BackTable / ENT / Podcast / Episode #19
Immunotherapy for Head and Neck Cancer
with Dr. Adam Luginbuhl
Dr. Adam Luginbuhl from Thomas Jefferson University Hospitals gives us the 101 on Immunotherapy as a treatment option for Head and Neck Cancer.
BackTable, LLC (Producer). (2021, March 30). Ep. 19 – Immunotherapy for Head and Neck Cancer [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Adam Luginbuhl
Dr. Adam Luginbuhl is an Associate Professor of Otolaryngology Head and Neck Surgery at Thomas Jefferson University.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
In this episode, Dr. Adam Luginbuhl joins Dr. Gopi Shah and Dr. Ashley Agan to discuss immunotherapy for treatment of head and neck cancer.
Dr. Luginbuhl describes the basics of cancer immunotherapy which aims to harness the body’s intrinsic immune system to target cancer cells. He provides an overview of the main checkpoint inhibitors (CTLA-4, PD-1, PDL-1) and their mechanisms of action. He also highlights new research developments aimed at exploring the role of immunotherapy as a neoadjuvant prior to surgery.
He then discusses the challenges in recruiting for clinical trials whereby he must find the balance between offering promising new treatments with limited evidence and traditional therapies. He states that the main contraindication and side-effect of immunotherapy is auto-immunity.
He emphasizes that the journey with head and neck cancer does not end after treatment. Since the head and neck region is vital to our interactions with the world – our appearance, our voice, our ability to eat and drink – he states that treatment should not only be focused on clearing cancer, but also maintaining patient quality-of-life.
Review Articles: Immunotherapy for Head and Neck Cancer:
National Cancer Databases:
National Comprehensive Cancer Network: https://www.nccn.org
American Head and Neck Society: https://www.ahns.info
National Cancer Institute: https://www.cancer.gov
[Dr. Gopi Shah]
When you talk to patients about the checkpoint inhibitors and the drugs that are available, does it help them in terms of survival/cure, or does it buy them more time? Are you talking about months or years? talking years? Is it more symptom relief or palliation?
[Dr. Adam Luginbuhl]
For those listeners who see patients on a regular basis, or those who have a family member with cancer, this might help in some way. One of the beautiful things about this is most replicated and probably first produced in melanoma, and we're seeing the same thing in head and neck. It's this thing called the “long tail.”
Let's talk about chemotherapy first, as a baseline. You give someone chemotherapy A and then you give another patient chemotherapy B. And what we saw with chemotherapy, is that it maybe extended life for 6 or 10 months, but ultimately everybody in the group of really sick patients did not survive. We're not talking about curable people, we're talking about really sick ones.
With immunotherapy, we see a different curve. We see that curve where you not only have 6 or 7 months of progression-free survival and improvement, but you also have this long tail in about 15% to 20% of patients that just survive. We have beautiful pictures of these initial PET scans in people with melanoma everywhere-- bones, lungs, everywhere. And then the next PET scan, nothing. And they go on for 5, 10, 15, 20 years. That's revolutionary. That's new. That's a different expectation.
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