Clinical Trials for Head and Neck Cancers: Increasing Cure Rates and Improving Quality of Life

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Topics include: Treatments and Understanding

How do I participate in a clinical trial?  Patient Power Founder and Host, Andrew Schorr, and Dr. William Nassib William, Jr. of MD Anderson Cancer Center explore the variables related to head and neck cancer clinical trials.  Together, they discuss trial types, novel approaches, variations between trials, and how to identify and overcome barriers to clinical trial participation.  

This content was sponsored, in part, by a pharmaceutical company.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Hello and welcome to Patient Power. I’m Andrew Schorr. When it comes to head and neck cancer, of course, we hope there is great promise in clinical trials to help us do better.  And there is a lot of work going on.  Joining us now is a leading expert in the field who knows all about clinical trials, and that’s Dr. William William from MD Anderson Cancer Center, a head a neck specialist. Dr. William, thank you for being with us on Patient Power. 

Dr. William:

Thank you. 

Andrew Schorr:

Dr. William, help us understand what kind of clinical research is going on now.  Help us understand the trials and the design.

Dr. William:

There are several types of clinical trials that patients can participate in once they are diagnosed with a head and neck cancer, and it really depends on the stage of their disease and where in their treatment course they are.  Some of these clinical trials, for example, are observational studies, where we're just trying to understand the biology of the disease. So we're going to be asking patients to donate, for example, a blood sample, or a sample from their tumor, and we're going to do analysis in the lab to understand how the disease progresses in these patients.  

Oftentimes patients agree to participate on clinical trials where they're going to be treated with different approaches.  So, for example, patients with potentially curable disease, locally advanced disease, may enroll in clinical trials that are looking at different ways of delivering radiation therapy or different ways of delivering chemotherapy or targeted therapies in combination with radiation therapy. 

Some of these studies are looking at improving the treatment efficacy, so that patients will have a higher chance of cure.  Some of these clinical trials are looking at, for example, decreasing the rate of side effects that are associated with these treatments. 

And then we have patients with metastatic disease.  These patients often have potentially incurable disease, but they are treatable cancers. For these types of tumors, we're generally looking at new systemic treatments, new chemotherapies, targeted agents, immunotherapies, where we're trying to improve patients' quality of life and improve survival of these patients.  

We also have clinical trials particularly at MD Anderson that are looking at preventing head and neck cancers in people that we believe are at high risk for tumors.  Some patients, for example, have premalignant lesions in their mouth that we know can transform into cancer in the future, and one of the focus of our—and one of the focuses of our program is actually to try to develop approaches to prevent cancers from developing in these patients. 

We also have clinical trials for screening patients for head and neck cancers.  A study will open in the next few months that's going to look at males that may be at increased risk for having head and neck cancers and try to develop approaches of how to screen them and catch these cancers early on. This will be focused primarily on head and neck cancer that are related to HPV, nowadays a well?known etiologic factor for these cancers. 

Andrew Schorr

Dr. William, can you describe some of the trials you’re involved in now, and how you feel about them? Are you excited about what the prospect of this science is?

Dr. William:

Some of the clinical trials that we have available at MD Anderson are looking at very novel approaches to either screen, prevent or treat patients with head and neck cancers. In the screening arena, we have a study that's going to open in the next few months that's going to look at males between 50 and 59 that may be at high risk for developing head and neck cancers.  We now know that HPV, the same virus that is associated with development of cervical cancer in women can also cause head and neck cancers in young adults. 

So this clinical trial will look at patients between the ages of 50 and 59, and we'll do some screening tests with some blood work. And depending on the results, these patients will then be thoroughly evaluated for the presence of head and neck cancers. So this is trying to shift the paradigm that we can actually try to catch these tumors very early on and potentially increase the chance for cure.  

Another study that we have at MD Anderson that's coming soon is a clinical trial that's looking at preventing head and neck cancers in patients that are believed to be at high risk. For example, we have patients that have white patches in their mouth that are called leukoplakia or red patches in the mouth that are called erythroplakia.  These lesions are considered premalignant lesions.  They predispose the patient to have a head and neck cancer within the next few years.  

What we're doing in a clinical study is looking at these patients that are at high risk for developing cancers and treating them with a form of immunotherapy to see if that can actually prevent cancers from happening even before they arise. 

We also have a set of clinical studies that are looking at different ways of giving radiation therapy to patients with established head and neck cancers.  A good portion of head and neck cancers are treated with a combination of chemotherapy and radiation therapy. And at MD Anderson, we have a study that is comparing conventional radiation therapy with a technique called IMRT, versus radiation therapy that's given through a technique called proton therapy. And the goal of this study is to assess whether the new technique with proton therapy will be as effective and less toxic than the standard technique that's done with IMRT. 

We also have a set of clinical studies looking at adding different chemotherapies in combination with radiation therapy to try to improve the chances for cure for patients with locally advanced head and neck cancers. 

And, lastly, we do have clinical studies in patients with metastatic disease.  These clinical trials are looking at new drugs either as single agents or in combination to try to improve the amount of time that patients will live.

Most of these clinical trials in the head and neck area are now focused on looking at new immunotherapies. These are drugs that can actually harness the patient's own immune system against the cancer, and preliminary findings in head and neck cancer studies have already demonstrated that this is a very promising treatment strategy for this disease.  

In combination with all of these clinical studies, we do have trials that are looking at quality of life for patients as they go through these treatments and also looking at the potential long?term toxicities for these patients and how we can ameliorate those toxicities, such as swallowing dysfunction, speech dysfunction, etc.

Andrew Schorr

If someone decides to participate in a clinical trial, what about cost?  How are these costs covered?  What should patients expect? 

Dr. William:

The cost coverage on clinical trials can vary a lot depending from study to study and institution to institution. However, for the most part any new medications that are being studied in a clinical trial will be provided free of charge to the patient.  Any extra procedures that have to be done because of the clinical trial will oftentimes also be covered by the study itself. 

However, patients or their insurance companies or Medicare may need to provide the costs for standard of care tests or standard of care procedures that are done throughout the course of a clinical study.  So, for example, a CT scan that would normally be done in a patient that would be treated outside of a clinical trial will probably be billed to the insurance company or the patient or Medicare.

Patients should discuss the cost of clinical trials with their physicians and their institutions as this may vary from place to place.  I think that's probably better.  

Andrew Schorr

Dr. William, one more thing about clinical trials: in your opinion, how do we identify what are the barriers to patients participating in clinical trials, and how do we overcome them? 

Dr. William:

Head and neck cancer is a complex disease, and it should be treated in highly specialized centers. What patients and healthcare providers need to understand is that any of the treatment options that we have available nowadays to treat head and neck cancers at some point were investigational, and they were only made available because patients agreed to participate on clinical trials, and physicians agreed to enroll these patients on clinical studies so that everybody could learn from this experience and improve our treatment options. 

Patient education and healthcare education is key so that we can increase participation of any potential candidate for a clinical study so that these new treatment modalities will not only benefit each individual patient but will actually benefit society overall from what we can learn from these clinical trials. 

Andrew Schorr

Dr. William William from MD Anderson Cancer Center, a head and neck specialist.  Thank you so much for being with us with this important information for patients and family members.

Dr. William:

Thank you. 

Andrew:

Remember, we have a lot more for you in our Head and Neck Cancer Center so be sure to be signed up and join our community, so you will always know whenever we post something new. I’m Andrew Schorr. Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on June 16, 2016