Head and neck cancer: effective prevention in youth and predictive diagnostics for personalised treatment strategies according to biological differences

Abstract

This article focuses on squamous cell carcinomas of the larynx, pharynx and oral cavity which count nearly 90% of the head and neck squamous cell carcinomas (HNSCC). Individual susceptibility depends on an individually given genetic background and/or acquired conditions or factors elevating the risk of HNSCC including smoking, alcohol abuse, and improper oral hygiene. A key issue in HNSCC pathogenesis is their development within large preneoplastic fields of mucosal epithelium made up of genetically altered cells that are clonally related to the carcinoma. Other individual differences in development of HNSCC comprise infection with pathogenic microbes and oncogenic human papillomavirus (HPV) subtypes like HPV 16 (a strong risk factor mainly for oropharyngeal cancer). Interestingly, the presence of HPV 16 also goes in line with better outcome after therapy. Vaccination against HPV infection in children plays an increasing role in prevention strategies and probably also reduces the oncogenic risk for HNSCC.

Fig. 1

Image series of a 71 years old male patient suffering from a laryngeal cT4_acN2_bcM0 carcinoma (left) pre and intra therapy after receiving one cycle TPF + cetuximab (right); the patient was early evaluated as good responder

Fig. 2

Comparison of IC₅₀ concentrations (inhibitory concentration which diminish colony formation to 50%) in the FLAVINO assay [35] of HNSCC with lower response to TPF-IC with good responders. (a), (b): based on volume reduction <50% (left) vs. >50% (right); (c), (d): based on tumour-surface reduction <30% vs. (left) vs. >30% (right). Horizontal lines in a, c and b, d, represent maximum tolerable plasma levels of cisplatin (6,667 nM [36]) and docetaxel (550 nM [37]), respectively. Clear differences in IC₅₀ for P and T exist between responders and no responders, and these allow for their distinction and hence could build a rational to analyse chemo response before starting chemotherapy