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Research in head and neck cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help prevent, find and treat head and neck cancer. They are also looking for ways to improve the quality of life for people with head and neck cancer.

The following is a selection of research showing promise for head and neck cancer. We’ve included information from PubMed, which is the research database of the National Library of Medicine. Each research article in PubMed has an identity number (called a PMID) that links to a brief overview (called an abstract). We have also included links to abstracts of the research presented at meetings of the American Society of Clinical Oncology (ASCO), which are held throughout the year.

Preventing head and neck cancer

Some substances or behaviours may prevent head and neck cancer or lower your risk of developing it. The following is noteworthy research into ways to prevent head and neck cancer or lower your risk.

Human papillomavirus (HPV) vaccines protect against infection with HPV. These vaccines were developed to lower the risk of cervical cancer. They may also lower the risk of developing other HPV-related cancers, including some types of head and neck cancer. HPV is mainly linked to oropharyngeal cancer, but some research suggests it may also be linked to other types of head and neck cancer (Lancet Oncology, PMID 25439690; CMAJ, PMID 24295862). One study showed that HPV vaccines lowered the number of oral HPV infections (ASCO, Abstract 153036).

Chemoprevention is an area of study that looks at taking certain supplements (such as vitamins) or certain drugs to help prevent cancer or prevent it from coming back. Researchers are looking at the following drugs as chemoprevention for oral cancer:

Find out more about research in cancer prevention.

Diagnosis and prognosis

A key area of research looks at better ways to diagnose and stage head and neck cancer. Researchers are also trying to find ways to help doctors predict a prognosis (the probability that the cancer can be successfully treated or that it will come back after treatment). The following is noteworthy research into diagnosis and prognosis.

Biomarkers are substances, such as proteins, genes or pieces of genetic material like DNA and RNA, that are naturally in the body. They can be measured in body fluids like blood and urine or tissue that has been removed from the body. A gene mutation or a change in the normal amount of a biomarker can mean that a person has a certain type of cancer. Biomarkers may also help doctors predict the prognosis or response to treatment in people with head and neck cancer. Researchers are looking at the following biomarkers to see if they can help doctors predict a prognosis for and find out which treatments will benefit a person with head and neck cancer:

Gene-based tests find differences between normal genes and genes that are changed (mutated) in cancer cells. Microarray analysis is a type of gene-based test that allows researchers to look at many genes together to see which ones are turned on and which ones are turned off. Analyzing many genes at the same time to see which are turned on and which are turned off is called gene expression profiling. Researchers hope that developing more gene-based tests will help doctors identify the best treatments for certain cancers, including head and neck cancer (Head and Neck, PMID 26614709; Annals of Oncology, PMID 25712460). Gene-based tests will also help doctors tailor more treatments to each person’s cancer based on their unique genetic makeup.

HPV status of cancer cells may affect prognosis for certain types of head and neck cancer. HPV status describes whether or not the virus is present and the type of HPV present. The different genetics associated with different HPV types may play a role in prognosis (Oral Oncology, PMID 27086490, PMID 26705063; Cancer, PMID 28295222). Some research also showed that HPV-positive tumours and HPV-negative tumours respond differently to some treatments, such as radiation therapy and surgery (Head and Neck, PMID 27080244; International Journal of Cancer, PMID 25857630; BMC Cancer, PMID 26311526; Lancet Oncology, PMID 28434660).

Sentinel lymph node biopsy removes the sentinel lymph node. The sentinel lymph node is the first lymph node or group of lymph nodes that receives lymph fluid from a tumour and the area around a tumour. It is the first lymph node that a cancer cell comes to and will likely spread to. A doctor can find the sentinel lymph node by injecting a radioactive isotope or blue dye. If cancer is found in a sentinel lymph node, all the lymph nodes within surrounding areas of the neck will be removed (called neck dissection). Currently, neck dissection is also used to check if cancer has spread to the cervical lymph nodes (lymph nodes of the neck) in people with head and neck cancer. Researchers are studying sentinel lymph node biopsy as an alternative to neck dissection for staging and assessing cervical lymph nodes in people with some types of head and neck cancer (European Journal of Cancer, PMID 26597442; Oral Diseases, PMID 26948863; Otolaryngology: Head and Neck Surgery, PMID 26070510).

Find out more about research in diagnosis and prognosis.

Treatment

Researchers are looking for new ways to improve treatment for head and neck cancer. Advances in cancer treatment and new ways to manage the side effects from treatment have improved the outlook and quality of life of many people with cancer. The following is noteworthy research into treatment for head and neck cancer.

