Personalized Chemotherapy Approaches in Head and Neck Cancer

Head and neck cancers are the collective term for various cancers originating from various areas of head and neck such as oral cavity, throat (pharynx), voice box (larynx), paranasal sinus, nasal cavity, and salivary glands. This cancer originates in cells that line the mucosal layer of the head and neck areas. These cancers develop when the healthy cells in these areas grow out of control and form a tumor. Head and Neck cancers are the sixth most commonly spread cancer across the world.

Types of Head and Neck Cancer

According to the part of the body where they develop these head and neck cancers can be classified into five major types.

• Laryngeal and hypopharyngeal cancer
• Nasal cavity cancers
• Nasopharyngeal cancer
• Oral and oropharyngeal cancer
• Salivary gland cancer

These types of cancers affect the voice box (larynx) and their surrounding tissues, air filled sacs around the nasal cavity, airway in the upper part of the throat, areas of nose, mouth, tongue and even salivary glands.

Causes of Head and Neck Cancer

• Tobacco and alcohol use
• Human papillomavirus infection (HPV), specifically type 16
• Occupational exposure to asbestos, formaldehyde, certain metals and ceramics
• Exposure to radiation
• Poor oral care for a prolonged period
• Epstein-Barr virus infection

Treating Head and Neck cancers

As with any cancer cure, similarly for head and neck cancer conventional treatment approaches usually followed according to the treatment guidelines. The various treatment options can include surgical removal of the infected part, radiation therapy, chemotherapy, immunotherapy, targeted therapy, and sometimes a combinational approach is also undertaken based on the severity of the cancer and its spread.

However, the treatment plan will depend upon various factors like the area where the cancer is present, the stage of the cancer, age, and other health factors. The traditional treatment methods were not as effective, and hence, a multifaceted approach must be practiced to prevent the recurrence. Incorporating personalized or precision medicine based approaches on individual needs significantly improved the recovery rates. Robotic surgeries are being increasingly incorporated into the field as they offer vast advantages such as, high precision and detailed visualization with its ability to handle complex surgical procedures along with minimally invasive procedures.

Chemotherapy approaches in Head and Neck cancer

The chemotherapy approach involves the mechanism of employment of medications to kill and eradicate the cancer cells, thus preventing their growth and spread. Chemotherapeutic procedures can be carried out either before the surgery (neo-adjuvant chemotherapy) or after the surgery ( adjuvant chemotherapy).

Treatment plans for personalized chemotherapy are created taking into account the features of cancer, its mutation, and spread, as well as aspects unique to each patient, like gene specificity and receptors. Personalized approaches offer an advantage such that it allows adaptive treatment plans by altering the regimens if needed thereby offering a dynamic approach in treating cancer.

• Tumour molecular profiling: Various advancement techniques in genomic sequencing have paved the way for better identifying genetic mutations and tumor alterations. Various chemotherapeutic medications targeting these specific mutations can yield a better outcome. Cetuximab targets the epidermal growth factor receptor and inhibits its over expression.
• Combination therapy approaches: oncologists can create a multi-treatment plan for their patients, including immunotherapy, radiation, and targeted therapy. For example, anticancer medication docetaxel, along with radiation therapy, produces an improvement in their quality of life.
• Biomarker driven treatments: Personalized chemotherapy relies on biomarkers that are responsible for blocking and inhibiting the pathways that are essential for growth and development of tumor cells

Conclusion

Personalized therapeutic regimens have developed as a novel approach in management of several cancers. This treatment approach has revolutionised cancer care by incorporating a wide range of strategies which enables the oncologists to selectively curate treatment plans based on individual needs that improve the quality of life. Multidisciplinary team approaches involving oncologists, surgeons, speech therapists, nutritionists are essential in planning and management of treatment and side effects involved in it.