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My name is Jonathan Schoenfeld.
I'm an Associate Professor of
Radiation Oncology at
Harvard Medical School and
a senior physician in
Radiation Oncology at
the Dana-Farber Brigham
and Women's Cancer Center.
It's a privilege to speak about
immunotherapy and radiation
for head-neck cancers.
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Here are my relevant
disclosures.
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For those who are not familiar
head-neck cancers occur at
different sub-sites with some of
the major sub-sites
including the nasopharynx,
oropharynx, oral cavity,
hypopharynx, and larynx.
These regions are very
important functionally,
for speaking, swallowing
and breathing.
Functional importance
makes treatment of
head-neck cancers complex
and patients with
head-neck cancers typically have
a multi-modality evaluation to
consider treatment options
including surgery,
radiation, and systemic
treatments to best
treat the cancer while
minimizing effects
on quality of life.
In addition to the
different sub-sites
and types of treatments,
there are also different
types of tumors.
This talk focuses on
the most common type of
tumor in the head and neck
squamous cell carcinomas.
Although the concepts that
I'll discuss apply to
some of the other common types
of head and neck tumors as well.
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Among squamous cell carcinomas,
there are generally
considered to be
two biologically
different types.
The first is the more
traditional type
of head and neck
cancer caused by
tobacco and alcohol use that
leads to progressive
genomic changes over time.
That causes head and
neck malignancies.
The second type of squamous
cell carcinomas are
head and neck tumors
that are related to
the human papilloma
virus or HPV.
HPV is a common infection that
impacts epithelial cells and
particularly the cells among
the lymphoid tissue and
the base of tongue and tonsils
within the oropharynx.
As shown, chronic HPV
infection can lead to
HPV integration into
the host DNA or into
the nucleus and give rise
to the expression of
the E6 and E7
oncoprotein that in
turn inhibit tumor
suppressors p53 and RB.
Over a period of
likely many years or
even decades expression of
the E6 and E7 proteins and
subsequent inhibition
of p53 and RB leads to
progressive genomic changes and
the formation of HPV
associated cancers.
The number of HPV associated
oropharyngeal cancers
is significant,
peaking among men aged
50 and older and
increasing in many
countries around the world.