Surgery

Researchers are looking for better ways of using surgery to treat head and neck cancers.

Transoral minimally invasive surgery uses either a surgical robot or an operating microscope and laser to remove head and neck tumours through the mouth. Researchers are studying transoral minimally invasive surgery to find out if it is as effective as and causes fewer side effects than treatment with either more invasive surgical procedures or chemotherapy and radiation (JAMA Otolaryngology: Head and Neck Surgery, PMID 23949352; Laryngoscope, PMID 23945993; Clinical Otolaryngology, PMID 27966287; International Journal of Radiation Oncology, Biology, Physics, PMID 25304787).

Neck dissection is surgery to remove lymph nodes from the neck. It can be used to treat advanced head and neck cancer that has spread to lymph nodes. A clinical trial is looking at whether using PET-CT to watch and wait may lower the number of neck dissections needed after radiation and chemotherapy, as well as complications from this surgery (New England Journal of Medicine, PMID 27007578; Health Technology Assessment, PMID 28409743).

Find out more about research in cancer surgery.

Radiation therapy

Researchers are looking for better ways of using radiation therapy to treat head and neck cancers.

Nimorazole is a drug that makes cancer cells more sensitive to the effects of radiation (called a radiosensitizer). Many cancer cells have lower levels of oxygen than normal cells, and this makes it harder to treat them with radiation. Nimorazole can get into cells with low oxygen levels so that they are more likely to be destroyed by the radiation. A clinical trial compared using nimorazole with radiation therapy given over a shorter period of time (accelerated radiation therapy) to using just accelerated radiation therapy. People with head and neck cancer who received nimorazole had better results and a longer survival than people who did not receive it. Researchers continue to study the role of nimorazole for head and neck cancer in clinical trials (Radiotherapy and Oncology, PMID 25913070; Acta Oncologica, PMID 25629651).

Proton beam radiation therapy uses proton beams instead of x-ray beams to destroy cancerous tissue. X-ray beams release energy before and after they hit their target. Proton beams are different because they release most of their energy after travelling a certain distance. As a result, proton beams cause very little damage to tissues that they pass through and more radiation can be delivered to the tumour. Researchers are studying the use of proton therapy to treat head and neck cancers, particularly cancer that comes back after it has been treated with radiation (Radiation Oncology, PMID 27639891; Journal of Cancer Research and Clinical Oncology, PMID 26521257).

Find out more about research in radiation therapy.

Chemotherapy

Researchers are looking for better ways of using chemotherapy to treat head and neck cancers.

Induction chemotherapy is chemotherapy that is given as the first treatment and followed by other treatments. Researchers are looking at the role of induction chemotherapy in treating head and neck cancer. They are trying to find out if induction therapy followed by chemoradiation is better than chemoradiation alone (Scientific Reports, PMID 26041604; Future Oncology, PMID 27093876; Journal of the National Cancer Institute, PMID 26681800; British Journal of Cancer, PMID 25474250; Radiotherapy and Oncology, PMID 26589131; European Journal of Cancer, PMID 26655558, PMID 28214653; Oncologist, PMID 26304911).

Metronomic chemotherapy gives smaller doses of a drug over a longer period of time, which can help lower side effects while controlling the cancer. One study looked at using metronomic chemotherapy with people who had a head and neck cancer that had come back after treatment. People were given smaller and more frequent doses of methotrexate and capecitabine (Xeloda) for 6 months. The trial found that the metronomic chemotherapy increased the amount of time before the cancer progressed (called progression-free survival) and the overall survival time (ASCO, Abstract e17007; Oral Oncology, PMID 25578869; Medicine, PMID 28403082). More research is needed to find out what role metronomic chemotherapy may have in treating head and neck cancer.

New chemotherapy drugs that show promise in treating head and neck cancers include:

Find out more about research in chemotherapy.

Targeted therapy

Targeted therapy drugs target specific molecules (usually proteins) that cause cancer cells to grow. The following targeted therapy drugs are showing promise in treating head and neck cancer.

