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Review
. 2024 Aug 6:14:1433333.
doi: 10.3389/fonc.2024.1433333. eCollection 2024.

Is precision medicine the solution to improve organ preservation in laryngeal/hypopharyngeal cancer? A position paper by the Preserve Research Group

Davide Mattavelli  1   2 , Gunnar Wichmann  3 , Davide Smussi  2   4 , Alberto Paderno  5 , Maria Serrahima Plana  6 , Ricard Nin Mesia  6 , Micaela Compagnoni  7 , Alessandro Medda  7 , Susanna Chiocca  7 , Stefano Calza  8 , Yinxiu Zhan  7 , Carla Rognoni  9 , Rosanna Tarricone  9   10 , Erika Stucchi  11   12 , Luigi Lorini  11 , Cristina Gurizzan  11 , Ksenia Khelik  13 , Eivind Hovig  13   14 , Andreas Dietz  3 , Cesare Piazza  1   2 , Paolo Bossi  11   12
Affiliations
Review

Is precision medicine the solution to improve organ preservation in laryngeal/hypopharyngeal cancer? A position paper by the Preserve Research Group

Davide Mattavelli et al. Front Oncol. .

Abstract

In locally advanced (LA) laryngeal/hypopharyngeal squamous cell carcinoma (LHSCC), larynx preservation (LP) strategies aim at the cure of the disease while preserving a functional larynx, thus avoiding total laryngectomy and the associated impact on the quality of life. In the last decades, apart from transoral and open-neck organ preservation approaches, several non-surgical regimens have been investigated: radiotherapy alone, alternate, concurrent or sequential chemoradiation, and bioradiotherapy. Despite major progress, the identification of reliable and effective predictors for treatment response remains a clinical challenge. This review examines the current state of LP in LA-LHSCC and the need for predictive factors, highlighting the importance of the PRESERVE trial in addressing this gap. The PRESERVE trial represents a pivotal initiative aimed at finding the optimal therapy for laryngeal preservation specific to each patient through a retrospective analysis of data from previous LP trials and prospectively validating findings. The goal of the PRESERVE trial is to develop a comprehensive predictive classifier that integrates clinical, molecular, and multi-omics data, thereby enhancing the precision and efficacy of patient selection for LP protocols.

Keywords: chemotherapy; head and neck; hypopharynx; larynx; organ preservation; radiotherapy; squamous cell carcinoma.

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Conflict of interest statement

PB: participation in an advisory board or conference honoraria for: Merck, Sanofi-Regeneron, Merck Sharp & Dohme, Glaxo Smith Kline, Merus, Pfizer, Sun Pharma, Angelini, Nestlè. MP: Eisai, Invited Speaker, MSD, Invited Speaker, Travel grants. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
10-year outcome data of patients treated with induction cisplatin plus fluorouracil followed by radiotherapy and concurrent cisplatin (radiotherapy in RTOG [Radiation Therapy Oncology Group] 91–11 phase III randomized trial). Representation of RTOG 91–11 data from the re-analysis by Licitra et al. (15).
Figure 2
Figure 2
Current recommendations from the European Society for Medical Oncology (ESMO) and the Americas Society of Clinical Oncology (ASCO) for the application of LP strategies in the management of locally advanced (LA) laryngeal/hypopharyngeal cancer.
Figure 3
Figure 3
Detailed design of the clinical PRESERVE trial, reporting selected population, methods of analysis, performed treatments and therapies, results and follow-up of patients. Specifically, patients affected by stage III-IV, non-metastatic, laryngeal/hypopharyngeal cancer candidates to total laryngectomy will be enrolled. For all patients, a multiomic assessment including clinical factors, radiomic and genomic analysis will be performed, providing a prediction of response to induction chemotherapy. Patients predicted with partial response (PR) will receive chemo-immunotherapy induction treatment. After three cycles, patients will undergo endoscopical and radiological restaging and receive curative treatment according to a tailored strategy, and subsequent follow-up.
See this image and copyright information in PMC

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