Head and Neck Cancer CE/CME ACCREDITED Watch Time: 38 mins

touchPANEL DISCUSSION Navigating the challenges of treatment provision in recurrent/metastatic head and neck squamous cell carcinoma

Three experts consider the optimal management of recurrent/metastatic head and neck squamous cell carcinoma (HNSCC).

Prof. Lisa Licitra

Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

CHAIR

Panelists:
Dr Aline Chaves, Prof. Joël Guigay
 
Video Chapters
Introduction

Prof. Lisa Licitra introduces a panel of leading experts in HNSCC and outlines the agenda for the discussion.

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1/4 Next Chapter
 
What are the key data informing the treatment of recurrent or metastatic HNSCC?

The expert panel outlines the key clinical trial data for chemotherapy-based regimens and immunotherapy in recurrent/metastatic HNSCC, and discusses how they apply these data to clinical practice.

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2/4 Next Chapter
 
How do the latest data translate into treatment decisions in clinical practice?

The HNSCC experts share the factors they use to guide treatment decisions for patients with recurrent/metastatic disease and how they combine these with the data from clinical trials to select the most appropriate treatment for each patient.

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3/4 Next Chapter
 
How can patient priorities be established and incorporated into the care plan?

The expert panel outlines the importance of establishing patient priorities in recurrent/metastatic HNSCC, how they approach this in clinical practice and use the information to guide the care plan for each patient.

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Learning Objectives & Overview
Overview

In this activity, three leading experts in head and neck cancer discuss the key data for the treatment of recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) and how it informs clinical practice. They also consider how patient priorities can be established and incorporated into the care plan.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of oncologists involved in the management of patients with HNSCC.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof Lisa Licitra discloses: Advisory board or speaker fees from AccMed, AstraZeneca, Bayer, Merck Serono, Merck Sharp & Dohme and Neutron Therapeutics, Inc. Research funds for clinical trials (donated to institution) from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Buran, Celgene International, Debiopharm International SA, Eisai, Exelixis, Hoffmann-La Roche ltd, IRX Therapeutics, Medpace, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer and Roche.

Dr Aline Chaves discloses: Advisory board or panel fees from Bayer, Merck and Merck Sharp & Dohme. Speaker’s Bureau fees from Bayer, Bristol Myers Squibb, Merck and Merck Sharp & Dohme.

Prof. Joël Guigay discloses: Advisory board or panel fees from Bristol Myers Squibb, Hookipa, Merck Sharp & Dohme, Merck Serono, Nanobiotix (all relationships active) and Roche (relationship terminated).

Content reviewer

Angela M. Hill, PharmD has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 26 May 2022. Date credits expire: 26 May 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

After watching this activity, participants should be better able to:

  • Recall the latest data for the treatment of recurrent/metastatic HNSCC
  • Use the latest data to select the most appropriate treatment for patients with recurrent/metastatic HNSCC
  • Explain the importance of establishing patient preferences and priorities in treatment decision-making
Faculty & Disclosures
Prof. Lisa Licitra

Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

Prof. Lisa Licitra is chief of the Head and Neck Cancer Medical Oncology Department at the Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. read more

Prof. Licitra is an associate professor at Università degli Studi di Milano and since 2019, she has been the scientific director of the Italian National Center for Oncological Hadrontherapy. 

Prof. Licitra is a past board member and vice president of the European Organization for the Research and Treatment of Cancer (EORTC). She was chair of the Head and Neck Cancer Cooperative Group of EORTC for 3 years and past-chair and secretary of the EORTC Thyroid Task Force. She acted as a member of the Educational Committee of the European Society for Medical Oncology (ESMO), the clinical editorial board of Oral Oncology and the Union for International Cancer Control (UICC) TNM Staging Committee. She is an honorary member of the European SocieTy for Radiotherapy and Oncology (ESTRO). She is chair of the G7 Domain in EURACAN (the European Reference Network for rare adult solid cancers).

