int translational research in head and neck cancer: preoperative chemotherapy in oral cavity cancer...
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Translational research Translational research in head and neck cancer: in head and neck cancer:
preoperative chemotherapy in oral cavity preoperative chemotherapy in oral cavity cancer based on disease molecular cancer based on disease molecular
profiling.profiling.
Paolo Bossi
MSO young investigator and Salvatore Venuta Prize
Medical OncologyHead and Neck UnitFondazione IRCCS
Istituto Nazionale Tumori MilanoINT
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Head and Neck Cancer: a challenging field
- Most “visible” cancers
- They affect social functions
- More frequent in socially-deprived people
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Multidisciplinary work
RADIOTHERAPY
MEDICALONCOLOGY
SURGERY
RADIOLOGYNUTRITION
MOLECULAR BIOLOGY
MULTIDISCIPLINARY
ASCO-ESMO Consensus on Quality Cancer Care
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- Microarray analysis of preTx Nasopharyngeal Cancer Radioresistance Profile?
- HPV negative oropharyngeal cancer:biomolecular prognostic factors
- Role of cytokine profile and growth factors in serum and drainage fluids
Ongoing studies on Translational Research…
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- The sixth most common cancer worldwide
- Visible? Parallel with colon cancer: 36% rate of early stage detection
- Overall Survivaldepending on stage:
Oral Cavity Squamous Cell Cancer–OCSCC-
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State of the art Treatment
“The ultimate goal of treatment is to eradicate the cancer, preserve or restore form and function, minimize the sequelae of treatment and finally prevent any subsequent new primary cancers”
STAGE III-IV: optimal surgery, followed by radio(chemo)therapy
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Aim of the study:
to improve survival of OCSCC through a molecular profiled selected treatment
Phase II study of preoperative TPF chemotherapy in locally advanced
resectable OCSCC
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Journal of Clinical Oncology 2003Journal of Clinical Oncology 2003
BACKGROUND –Induction PF study
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198 patients enrolled
2 treatment arms: 1) CT (CDDP-5FU) surgery+/- RT2) surgery+/- RT
no different postoperative morbidity
no difference in survival
BACKGROUND - Induction PF study
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Global Overall Survival
Months
0 12 24 36 48 60 72 84 96 108 120
Pro
babi
lity
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
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Overall Survival, by treatment arm
Months
0 12 24 36 48 60 72 84 96 108 120
Pro
babi
lity
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
TreatmentControl
0.3402P
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Less mandibulectomy and postoperative RTin chemotherapy treated arm
BACKGROUND - Induction PF study
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- Pathologic Response Rate similar to Radiological-Clinical one
- Pathologic Complete Response (pCR) obtained in 27% of the patients treated with induction CT
BACKGROUND - Induction PF study
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Overall Survival
according to response to chemotherapy
p = 0.03p = 0.03p = 0.03p = 0.03
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NEXT STEP
need for effective antiblastic treatment with a biological tumor selection
To spare toxic treatment to whom is not expected to optimally respond
NEXT STEP
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NEXT STEP: TPF better than PF
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NEXT STEP: predictive factors
p53 in Head and Neck Cancer
- TP53 mutations recognized prognostic factor (disruptive mut and non functional protein in particular)
- Predictive role of p53 in response to chemotherapy
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pCRnon pCR
pts
p53 protein "functional"
status
p53 nonfunctional
2/14(14%)
18/37(49%)
20
p53 functional
12/14(86%)
19/37(51%)
31
P = 0.02
NEXT STEP: predictive factors
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p53 translational research
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NEXT STEP: predictive factors
Beta-Tubulin in Head and Neck Cancer
-
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Ongoing phase II study of preoperative TPF
INCLUSION CRITERIA
- Hystologically proved primary OCSCC- Stage T2 (> 3 cm)-T3, N1-N3 and T4a any N
-WHO performance status < 1
- Availability of Formalin Fixed Paraffin Embedded biopsy of the tumour
- Radiological imaging with MRI pre-therapy
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Ongoing phase II study of preoperative TPF
EXCLUSION CRITERIA
- Prior antitumor therapy for head & neck cancer
- Previous OCSCC to less than 2 cm from primary
- Screening laboratory values
- Weight loss > 20% in previous 3 months
- Technical unresectability defined as: T4b staging or N ulcerating the skin or encasing internal carotid
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Ongoing phase II study of preoperative TPF
STUDY DESIGN
Patient Selection and Informed Consent
Diagnostic Biopsy and Molecular Analysis
non functional p53 and high B-TubPatient non eligible
functional p53 or high B-Tub
3 cycles of TPF chemotherapy
Surgery
Postoperative (chemo)radiation
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Ongoing phase II study of preoperative TPF
PRIMARY ENDPOINT
To increase rate of pCR to 50% of the patients treated with induction chemotherapy
Sample Size: type I error of 10% for a mono-lateral test, power of
95% (beta=5%), plus 10% drop-out rate = 64 patients to be enrolled
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Ongoing phase II study of preoperative TPF
SECONDARY ENDPOINT
- Early functional response evaluation by DWI and DCE MRI
- Comparison between (DWI - DCE) MRI response and pathological response
Functional Imaging as possible predictor of early response and for the measurement of drug effects on tumour (micro)vascularity and
capillary permeability.
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Ongoing phase II study of preoperative TPF
SECONDARY ENDPOINT
- Percentage of patient receiving postop radiotherapy and chemotherapy
- Progression free survival and overall survival
- Second primary tumour incidence
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Ongoing phase II study of preoperative TPF
STRENGHT
- Molecular profiled driven treatment
- Prospective trial in specialized Centers
- Centralized pathologic, molecular and radiologic evaluation
- Trial potentially opening new scenarios in personalized treatment
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Ongoing phase II study of preoperative TPF
WEAKNESS
- Only 2 molecular alteration as predictor of response
- Trial based on adding therapy, not on “removing” part of it (need for larger trial)
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Ongoing phase II study of preoperative TPF
CONCLUSIONS
- Results foreseen within 2012
- Looking for increase in OS, through new therapeutic strategy
- Towards an individualized treatment approach
- The importance of multidisciplinary work and translational research