Head and Neck Cancer, Immunotherapy CE/CME ACCREDITED Watch Time: 33 mins

touchPANEL DISCUSSION Immunotherapy for recurrent or metastatic HNSCC: What are the practical considerations?

Three experts explore the clinical application of immune checkpoint inhibitors for patients with recurrent or metastatic HNSCC.

Prof. Kevin Harrington

The Institute of Cancer Research, London, UK

CHAIR

Panelists:
Prof. Barbara Burtness, Prof. Jean-Pascal Machiels
 
Video Chapters
Introduction

Prof. Kevin Harrington introduces the panel of leading experts in head and neck cancer, and outlines the agenda for the discussion on the practical considerations when using immunotherapy to treat patients with recurrent or metastatic HNSCC.

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1/4 Next Chapter
 
Immune checkpoint inhibitors in the treatment of recurrent or metastatic HNSCC: How do we apply the trial data to clinical practice?

The expert panel considers the key trial data and discusses the use of immune checkpoint inhibitors in different clinical settings.

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2/4 Next Chapter
 
What factors can be used to guide the use of immune checkpoint inhibitors in clinical practice?

The expert panel discusses the factors that can help guide treatment with immune checkpoint inhibitors. They also consider biomarkers that may support clinical decision-making in the future.

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3/4 Next Chapter
 
How can we identify and manage possible immune-related adverse events in patients with HNSCC?

The expert panel outlines the processes that they put in place to monitor for and manage immune-related adverse events.

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Overview & Learning Objectives
Overview

In this activity, three leading experts in head and neck squamous cell carcinoma (HNSCC) consider the use of immune checkpoint inhibitors for treating recurrent or metastatic HNSCC in daily clinical practice. They discuss the application of clinical trial data to decision-making, how patient-specific factors influence treatment strategies and approaches to ensure the timely identification and management of potential immune-related adverse events.

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 who are involved in the management of patients with head and neck squamous cell carcinoma.

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

Prof. Kevin Harrington discloses: Advisory board or panel fees from Amgen, InMed Medical Technology (Shanghai) and Merck. Consultant fees from Amgen, Arch Oncology, AstraZeneca, Boehringer Ingelheim, F Hoffmann-La Roche Ltd., Global Data, Idera Pharmaceuticals Inc., Inzen Therapeutics, iTeos Pharmaceuticals, Merck Serono, Merck Sharp & Dohme and Replimune. Grants/research support from AstraZeneca, Boehringer Ingelheim and Replimune.

Prof. Barbara Burtness discloses: Advisory board or panel fees from Actinium, AstraZeneca, Cue Biopharma, Debiopharm, Exelixis, IO Biotech, Kura, Macrogenics, Merck KGaA, Merck, Mirati, Nektar, Nuvelution and Vaccinex. Consultant fees from Genentech. Grants/research support from Merck. Speaker’s bureau fees from Education Alliance.

Prof. Jean-Pascal Machiels discloses: Advisory board or panel fees from ALX Oncology, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cue Biopharma, eTheRNA, Incyte, Innate, iTEOS Therapeutics, Janssen, Merck Serono, Nektar, Novartis, Pfizer and Roche. Safety monitoring board for Psioxus. Other financial or material support from Amgen, Bristol Myers Squibb, Merck Sharp & Dohme and Pfizer. 

Content reviewer

Ryan N Bookout, PharmD, BCOP, FHOPA has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

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

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: 27 January 2022. Date credits expire: 27 January 2023.

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

Learning Objectives

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

  • Outline how key clinical trial data for immune checkpoint inhibitors in recurrent or metastatic HNSCC can be applied to clinical practice
  • Discuss factors that may help guide the use of immune checkpoint inhibitors for patients with recurrent or metastatic HNSCC
  • Formulate a strategy to monitor for and manage the possible adverse events of immune checkpoint inhibitors
Faculty & Disclosures
Prof. Kevin Harrington

The Institute of Cancer Research, London, UK

Prof. Kevin Harrington is a National Institute for Health Research (NIHR) Senior Investigator and Head of the Division of Radiotherapy and Imaging at The Institute of Cancer Research (ICR), London, UK. He is also an Honorary Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust and St George’s Hospital, where he specializes in new treatments for head and neck cancer. read more

Prof. Harrington’s research interests include immunotherapy, targeted radiation sensitizers and oncolytic virotherapy. In the field of immunotherapy for cancer, he has been involved in the development of immune checkpoint inhibitors and innate immune activators. He has been principal investigator for multiple phase I, II and III studies of novel agents in head and neck cancer. He is currently leading a programme of pre-clinical and clinical research into targeted radiosensitizers. 

Prof. Harrington serves as the chair or lead on a number of research networks/programmes, including the ICR Wellcome Trust Clinical Training Programme, and he is an executive board member for the CRUK ICR/Imperial Major Centre for Convergence Science. He also serves on Steering Committees and Scientific Advisory Boards guiding the development of trials of immune checkpoint inhibitors in head and neck cancer. Prof. Harrington has published over 560 peer-reviewed publications and more than 50 book chapters.

Prof. Kevin Harrington discloses: Advisory board or panel fees from Amgen, InMed Medical Technology (Shanghai) and Merck. Consultant fees from Amgen, Arch Oncology, AstraZeneca, Boehringer Ingelheim, F Hoffmann-La Roche Ltd., Global Data, Idera Pharmaceuticals Inc., Inzen Therapeutics, iTeos Pharmaceuticals, Merck Serono, Merck Sharp & Dohme and Replimune. Grants/research support from AstraZeneca, Boehringer Ingelheim and Replimune.