Tyrosine kinase inhibitors are drugs that block the enzyme tyrosine kinase, which helps cells develop and grow. Researchers are looking at the following kinase inhibitors in treating head and neck cancer:

PI3K (phosphoinositide 3-kinase) inhibitors work by switching off PI3K, which is an enzyme in cells that makes them grow and divide. Researchers are looking at the following PI3K inhibitors for treating head and neck cancers:

Monoclonal antibodies are a type of targeted therapy that binds to specific antigens on cancer cells to help destroy them. Researchers are looking at panitumumab (Vectibix) as a treatment for head and neck cancer (Lancet Oncology, PMID 25596660, PMID 25596659; European Journal of Cancer, PMID 28040660).

mTOR inhibitors work by blocking mTOR, which is a protein that regulates cellular metabolism and growth and how quickly cells multiply. Researchers are looking at the following mTOR inhibitors for treating head and neck cancers:

Find out more about research in targeted therapy.

Immunotherapy

Immunotherapy boosts the immune system or helps it find cancer cells and attack them. Researchers are studying the following types of immunotherapy for head and neck cancer.

Immune checkpoint inhibitors work by stopping cancer cells from affecting immune system cells in our bodies. The immune system normally stops itself from attacking healthy cells in the body by having some cells make specific proteins called checkpoints. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors are monoclonal antibodies that work by blocking checkpoint proteins so T cells (a type of white blood cell) can attack and kill cancer cells. Health Canada recently approved the checkpoint inhibitor nivolumab (Opdivo) to treat recurrent head and neck cancer after plantinum-based chemotherapy (New England Journal of Medicine, PMID 27718784; Lancet Oncology, PMID 28651929). Researchers are also studying pembrolizumab (Keytruda) (American Health and Drug Benefits, PMID 26380607; Lancet Oncology, PMID 27247226; Journal of Clinical Oncology, PMID 28328302).

Find out more about research in immunotherapy.

Other treatments

Researchers are looking at the following as possible treatments for head and neck cancers.

Photodynamic therapy (PDT) destroys cancer cells using a drug called a photosensitizer, which makes them very sensitive to laser light. The laser light sources usually can’t pass through more than a few millimetres of tissue, so PDT is mainly used to treat areas on or just under the skin, or in the lining of some internal organs. Researchers are studying PDT in treating head and neck cancer (Lasers in Medical Science, PMID 25563461; Oral Oncology, PMID 26865261; Photodiagnosis and Photodynamic Therapy, PMID 26072296, PMID 25917042).

Low-level laser therapy uses a low-power laser to remove tissue. Researchers are studying low-level laser as an alternative to radiation therapy to prevent sore mouth (mucositis), which is a common side effect of radiation therapy given with chemotherapy (chemoradiation) (Oral Oncology, PMID 26559740).

Radiofrequency and microwave ablation uses high-frequency electrical waves to create heat to destroy cancer cells. It may be a promising alternative treatment to standard therapy for recurrent or advanced head and neck cancers (Journal of Vascular and Interventional Radiology, PMID 26210246).

Supportive care

Living with cancer can be challenging in many different ways. Supportive care can help people cope with cancer, its treatment and possible side effects. The following is noteworthy research into supportive care for head and neck cancer.

Dry mouth is a common side effect of radiation therapy for head and neck cancer because this treatment damages the salivary glands. Clinical trials are looking at different substances to help protect the salivary glands during radiation therapy or help soothe a dry mouth (Radiotherapy and Oncology, PMID 25890572; Otolaryngology: Head and Neck Surgery, PMID 27048670; European Journal of Oncology Nursing, PMID 28279391).

Depression is very common in people with head and neck cancer. Recent studies show that survival for head and neck cancer is lower in people who have depression (JAMA Otolaryngology: Head and Neck Surgery, PMID 26796781; Psychosomatic Medicine, PMID 26632757). Researchers believe that screening for depression, and appropriate treatment for it, should be an important part of supportive care for people with head and neck cancer. Studies are looking at ways to help with depression and quality of life in general, including exercise and meditation (Cancer, PMID 26828426; Journal of Alternative and Complementary Medicine, PMID 28437147).

Sore mouth (mucositis) is a common side effect of radiation therapy for head and neck cancer. Clinical trials are looking at different substances to help prevent or soothe sore mouth (Phytotherapy Research, PMID 27555604; Asia-Pacific Journal of Clinical Oncology, PMID 25471468; Oral Health and Preventive Dentistry, PMID 25431805; Nutrition and Cancer, PMID 26451712).

Learn more about cancer research

Researchers continue to try to find out more about head and neck cancer. Clinical trials are research studies that test new ways to prevent, detect, treat or manage head and neck cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Many of the standard treatments for head and neck cancer were first shown to be effective through clinical trials.

Find out more about cancer research and clinical trials.

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