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Q I am a 55-year-old woman with Human Papilloma Virus (HPV)-positive head & neck squamous cell carcinoma (HNSCC), with metastases to my thorax. I have had treatment with cisplatin + 5FU and radiation, but my cancer has progressed after treatment, with metastases to my chest lymph nodes. I’ve been told that some new immunotherapy drugs are having spectacular success. Can you suggest a good clinical trial for me?
A Immunotherapy drugs known as checkpoint blockade antibodies (Keytruda, Opdivo and others) have shown great promise in HNSCC. These drugs work best in tumors that are “visible” to the immune system, perhaps because they have many mutations and express mutated proteins that are easily recognized by immune cells.
When the HPV virus is present in HNSCC, it may present viral proteins that are good targets for immune cells, and checkpoint drugs provide activation of these T cells. Some of the most interesting trials for HNSCC combine checkpoint antibodies with additional drugs to increase the efficacy of the former. Below are some trials specifically for HNSCC patients who experienced disease progression after treatment with platinum drugs:
NCT02178722 combines the checkpoint drug Keytruda with an IDO inhibitor—another kind of immunostimulating drug.
NCT02452424 combines Keytruda with a targeted drug that may prevent tumor cells from proliferating and metastasizing.
NCT02335918 combines checkpoint drug Opdivo with the promising immunotherapy drug varlilumab.
NCT02280811 involves modification of your own immune cells (T cells), altering them to recognize HPV-infected cells. This trial involves isolating T cells from your blood and re-engineering them to specifically attack cancer cells expressing HPV proteins. A hospital stay for chemotherapy and infusion of modified T cells is part of this trial.
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The time it takes for medical ideas to diffuse through the community when one misses a critical talk or paper.
The life expectancy of a patient with metastatic melanoma. This number has not changed in decades.
The variance of 5-year survival rates for similar patients depending on where they are treated and by whom.
The number of lives we estimate can be saved annually by optimizing and expanding the use of available drugs.
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