Prof. Licitra is a recipient of the Venosta AIRC/FIRC award. She won the ESMO Award in 2021. She is author of 384 papers in peer-reviewed journals.

Prof Lisa Licitra discloses: Advisory board or speaker fees from AccMed, AstraZeneca, Bayer, Merck Serono, Merck Sharp & Dohme and Neutron Therapeutics, Inc. Research funds for clinical trials (donated to institution) from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Buran, Celgene International, Debiopharm International SA, Eisai, Exelixis, Hoffmann-La Roche ltd, IRX Therapeutics, Medpace, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer and Roche.

Dr Aline Chaves

DOM Oncology Group, Divinópolis, Brazil

Dr Aline Chaves is director of the DOM Oncology Group in Divinópolis, Brazil. read more

Dr Chaves is president of the Brazilian Group of Head and Neck Cancer (GBCP) and chair of the Head and Neck Latin American Cooperative Oncology Group. She is also on the Medical Ethics Committee for the Brazilian Society of Clinical Oncology and a researcher for the head and neck study group, UFSJ.

Dr Aline Chaves discloses: Advisory board or panel fees from Bayer, Merck and Merck Sharp & Dohme. Speaker’s Bureau fees from Bayer, Bristol Myers Squibb, Merck and Merck Sharp & Dohme.

Prof. Joël Guigay

Cancer Center Antoine Lacassagne, Nice, France

Prof. Joël Guigay is a professor of medicine and past director of Cancer Center Antoine-Lacassagne in Nice, France. read more

Prof. Guigay is the president of Unicancer Head & Neck (UCHN) and deputy director of the Hospital University Federative OncoAge. Additionally, he is an active member of many national and international societies, including as a faculty member for head and neck cancers for the European Society for Medical Oncology (ESMO) and co-chair of the scientific committee of the Head and Neck Cancer International Group (HNCIG).

Prof. Guigay’s areas of research include clinical studies with new drugs and translational research with a focus on immunotherapy. He coordinates several clinical trials, including phase I to large randomized trials in recurrent or metastatic HNSCC.

Prof. Joël Guigay discloses: Advisory board or panel fees from Bristol Myers Squibb, Hookipa, Merck Sharp & Dohme, Merck Serono, Nanobiotix (all relationships active) and Roche (relationship terminated).

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Question 1/5
What did the TPExtreme trial show regarding the use of cisplatin, docetaxel and cetuximab (TPEx) vs platinum, 5-fluorouracil and cetuximab (EXTREME) for the treatment of patients with recurrent/metastatic HNSCC?

HNSCC, head and neck squamous cell carcinoma; OS, overall survival; QoL, quality of life.
Correct

In the TPExtreme trial, OS did not differ significantly between the TPEx and EXTREME groups (14.5 months vs 13.4 months, respectively; p=0.23). Better quality of life was seen in the TPEx group vs the EXTREME group for global health status, physical functioning and role functioning.1

Abbreviation

OS, overall survival.

Reference

  1. Guigay J, et al. Lancet Oncol. 2021;22:463–75.
Question 2/5
The KEYNOTE-048 trial investigated pembrolizumab alone or with chemotherapy vs EXTREME (platinum, 5-fluorouracil, cetuximab) in the first-line treatment of recurrent/metastatic HNSCC. Which of the following statements is true regarding the OS reported in the trial?

CPS, combined positive score; HNSCC, head and neck squamous cell carcinoma; OS, overall survival; PD-L1, programmed death-ligand 1.
Correct

In the KEYNOTE-048 trial, pembrolizumab alone improved OS vs EXTREME in the PD-L1 CPS ≥20 and CPS ≥1 populations, and was non-inferior in the total population. Pembrolizumab plus chemotherapy improved OS vs EXTREME in the total population and in the PD-L1 CPS ≥20 and ≥1 populations.1

Abbreviations

CPS, combined positive score; OS, overall survival; PD-L1, programmed death-ligand 1.

