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Which investigational immunotherapy combinations do you think are most promising?

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Immune checkpoint inhibitor (ICI) + LAG3 inhibitor
   
ICI + bispecific antibody
   
ICI + tyrosine kinase inhibitor
   
Triplet combinations
   

Tutorial

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Which targeted therapy do you think will have the biggest impact on future practice?

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VEGF inhibitors
   
Antibody-drug conjugates
   
HRAS inhibitors
   
PI3K inhibitors
   

Tutorial

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Poll

In your opinion, what are the main challenges when treating patients with R/M SCCHN?

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Limited treatment options
   
Managing side effects
   
Lack of biomarkers
   
Other
   
 
Expert Interviews
Head and Neck Cancer, Immunotherapy CE/CME accredited

touchEXPERT OPINIONS
Experts answer questions with in-depth advice on the current clinical landscape and how new therapies and guidance might impact regional clinical practice. Useful tips below will show how to navigate the activity. Close

What’s on the horizon to tackle unmet needs in recurrent/metastatic SCCHN?

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Dr Aline Chaves is a medical oncologist and director of the DOM Oncology Group in Divinópolis, Brazil.

Dr Chaves is founder and director of the Brazilian Group of Head and Neck Cancer and co-chair of the Latin American Cooperative Oncology Group (LACOG) – Head and Neck.

Dr Aline Chaves discloses: Advisory board or panel fees from Knight, Merck Serono and MSD. Speaker’s Bureau fees from Eli Lilly, Knight, Merck Serono and MSD.

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Prof. Makoto Tahara is chief of the Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan. read more

Prof. Tahara has a strong interest in the development of novel treatments for head and neck cancer, including thyroid cancer, and has been a principal investigator on six investigator-initiated clinical studies. He has been a steering committee member for 15 global clinical studies. Additionally, Prof. Tahara was a group manager of the Head and Neck Cancer Group in the Japanese Clinical Oncology Group (JCOG) from 2012 to 2016. 

Prof. Tahara has served as a reviewer or member of the editorial board for five international journals, and has authored or co-authored more than 150 international scientific papers.

Prof. Makoto Tahara discloses: Advisory board or panel fees from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Eisai, Lilly, Merck Biopharma, MSD and Pfizer. Consultant fees from Astellas, Genmab and Janssen Pharmaceuticals. Grants/Research Support from Bayer and Ono Pharmaceutical.

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Dr Ranee Mehra is director of Head and Neck Medical Oncology, head of the Solid Tumor Section and professor in the Department of Medicine at the Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.

Dr Mehra is a clinical investigator with a focus on the treatment of head and neck and thoracic cancers. Her research interests also include incorporation of biomarkers in clinical trial design and developmental therapeutics.

Dr Mehra is a member of the American Society of Clinical Oncology (ASCO) and the Eastern Cooperative Oncology Group (ECOG) Head and Neck Core Committee. She is also a member of the National Cancer Institute (NCI) Head and Neck Recurrent/Metastatic Task Force.

Dr Ranee Mehra discloses: Advisory board or panel fees from Coherus, EMD Serono/Merck and Janssen (relationships terminated). Grants/Research Support from Merck.

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Learning Objectives

After watching this activity, participants should be better able to:

  • Recall unmet treatment needs for patients with recurrent/metastatic SCCHN
  • Discuss the rationale and latest data for immunotherapy-based treatments in development for recurrent/metastatic SCCHN
  • Evaluate the rationale and latest data for investigational targeted therapies for recurrent/metastatic SCCHN
Overview

In this activity, oncologists specializing in the treatment of head and neck cancer consider the current unmet treatment needs for patients with recurrent/metastatic SCCHN and provide an update on treatment approaches under investigation, including the available clinical trial data.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of oncologists involved in the management of patients with head and neck cancer.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Aline Chaves discloses: Advisory board or panel fees from Knight, Merck Serono and MSD. Speaker’s Bureau fees from Eli Lilly, Knight, Merck Serono and MSD.

Prof. Makoto Tahara discloses: Advisory board or panel fees from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Eisai, Lilly, Merck Biopharma, MSD and Pfizer. Consultant fees from Astellas, Genmab and Janssen Pharmaceuticals. Grants/Research Support from Bayer and Ono Pharmaceutical.

Dr Ranee Mehra discloses: Advisory board or panel fees from Coherus, EMD Serono/Merck and Janssen (relationships terminated). Grants/Research Support from Merck.

Content Reviewer

Danielle Walker, DNP, APRN, AGNP-C has no relevant financial relationships to disclose.

Touch Medical Contributors

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

Amelia Campbell-Warner discloses: Employee or independent contractor relationship – Astellas and Ipsen (relationships terminated).

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 29 February 2024. Date credits expire: 01 March 2025.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

This activity is CE/CME accredited

To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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Topics covered in this activity

Head and Neck Cancer / Immunotherapy
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touchEXPERT OPINIONS
What’s on the horizon to tackle unmet needs in recurrent/metastatic SCCHN?
0.75 CE/CME credit

Question 1/5
Which of the following statements is true regarding the response rates associated with first-line pembrolizumab for recurrent or metastatic SCCHN in the KEYNOTE-048 trial after 4 years of follow-up?

CPS, combined positive score; ORR, objective response rate; PD-L1, programmed death-ligand 1; SCCHN, squamous cell carcinoma of the head and neck.

