Session 4:

Quality of

life and

targeted

therapy

Panel:

Christoph Zielinski Vienna Austria lecture

Jan Vermorken Antwerp Belgium

Jeffrey Myers Houston Texas, USA

Lisa Licitra Milano Italy

Johan Wennerberg Lund Sweden moderation

Health:

"Health is a state of complete physical, mental and

social well-being and not merely the absence of

disease or infirmity is a fundamental human right.”

WHO, 1948

Disability:

"... any restriction or lack (resulting from an

impairment) of ability to perform an activity in the

manner or within the range considered normal for

a human being."

WHO 1980

QoL:

"Quality of life refers to patient's appraisal of and

satisfaction with their current level of functioning as

compared to what they perceive to be a possible ideal.”

(Cella & Tulsky. Measuring quality of life today: Methodological aspects. Oncology 1990;4(5):29-38)

How do we measure QoL?

E. Hammerlid, thesis, 1997

How do we measure H&N QoL?

E. Hammerlid, thesis, 1997

EORTC QLQ-C30 (version 3)

EORTC QLQ-C30 (version 3)

EORTC QLQ-C30 (version 3)

EORTC QLQ-C30 (version 3)

Whats the Quality of Life for H&N Ca Patients?

Survivors vs. Non-survivors

Time point

1 year

6 months

3 months

Diagnosis

Me

an

sco

re

100

90

80

70

60

50

40

30

20

10

0

Physical function

Survivors

Died 1-5 y

Died 6-12 m

Died 3-6 m

Died 0-3 mMats Nordgren, Thesis: HRQL in H&N Ca; A five-year prospective multicenter study, 2005

HRQL in oral cancer survivors

Single items (QLQ-H&N35)

Time point

5 years

1 year

6 months

3 months

Diagnosis

Me

an

sco

re

100

90

80

70

60

50

40

30

20

10

0

Survivors

dry mouth

sticky saliva

open mouth w ide

Mats Nordgren, Thesis: HRQL in H&N Ca; A five-year prospective multicenter study, 2005

Targeted therapy – Therapeutic strategies

Signal transduction pathways

EGFR

Antiangiogenesis

VEGF

Unique metabolic requirements

Iodine 131

Hypoxic cell sensitizers

Promises for the future!

Targeted therapy!Advertisment, EJC 2006;42

Depicting a bright

future …

Advertisment, Acta Oncologica 2005; 44

What’s the base of evidence?

#1 Carcinoma, Squamous cell [mh] 71 413#2 Head and Neck Neoplasms [mh] 161 362#3 #1 OR #2 199 717

#4 Quality of Life [mh] 50 229#5 HRQL [tw] 848#6 #4 OR #5 50 365

#7 Targeted therapy 19 688

#8 #3 AND #6 AND #7 8

Questions to consider:

- Which are the common types of toxicity induced through „targeted“ treatment?

- Can we reduce chemotherapeutic dosage – and thereby toxicity - by adding targeted drugs to the treatment regimen?

Issues to discuss (1):

- The learning curve to handle toxicities

- The relationship of QoL and survival in targeted therapy

- Which evidence level (1-8) has the data collection?

Issues to discuss (2):

- May QoL (QLQ C-30; H&N35) serve as an outcome end point?

- Can we anticipate new toxicities?

- QoL v.s. cost/benefit of targeted therapy.

What can we expect to achieve?

Advertisment, EJC 2006;42

”Is our enthusiasm adequate?”