Expert Point of View: Lori J. Wirth, MD

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Lori J. Wirth, MD

Chemotherapy dampens the immune response, and if we can boost that response up front, it may have the potential to cure patients.

—Lori J. Wirth, MD

Pembrolizumab [Keytruda] has a more favorable side-effect profile than cytotoxic chemotherapy and cetuximab [Erbitux]. This is particularly important for recurrent/metastatic head and neck cancer patients who have been so beaten up by their disease, the treatment for their disease, and their comorbidities,” explained Lori J. Wirth, MD, Medical Director of the Head and Neck Oncology Program, Center for Head and Neck Cancers, Massachusetts General Hospital and Harvard Medical School, Boston.

“The 25% overall response rate is life altering for these patients, who have been through the ringer with surgery, radiotherapy, and chemotherapy directed to the head and neck,” she continued.

Dr. Wirth is impressed that the drug works on both human papillomavirus (HPV)-positive and HPV-negative squamous cell head and neck cancers. “We previously assumed that head and neck cancers would not respond to immunotherapy. There is an emerging story about immunotherapy in oncology, showing that our assumption was wrong. This study is one more proof that our older assumptions were off base, and it is an example of when it is good to be proven wrong,” she said.

The encouraging results in recurrent/metastastic squamous cell head and neck cancers suggest that bringing pembrolizumab upfront as part of first-line therapy may lead to improved outcomes. In the future, combination therapies that include chemotherapy, radiation, and immunotherapy will be studied, she said.

“Chemotherapy dampens the immune response, and if we can boost that response up front, it may have the potential to cure patients,” Dr. Wirth ­commented. ■

Disclosure: Dr. Wirth reported no potential conflicts of interest.


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