July 2013

Head and Neck Oncology Program at UNC Lineberger

 

The UNC Head and Neck Oncology Program offers a full range of leading-edge diagnostic and therapeutic techniques for the treatment of all benign and malignant tumors of the head and neck in adult and pediatric patients.

 

The multidisciplinary team consists of surgeons, medical oncologists, radiation oncologists, pathologists, diagnostic and interventional radiologists, dentists, epidemiologists, prosthetic specialists, nutritionists, speech and swallowing specialists, nurses and social workers.

"The UNC Head and Neck Oncology Program is truly a team effort that has developed over time. We've run a tumor board for over 20 years, which really was ahead of its time," said Dr. Mark C. Weissler, Chief of Head and Neck Oncology. "Over the years, we have developed this multidisciplinary approach, which has been a central aspect of UNC's approach to cancer in general. I really think it has been successful."

The UNC Head and Neck Oncology Program's team of specialists brings expertise and understanding to these complex cancers where vital life functions may be affected. The team meets formally on a weekly basis to discuss all of their cases. They present 30 to 40 patients per week and discuss what the best overall plan is for each of them.

In addition to treating patients, the Head and Neck Oncology Program also explores better treatment options through collaborative, clinical and translational research.

To make a referral, call the Program Coordinator at 919-966-9717. For additional information, visit the program's website.

Multidisciplinary Conference

 

Referring physicians and colleagues are invited to submit cases to and participate in the UNC Head and Neck Oncology Multidisciplinary Conference. The Head and Neck Oncology Multidisciplinary Conference is held on Friday mornings from 7:00-8:30 a.m. Referring physicians and colleagues wishing to present a case or obtain an opinion may attend via teleconference. To schedule a case, please contact Laura Lyndon Miller, Program Assistant, via email, or call 919-966-9717.

 

 

Combining advances in minimally invasive transoral laser and robotic surgery with recent breakthroughs in cancer drug development

 

Recent additions
to the Head and Neck Oncology Program
at UNC, Trevor Hackman, MD, Department of Otolaryngology, and Jared Weiss, MD, Department of Medical Oncology, have teamed up to launch a first-of-its-kind clinical trial in head and neck cancer therapy. The trial combines advances in minimally invasive transoral laser and robotic surgery, commonly referred to as TLM and TORS, with recent breakthroughs in cancer drug development. While induction chemotherapy followed by radiotherapy has been previously explored, this trial marks the first time induction chemotherapy 
followed by transoral surgery has ever been investigated.

 

Modern cancer therapy aims to increase cure rates and minimizing patient morbidity. This novel, and so far highly successful, clinical trial investigates the effectiveness of induction chemotherapy to achieve a partial or complete tumor response. Coupled with minimally invasive surgery, patients have the potential for curative intent therapy without the short and long term morbidity of radiation therapy.

 

(LCCC 1125Multimodality Risk adapted Tx including carboplatin/paclitaxel/Lapatinib as induction for SCCHN; PI: Weiss)

 

 

Novel reconstruction techniques for head and neck cancers

Nationally recognized as a leader in treating
head and neck cancers, the UNC Head and
Neck Oncology Program is home to a leading reconstructive surgery program. Microvascular free tissue transfer has become the standard of care for the reconstruction of complex head and neck cancers. The art of reconstruction extends beyond cosmetic repair. At UNC, the restoration
of functionality and minimization of damage at the tissue donor and recipient sites are areas of paramount importance.

Trevor Hackman, MD, co-developer and clinical pioneer of the extended pedicled palatal flap for skull base reconstruction, leads the UNC Head and Neck Reconstructive Program. Internationally recognized for advances in skull base reconstruction, he and his team performed the first endoscopic free tissue transfer at UNC and have developed novel reconstruction techniques that reduce tissue damage, improve cosmetic appearance and maintain oral functionality and quality of life. By maintaining and advancing the state of the art of head and neck cancer treatment, the UNC Head and Neck Oncology Program provide patients with the most advanced care possible.

