To treat or not to treat: balancing therapeutic outcomes, toxicity and quality of life in patients with recurrent and/or metastatic head and neck cancer

Abstract

There are a number of challenges facing head and neck cancer patients who present with metastatic or locally recurrent head and neck cancer; such as, limited treatment options, overall poor prognosis, and high symptom burden secondary to tumor and treatment. Disease and symptom management can be difficult, and requires that the potential benefits versus the adverse effects of systemic therapy be weighed very carefully. Individual patient characteristics including performance status, weight loss, symptom burden, comorbidities, and social supports must be taken into consideration. Unfortunately, reliable data describing the impact of therapy on symptom burden and quality of life (QOL) is lacking. Recently completed randomized phase III treatment trials have demonstrated the feasibility of incorporating patient reported outcome measures to assess symptoms and QOL into clinical studies. Nonetheless, obstacles to accurate and thorough QOL reporting remain. Development of tools directed at symptom burden and functional impairment in the metastatic or recurrent head and neck cancer population is needed. Such tools would enhance our ability to assess the impact of treatment, thus optimizing treatment decisions for patients with recurrent and/or metastatic head and neck cancer.

Nivolumab versus standard, single-agent therapy of investigator's choice in recurrent or metastatic squamous cell carcinoma of the head and neck (CheckMate 141): health-related quality-of-life results from a randomised, phase 3 trial

“…Maximising the QoL of patients with cancer is increasingly recognised as an important therapeutic goal, 1,10 particularly in the context of improved survival. Patients with SCCHN rank the ability to speak, swallow, and perform daily tasks in the absence of pain as very high priorities.…”

“…Patients with R/M SCCHN may have residual toxicities caused by prior systemic therapies that can impact performance status, limit the administration of subsequent treatments, and predispose patients to developing additional toxicities. 10…”

“…5,6 Patient-reported outcomes (PROs) have been collected to assess QoL in a limited number of clinical trials of chemotherapy and targeted therapies in R/M SCCHN, few of which have demonstrated improvements or significant differences between treatment arms. 7–10 However, baseline QoL scores have been reported to be independent prognostic factors for OS in patients with R/M head and neck cancer. 11 Therefore, there is a large unmet medical need for treatments that improve prognosis as well as preserve and maximise QoL.…”

Immunologically augmented skin flap as a novel dendritic cell vaccine against head and neck cancer in a rat model

“…Cancer immunotherapy is one of several new options available for patients seeking less invasive and more expedient alternatives. 2 , 8 , 9 …”

“… 4 , 10 , 11 Currently, the major focus of cancer-specific DC-based immunotherapy is shifting toward the improvement of overall survival and quality of life, including performance status. 8 , 9 …”