After 4 years of follow-up in the KEYNOTE-048 trial, the ORR with pembrolizumab alone was 23.3% in patients with PD-L1 CPS ≥20, 19.1% in patients with PD-L1 CPS ≥1, and 16.9% in the total population. The ORR with pembrolizumab plus chemotherapy was 43.7% in patients with PD-L1 CPS ≥20, 37.2% in patients with PD-L1 CPS ≥1, and 36.3% in the total population.

Abbreviations

CPS, combined positive score; ORR, objective response rate; PD-L1, programmed death-ligand 1.

Reference

Harrington KJ, et al. J Clin Oncol. 2023;41:790–802.

Question 2/5
Which of the following statements best summarizes the latest data for investigational or novel immunotherapy-based combinations for recurrent/metastatic SCCHN?

ChT, chemotherapy; CTLA-4, cytotoxic T-lymphocyte associated protein 4; PD-1, programmed cell death protein 1; PD-L1, programmed death-ligand 1; SCCHN, squamous cell carcinoma of the head and neck; TKI, tyrosine kinase inhibitor.

Multiple studies have demonstrated consistent and promising results with PD-1/PD-L1 inhibitors plus cetuximab.1 The combination of PD-1/PD-L1 inhibitors plus carboplatin and paclitaxel demonstrated anti-tumour activity and tolerable toxicity profiles in patients with R/M SCCHN.2,3 There are a number of PD-1/PD-L1 inhibitors in combination with TKIs under investigation for R/M SCCHN that have shown variable antitumour activity with manageable toxicity profiles.4–7 However, multiple studies did not meet their primary endpoint (OS/ORR) when assessing the efficacy of CTLA-4 inhibition in combination with anti-PD-1/PD-L1 monoclonal antibodies compared to standard-of-care regimens.8–11  

Abbreviations

CTLA-4, cytotoxic T-lymphocyte associated protein 4; ORR, objective response rate; OS, overall survival; PD-1, programmed cell death protein 1; PD-L1, programmed death-ligand 1; R/M SCCHN, recurrent or metastatic squamous cell carcinoma of the head and neck; TKI, tyrosine kinase inhibitor.

References

1. Wise-Draper TM, et al. Am Soc Clin Oncol Educ Book. 2022;42:1–14; 2. Dzienis MR, et al. Ann Oncol. 2022;33(Suppl. 7):S839–40; 3. Fayette J, et al. J Clin Oncol. 2023;41(Suppl. 16):Abstr 6003; 4. Rottey S, et al. J Immunother Cancer. 2022;10(Suppl. 2):A597; 5. Gui L, et al. Ann Oncol. 2022;33(Suppl. 9):S1524; 6. Kao HF, et al. Clin Cancer Res. 2022;128:1560–71; 7. Licitra L, et al. Presented at: Multidisciplinary Head and Neck Cancers Symposium 2024, Phoenix, AZ, USA. 29 February–2 March 2024. Abstract; 8. Ferris RL, et al. Ann Oncol. 2020;31:942–50; 9. Psyrri A, et al. Ann Oncol. 2023;34:262–74; 10. Harrington KJ, et al. JAMA Oncol. 2023;9:779–89; 11. Haddad RI, et al. J Clin Oncol. 2022;41:2166–80.

Question 3/5
Your patient with metastatic SCCHN is entering a clinical trial investigating eftilagimod alpha, a LAG-3-targeting agent, plus pembrolizumab. They ask you what outcomes have been reported from prior trials. What do you tell them regarding the ORR from the TACTI-002 trial?

LAG-3, lymphocyte activation gene 3; ORR, objective response rate; SCCHN, squamous cell carcinoma of the head and neck.

In the phase II TACTI-002 trial investigating eftilagimod alpha plus pembrolizumab in the second-line setting, an ORR of 30% was reported in 37 patients.

Abbreviation

ORR, objective response rate.

Reference

Doger de Spéville BD, et al. J Clin Oncol. 2023;41(Suppl. 16):6029.

Question 4/5
Which of the following is a target of bevacizumab, an agent currently under investigation for the treatment of recurrent or metastatic SCCHN?

EGFR, epidermal growth factor receptor; LAG-3, lymphocyte activation gene 3; PI3K, phosphatidylinositol 3-kinase; SCCHN, squamous cell carcinoma of the head and neck; VEGF, vascular endothelial growth factor.

Bevacizumab is a humanized anti-VEGF monoclonal antibody approved for the treatment of various cancer types and is currently under investigation for R/M SCCHN. Although bevacizumab is not approved for SCCHN, clinical trials of bevacizumab have shown its effectiveness and tolerability in improving the outcomes of patients with R/M SCCHN. The VEGF pathway is a promising therapeutic target in SCCHN; however, further studies should focus on minimizing unwanted adverse effects, especially bleeding events.

Abbreviations

R/M, recurrent or metastatic; SCCHN, squamous cell carcinoma of the head and neck; VEGF, vascular endothelial growth factor. 

Reference

Li Q, et al. Signal Transduct Target Ther. 2023;8:31.

Question 5/5
In what range was the reported ORR in the innovaTV 207 trial evaluating tisotumab vedotin monotherapy in patients with recurrent/metastatic SCCHN who have received prior lines of therapy, including platinum therapy?

ORR, objective response rate; SCCHN, squamous cell carcinoma of the head and neck.

The phase II innovaTV 207 study evaluated the efficacy of tisotumab vedotin in patients with R/M SCCHN (n=15). The ORR was reported as 40%. 

Abbreviations

ORR, objective response rate; R/M SCCHN, recurrent or metastatic squamous cell carcinoma of the head and neck. 

Reference

Cirauqui B, et al. Cancer Res. 2023;83 (Suppl. 8):CT164.

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