Additional Advances in Head and Neck Squamous Cell Carcinoma With Deborah Wong, MD, PhD

Dr. Deborah Wong, Director of the Medical Oncology Program and Clinical Trials Program for Head and Neck Squamous Cell Cancers (HNSCC) and an Associate Clinical Professor of Medicine at the University of California Los Angeles (UCLA) is currently serving as co-chair of i3 Health’s accredited CME/NCPD activity, Recurrent and Metastatic HNSCC, Harnessing Immunotherapy and Comprehensive Care. With new developments in the field occurring over recent months, Dr. Wong sat down with us again to share new updates in treatment and management of HNSCC.

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Online Accredited CME/NCPD Activity

i3 Health: Hello, and welcome to this i3 Health interview. Today, I’m joined by Dr. Deborah Wong, who is currently the co-chair of i3 Health’s CME/NCPD activity titled Recurrent and Metastatic HNSCC, Harnessing Immunotherapy and Comprehensive Care. She’s joining us today to share some additional insights and advancements in the field that have occurred in the past several months. Thank you so much for joining us today, Dr. Wong. Would you like to begin with introducing yourself?

Deborah Wong, MD, PhD: My name is Dr. Deborah Wong and I’m an Associate Clinical Professor of Medicine at the University of California Los Angeles, and I’m the Director of the Medical Oncology Program, Clinical Trials Program for Head and Neck Cancers.

i3 Health: Awesome. Again, we are excited to have you back in to give us this update. To start off, could you provide us a brief update on advancements for HNSCC since recording?

Dr. Wong: Yes, I’m very happy to do so. I’m very glad to say that there has been a lot of ongoing clinical research activity in the field of head and neck cancer—in recurrent, metastatic, and in particular, squamous cell carcinomas of the head and neck. Again, these arise primarily from the oral cavity, the oral pharynx, hypopharynx, and larynx. There also have been some new exciting developments in regards to a shift in the standard of care, or a new standard regimen for nasopharyngeal cancer, which is a distinct subset of head and neck cancer.

In the field of squamous cell carcinomas of the head and neck arising from the oral cavity, oral pharynx, hypopharynx, and larynx, there’s been continued activity in regard to trying to find chemotherapy-free combinations in the front-line recurrent metastatic setting. During Dr. Hanna’s and my i3 Health presentation, Dr. Hanna went through some of the novel clinical trials that were ongoing, and many of these have advanced to registration studies, specifically in the arena of immune checkpoint inhibition in combination with anti–epidermal growth factor receptor (EGFR) therapies.

The two anti-EGFR targeted therapies have advanced and are now moving towards registrational phase 3 studies. One is BCA101 from Bicara Therapeutics in combination with pembrolizumab, and the other is the MCLA158 compound, which is being evaluated both in combination with anti–programmed cell death protein 1 (PD-1) in the frontline setting, as well as continue to be developed in the second-line and later settings. So, there’s lots of exciting movement in regard to anti-EGFR therapies for head and neck cancer. And what we’ve seen to-date is very exciting data, particularly for human papillomavirus (HPV)–negative squamous cell carcinomas at the head and neck.

Beyond HPV-negative, for HPV-positive head and neck cancers, there have also been very exciting developments and advances with many agents advancing also to registrational studies. Some examples include the HOOKIPA study, which is moving towards opening a phase 3 registrational study for HPV genotype 16, a positive recurrent metastatic head and neck cancer that will be in combination with pembrolizumab. In addition, BioNTech, the BNT113 has a similar registrational study among others. So, lots of exciting developments and continuing to move towards tailoring therapies based on disease biology.

One example that I’ve mentioned is HPV-negative head and neck cancer versus HPV-positive. Beyond that, other than anti-EGFR, there are ongoing advances in exploring antibody-drug conjugates (ADCs) for head and neck cancer with enfortumab vedotin, or EV, as well as sacituzumab govitecan. So, we have novel immune checkpoint targeted therapy combinations, antibody-drug conjugate combinations advancing to later stages of clinical development, and of course, we have ongoing evaluation of novel immuno-oncology combinations as well. So, there’s really exciting stuff for squamous cell carcinoma of the head and neck.

In the recurrent metastatic setting, they’re also beyond the relapsed metastatic setting. There are lots of ongoing exciting research on incorporating newer systemic therapy approaches in the curative intent setting. For example, incorporating a radio ligand that’s injected into the tumor in combination with chemoradiation. That has advanced to the phase 3 arena as well for the curative intent setting. There are also some ongoing studies looking at novel immunotherapies to be given after chemoradiation for patients who undergo curative intent definitive chemoradiation.

And then finally, a really exciting space in the curative intent setting is for patients who are surgically resectable, continuing to look at neoadjuvant strategies of anti–PD-1 or PD-1 in combination with other systemic therapies before surgery to see if that will improve outcomes for patients with locally advanced head and neck cancer.

i3 Health: That was such an incredible update. There are so many good things to hear about and so many good things to look forward. Is there anything you would like to speak on specifically for the end of the year or even next year that you’re looking forward to in updates to how we treat head and neck?

Dr. Wong: Yeah, I think the studies that I mentioned, or I alluded to, are all very exciting things to be on the lookout for. They may not come about by the end of the year, but certainly we’ll have an ever-growing body of literature on ways we might tailor therapies based on disease biology. I will also mention, as I alluded to at the very beginning with regards to nasopharyngeal cancer, which also may be a squamous cell carcinoma or sometimes poorly differentiated carcinoma oftentimes associated with Epstein-Barr virus, or EBV, infection.

One new advancement that is available in the form of an FDA-approved regimen is toripalimab, which is an anti–PD-1 immunotherapy, which has been approved and is available for use in the US in combination with platinum gemcitabine in the front-line recurrent metastatic setting. In addition, it’s also FDA-approved and available in the second-line setting for nasopharynx cancer.

Interestingly, at the American Society of Clinical Oncology (ASCO) Meeting this past year, there was a very exciting abstract that was presented evaluating toripalimab in conjunction with induction chemotherapy and chemoradiation for patients with locally advanced nasopharyngeal cancer. Very exciting preliminary data, and we’re awaiting registrational data on that too. So, there’s definitely some movement in the field of managing head and neck cancers, both nasopharyngeal cancers and otherwise, but still lots more to do.

i3 Health: Thank you so much, Dr. Wong, for this incredible update for us, and hopefully soon we’ll be able to talk more about how these trials came to fruition, maybe next year, maybe the following year. But there are definitely exciting things to look forward to and again, we appreciate your expertise on this.

Dr. Wong: Of course. Thank you so much for the opportunity and indeed, exciting times for patients, as well as for all of us who treat patients who have advanced head and neck cancer.

About Dr. Wong

Deborah Wong, MD, PhD, is the Director of the Medical Oncology Program and Clinical Trials Program for HNSCC and an Associate Clinical Professor of Medicine at UCLA. Dr. Wong specializes in the treatment of patients with advanced solid tumors, including head and neck cancers. Her research interest is in the identification of novel therapeutics for HNSCC and understanding the mechanisms of resistance to existing therapies. Dr. Wong is an active leader and participant in over 30 active clinical trials.

Transcript edited for clarity. Any views expressed above are the speakers’ own and do not necessarily reflect those of i3 Health.