 

Genomic alterations in head and neck cancers are possible therapy targets

Neil Hayes, MD, MPH, associate professor in UNC's Division of Hematology and Oncology, is one of the leaders of the efforts by the Cancer Genome Atlas (TCGA) to sequence the genes responsible for head and neck cancers. The group's work has identified several mutations that offer possibilities for near term and future clinical therapies for patients with head and neck squamous cell carcinoma (HNSCC).

The TCGA project has isolated 18 genes that were frequently mutated in the cancer, many of which offer potential therapy targets. Even genes without a mutation may help identify other targetable proteins. In one example, the absence of a mutation in the TP53 gene is linked to HPV-driven head and neck cancers, which sometimes have mutations in the H-Ras gene. These mutations can be targeted by existing therapies such as Farensyl transferase inhibitors.

The identification of these targetable mutations means that the HNSCC group's work could lead to new therapies in the clinic with existing pharmaceuticals in the near term, as well as pointing the way for future therapeutic discoveries. Potential drugs targeting frequently mutated genes such as PIK3CA are already in development. Read more here.

 

More clinical trials in Head and Neck Oncology

14E-MC-JXBAPhase 2 Study to Evaluate the Pharmacokinetics and Drug-Drug Interaction of Cetuximab and Cisplatin in Patients with Recurrent or Metastatic Carcinoma of the Head and Neck (PI: Hayes)

CCCWFU-60107: Phase I/II Clinical Trial Of Combined Re-irradiation With Pemetrexed And Erlotinib Followed by Maintenance Erlotinib For Recurrent And Second Primary Squamous Cell Carcinoma of the Head and Neck (PI: Chera)

LCCC 1103: A Phase II study of carboplatin, nab-paclitaxel and cetuximab for induction chemotherapy for locally advanced squamous cell carcinoma of the head and neck (PI: Weiss)

LCCC 1120: Phase II Study of De-intensification of Radiation and Chemotherapy for Low-Risk HPV-related Oropharyngeal Squamous Cell Carcinoma (PI: Chera)

NCI 8317: Phase I/II trial of Cediranib alone or Cediranib and Lenalidomide in iodine 131-refractory differentiated thyroid cancer (PI: Hayes) 

RTOG 0920: A Phase III Study of Postoperative Radiation Therapy (IMRT) +/- Cetuximab for Locally-Advanced Resected Head and Neck Cancer (PI: Chera)

RTOG 1008A Randomized Phase II Study of Adjuvant Concurrent Radiation and Chemotherapy versus Radiation Alone in Resected High-Risk Malignant Salivary Gland Tumors (PI: Chera)

RTOG 1216-CIRBRandomized Phase II/III Trial of Surgery and Postoperative Radiation Delivered with Concurrent Cisplatin versus Docetaxel versus Docetaxel and Cetuximab for High-Risk Squamous Cell Cancer of the Head and Neck (PI: Chera)

 

Remembering Dr. Keith Amos

UNC lost a dear colleague on June 17 when Dr. Keith Amos died suddenly in Edinburgh, Scotland, while on a Dr. Claude Organ, Jr., Travel Award from the American College of Surgeons. Dr. Amos was a treasured member of the UNC School of Medicine, the Department of Surgery, the Division of Surgical Oncology and the UNC Lineberger Comprehensive Cancer Center. He was a caring doctor, avid researcher, engaged collaborator, effective teacher and just a terrific human being. Colleagues, medical students, surgery residents and especially patients, to whom he was so dedicated, will sorely miss him.

 

If you would like to leave a remembrance of Dr. Amos, please visit our legacy site at keithamosremembered.web.unc.edu.

 

 

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For questions about all clinical trials at UNC, contact the UNC Lineberger Protocol Office at 919-966-4432 or (toll-free) 1-877-668-0683. For questions about clinical trials offered at other sites, contact the UNC Cancer Network at 919-966-7359 or (toll-free) 1-877-668-0683.

 

To make an appointment at the N.C. Cancer Hospital for one of your patients, visit our web page for referring physicians. You may also contact the Carolina Consultation Center at 1-800-862-6264.