Reference

  1. Burtness B, et al. Lancet. 2019;394:1915–28.
Question 3/5
During a consultation with your patient with oral cavity cancer, you confirm that the disease is recurrent. PD-L1 CPS is <1. Assuming universal availability and reimbursement, which of the following treatments should be discussed with the patient for the first-line treatment of the disease recurrence?

CPS, combined positive score; PD-L1, programmed death-ligand 1.
Correct

Cetuximab plus chemotherapy (EXTREME) has been found to prolong OS vs chemotherapy alone in patients with recurrent/metastatic HNSCC.1 In the KEYNOTE-048 trial, OS with pembrolizumab alone was non-inferior vs EXTREME in the total population. Pembrolizumab plus chemotherapy improved OS vs EXTREME in the total population.2 EHNS–ESMO–ESTRO guidelines (including the pan-Asian adaptation) recommend cetuximab plus chemotherapy as the standard treatment for patients with a PD-L1-negative tumour.3,4 NCCN guidelines recommend pembrolizumab plus chemotherapy as the preferred regimen in the first-line setting.5

Abbreviations

EHNS, European Head and Neck Society; ESMO, European Society for Medical Oncology; ESTRO, European SocieTy for Radiotherapy & Oncology; HNSCC, head and neck squamous cell carcinoma; NCCN, National Comprehensive Cancer Network; OS, overall survival; PD-L1, programmed death-ligand 1.

References

  1. Vermorken JB, et al. N Engl J Med. 2008;359:1116–27.
  2. Burtness B, et al. Lancet. 2019;394:1915–28.
  3. Machiels JP, et al. Ann Oncol. 2020;31:1462–75.
  4. Keam B, et al. ESMO Open. 2021;6:100309.
  5. NCCN Guidelines. Head and neck cancers. Version 1.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf (accessed 21 April 2022).
Question 4/5
When developing a care plan for your patient with recurrent/metastatic HNSCC, which of the following should be taken into consideration?

HNSCC, head and neck squamous cell carcinoma.
Correct

When developing a care plan for patients with recurrent/metastatic HNSCC, clinicians should be aware of the factors that influence well-being, including:

  • Aesthetic disfigurement due to locoregional tumour progression1
  • Life-threatening complications1
  • Symptoms (pain, nausea, constipation, sleep disturbances, difficulty swallowing, etc.)2
  • Presence of a caregiver3
  • Low median OS (<1 year)4

Additionally, HNSCC can impact psychosocial health, including causing psychological distress, social isolation and compromised quality of life.5,6

Abbreviations

HNSCC, head and neck squamous cell carcinoma; OS, overall survival.

References

  1. Szturz P, Vermorken JB. Lancet. 2020;396:379.
  2. Gunn GB, et al. Head Neck. 2013;35:1490–8.
  3. Kassir ZM, et al. BMC Cancer. 2021;21:1127.
  4. Price KAR, Cohen EE. Curr Treat Options Oncol. 2012;13:35–46.
  5. Johnson DE, et al. Nat Rev Dis Primers. 2020;6:92.
  6. Dahill A, et al. Br J Oral Maxillofac Surg. 2020;58:959–65.
Question 5/5
You are discussing possible treatment options with your patient with recurrent/metastatic HNSCC. What approach do you use during the consultation?

HNSCC, head and neck squamous cell carcinoma.
Correct

When discussing treatment options with patients with recurrent/metastatic HNSCC, it is important to understand treatment expectations from the patient’s point of view, and to consider different patient communication styles, coping mechanisms and health literacy levels. The discussion about treatment should incorporate the patient’s priorities, balancing the desire to prolong survival with the need for a good quality of life.1,2 

Abbreviation

HNSCC, head and neck squamous cell carcinoma.

References

  1. Rhoten BA, et al. Support Care Cancer. 2021;29:377–85.
  2. Nilsen ML, et al. Laryngoscope. 2020;130:2354–9.
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