VIII Franco Brazilian Congress of Oncology

Managing strategies for lung, head and neck cancer

Dr William Nassib William Junior – MD Anderson, Houston, TX, USA

Here at the congress we’re going to be discussing topics in lung cancer and head and neck cancer. In lung cancer we’re going to particularly discuss the role of the new molecular targeted agents for management of this disease. We’re also going to discuss some of the approaches that we’re taking to try to improve the efficacy of treatment for patients with earlier stage disease and locally advanced disease.

We have particular interest in developing neoadjuvant chemotherapy for non-small cell lung cancers. Our idea is that with neoadjuvant chemotherapy integrating novel targeted agents we will be able to have an early read-out of the efficacy of these agents without having to wait long-term for recurrence free survival and overall survival endpoints which is typically what is done in trials that use the adjuvant approach to develop systemic therapy.

So our goal is to integrate novel targeted agents with chemotherapy in the neoadjuvant setting and look at the pathologic response, or major pathologic response, as an endpoint. That endpoint can be readily available right after surgical resection and we know that this endpoint correlates well with long-term recurrence free survival and overall survival. So we believe that by doing smaller trials that are nimble and they can be more efficient and we can have an early read-out of the efficacy of these drugs and we can select early on the drugs that we would want to study in larger phase III trials. So we will be discussing a study that will open at MD Anderson in the very near future, hopefully in the next month, with a drug called nintedanib in combination with platinum-based chemotherapy in the neoadjuvant setting for non-small cell lung cancers.

We’re also going to be discussing several topics in head and neck cancers. One of the topics that we will be discussing is actually the role of novel prognostic markers in head and neck squamous cell carcinomas. I particularly would like to focus on the role of prognostic markers in oral leukoplakia. Oral leukoplakia or oral pre-malignant lesions are precursors of oral cancers and we know that there are several markers that can predict which patients are going to eventually develop oral invasive cancer. So we will be discussing some of those and we will be discussing the approach that we’re taking at MD Anderson to try to discover even more novel biomarkers that can predict who is going to develop oral cancer in patients with pre-malignant lesions. Hopefully we’ll be able to find a marker that is a risk factor but also can be targeted so that we can prevent cancers in these patients. So we will be discussing some of those approaches as well.

We’re also going to discuss the role of predictive biomarkers in head and neck squamous cell carcinomas. We know that EGFR targeted drugs are the only molecularly targeted agents that are approved for treatment of head and neck squamous cell carcinomas but, as of yet, we don’t have a biomarker of response to these drugs. We have some clinical trials going on at MD Anderson with novel designs where we’re trying to identify predictive markers of benefit from EGFR inhibitors. So we have studies that are personalised with biopsies pre-treatment, biopsies post-treatment with adaptive randomisation that can be very efficient with a smaller sample size to try to identify novel markers of response to EGFR targeted agents. We will be presenting some of these approaches at the conference today.