Prof. Barbara Burtness

Yale Cancer Center, New Haven, CT, USA

Prof. Barbara Burtness is a Professor of Medicine at the Yale School of Medicine, and Interim Associate Director for Diversity, Equity and Inclusion at the Yale Cancer Center, New Haven, CT, USA. read more

Prof. Burtness serves as Co-Leader of the Developmental Therapeutics Program, Leader of the Disease Aligned Research for Head and Neck Cancer, and Director of the Yale Head and Neck Specialized Program of Research Excellence. 

Prof. Burtness is internationally recognized for her research in head and neck cancer. She chairs the ECOG-ACRIN Cooperative Group Head and Neck Cancer Therapeutics Committee, and leads national and international trials of targeted therapy in head and neck cancer. 

Prof. Burtness has served on the editorial board for a number of journals, including the Journal of Clinical Oncology and Clinical Cancer Research. She has contributed to a number of practice guidelines, standards and consensus statements in head and neck cancer, and has also published widely on the topic, with over 200 publications.

Prof. Barbara Burtness discloses: Advisory board or panel fees from Actinium, AstraZeneca, Cue Biopharma, Debiopharm, Exelixis, IO Biotech, Kura, Macrogenics, Merck KGaA, Merck, Mirati, Nektar, Nuvelution and Vaccinex. Consultant fees from Genentech. Grants/research support from Merck. Speaker’s bureau fees from Education Alliance.

Prof. Jean-Pascal Machiels

Cliniques Universitaire St-Luc, Brussels, Belgium

Prof. Jean-Pascal Machiels is Head of Medical Oncology, and Director of the Oncology Center, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium. read more

Prof. Machiels is chair of the European Organisation for Research and Treatment of Cancer (EORTC) Head and Neck group, and section editor for the head and neck cancer section of the European Journal of Cancer.

Prof. Machiels has been principal or collaborating investigator on numerous clinical trials, including phase I and translational studies, assessing the efficacy of potential new treatments for head and neck cancer. He has published more than 200 papers based on his research.

Prof. Jean-Pascal Machiels discloses: Advisory board or panel fees from ALX Oncology, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cue Biopharma, eTheRNA, Incyte, Innate, iTEOS Therapeutics, Janssen, Merck Serono, Nektar, Novartis, Pfizer and Roche. Safety monitoring board for Psioxus. Other financial or material support from Amgen, Bristol Myers Squibb, Merck Sharp & Dohme and Pfizer. 

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Question 1/4
You have just initiated pembrolizumab monotherapy in the first-line setting for a patient with metastatic HNSCC. Assuming the patient’s disease does not progress and they do not experience unacceptable toxicity, how long should you keep the patient on this treatment regimen?

HNSCC, head and neck squamous cell carcinoma.
Correct

The recommended length of treatment with pembrolizumab is until there is progression of disease, unacceptable toxicity or up to 24 months.1,2 

References

  1. Pembrolizumab. PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2021/125514s096lbl.pdf (accessed 20 December 2021).
  2. Pembrolizumab. SmPC. Available at: www.ema.europa.eu/en/documents/product-information/keytruda-epar-product-information_en.pdf (accessed 20 December 2021).
Question 2/4
Which of the following factors is considered independently of all other patient-specific factors when treating patients with recurrent or metastatic HNSCC?

HNSCC, head and neck squamous cell carcinoma.
Correct

Due to the distinct pharmacodynamic features of immune checkpoint inhibitors, there are several factors impacting the decision-making process in the recurrent or metastatic setting. Platinum compounds represent the chemotherapeutic backbone in not only palliative but also curative protocols; therefore, a distinction between platinum-sensitive and platinum-refractory disease must be made first, before considering factors such as pathologically determined CPS, clinically assessed biological age, disease burden and pace of the disease.1

CPS, combined positive score.  

Reference

  1. Szturz P, Vermorken JB. Ann Transl Med. 2020;8:975.
Question 3/4
Which of the following approaches would you recommend for managing mild facial oedema in a patient with recurrent or metastatic HNSCC who is receiving treatment with an immune checkpoint inhibitor?

HNSCC, head and neck squamous cell carcinoma.
Correct

Mild oedema usually goes away on its own, particularly if helped by elevating the swollen part of the body above the level of the heart or, in some cases, elevating the affected body part while sleeping. Salt can increase fluid retention and worsen oedema; patients are recommended to follow their treating clinician’s recommendations regarding salt consumption.1

Reference

  1. Edema. (Mayo Clinic: Patient care and health information). 2020. Available at: www.mayoclinic.org/diseases-conditions/edema/diagnosis-treatment/drc-20366532 (accessed 22 December 2021).
Question 4/4
Chest imaging for your patient with HNSCC, who is being treated with an immune checkpoint inhibitor, shows a few ground glass opacities indicating interstitial pneumonitis. The patient is not currently symptomatic and does not have any underlying lung conditions. What should you do?

HNSCC, head and neck squamous cell carcinoma.
Correct

As the patient is asymptomatic they are considered to have grade 1 toxicity (classified as mild). For this level of toxicity, monitor for symptoms every 2 or 3 days and consider a repeat CT in 3–4 weeks. If the patient’s condition worsens and they show symptoms such as cough, chest pain, fever and anoxia, treat as grade 2 toxicity and temporarily hold treatment until resolution to grade 1 or less.1 

Reference

  1. Zhu S, et al. Front Oncol. 2020;10:1785.
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