head and Neck Cancer care is undeniably brighter. Beyond the knife, radiation, and chemotherapy, targeted therapy and immunotherapy are offering a new era of hope, transforming Head and Neck Cancers from being associated with disfigurement and despair into one where long-term survival and a good quality of life are increasingly within reach.