Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Dr. Brook, traditionally the treatment for head and neck cancer has been surgery, radiation, chemotherapy or some combination of those three. But there are some new and emerging treatment approaches to head and neck cancer along with many other cancers. Can you tell us a little bit about immunology? What is immunotherapy in the care of the head and neck cancer patient?
Itzhak Brook, M.D., M.Sc.: Most days, we don’t get cancer because our immune system is like the police department of our body. They detect cancer early and eliminate it. Unfortunately, in the case of cancer, the cancer cells can fool the immune system, and they go undetected and cause the disease. The main advantage of immunotherapy is that we are using the body’s defenses, the immune system, to kill the cancer in a much better way than the chemotherapy. Chemotherapy destroys the cancer cells, but it also affects the body cells. Immunotherapy is more precise. It is directed only to the cancer cells, so the rest of the body stays unscathed. That’s the beauty of immunotherapy. So, immunotherapy is an evolving field in cancer. They have many, many new drugs in the pipeline, and many studies are being done. But right now, there are several drugs that are good and seem to help in a patient with cancer, cancer that has already spread or that surgery cannot reach. The body’s own immunity would reach it.
One of them is monoclonal antibodies that were developed specifically for the cancer cells, and the other one is checkpoint inhibitors, which overcome the attempt by the cancer cells to fool the immune system and protect the cancer cells from their own immunity. So, by blocking those checkpoints, the body’s own immunity comes in and destroys the cancer cells. Those drugs are very promising because first of all, they are more effective in getting only the cancer cells. They do cause fewer side effects, and we are hopeful that they would be the new armamentarium that we will have for head and neck cancer.
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: So, would you say that’s something you should ask your physician about to find out what clinical trials and what types of medications are offered for your specific type of cancer at the time of diagnosis?
Itzhak Brook, M.D., M.Sc.: Absolutely, and that is depending on your own illness, on the seriousness or stage of the illness. And your physician would be able to consult the right specialist to tailor the specific treatment for you, and that’s very important because now we have a new tool that can augment the chemotherapy. And many of those treatments are given in combination. Conventional treatment with chemotherapy plus immunotherapy seems to work very well in many patients.
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes. The future is exciting in that regard. In the case of the HPV-positive oropharyngeal cancers, there has also been a lot of interest and push toward robotic surgery in caring for that patient population. I know that that’s not for everybody, and it’s more suited for some of the smaller tumors because of the side effects that might go along with it. What is your understanding of the role of robotic surgery in the care of head and neck cancer patients?
Itzhak Brook, M.D., M.Sc.: Robotic therapy is an amazing new procedure. It’s being done using the robotic tools that are able to do the surgery in a much less invasive way without traumatizing many of the normal tissues of the body. They cause less damage. The recovery period is shorter, and patients benefit from it tremendously. In that procedure, there is a robotic machine that the surgeon operates, and it allows very, very precise ability to cut the cancer out, and it does cause less long-term damage to the tissues and less deformity, you may say. And that’s a wonderful tool. But unfortunately, as you said, it is limited to areas of the body that the robot can reach. And when the cancer is in places that are not reachable by the robotic approach, one needs to use the conventional approach. But even in that area, there is a development of using endoscopic surgery where one can use a laser and the endoscopic approach, or the laser can kill or burn out the cancers that are more deeply located in the throat, again saving major surgery and even saving removal of the larynx from patients.
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: That’s right. And also, there’s a push toward de-escalation of the radiation and the chemotherapy in some of these HPV-positive patients, as well, because the tumors are more responsive to the treatment. So, there are many studies going on looking at whether we can do less treatment for the different types of diseases. As you spoke earlier, I think finding the right specialists is important; not everybody is a specialist in all these new and advanced technologies. If you’re looking for robotic surgery, find that specialist that really does a lot of robotic surgery and is an expert in that field. The same is true for the immunotherapy and other treatment approaches as well. So, I think being your own advocate, again, to find these different alternative options and these new treatments in clinical trials becomes exceedingly important in the age of all these new discoveries.
Itzhak Brook, M.D., M.Sc.: Fortunately, the knowledge of experience in those procedures, the laser and the robotic surgery, is becoming more prevalent in the United States. And when I had my cancer, when I needed to make choices 10 years ago, there were only a handful of experts. But right now, almost every major medical center has an expert in those fields, so it’s more available for people.
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Absolutely. So, even if you have to travel a distance to get to those major medical centers, it’s worth the effort and travel and time to be able to seek these other opinions and see what your other options are before pursuing your treatment.
Itzhak Brook, M.D., M.Sc.: Absolutely.
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes, I agree.