What are the treatment options for throat cancer?

Based on a paper titled “Immunotherapy for Head and Neck Cancer: A Paradigm Shift From Induction Chemotherapy to Neoadjuvant Immunotherapy”

Originally written by: Shibata et al., 2021 

https://www.frontiersin.org/articles/10.3389/fonc.2021.727433/full

Written by: Murielle Nsiela 

Throat cancer is the overgrowth of cancerous cells that begin in the voice box (also known as the pharynx or larynx), the food pipe (scientifically known as the oesophagus), and the thyroid.¹ There are 12,400 cases of throat cancer in the UK every year, which rounds up to 34 cases every day.² Throat cancer symptoms in the early stages of the disease are similar to that of the cold, including hoarseness and sore throat. However, a warning sign associated with throat cancer is a continuous sore throat that lasts longer than 2 weeks, while a sore throat associated with a cold usually goes away within 2 weeks or less. 

There are advanced symptoms of throat cancer: difficulty swallowing, a lump in the mouth or throat, voice changes, ear or jaw pains, persistent cough, and difficulty breathing. Additional symptoms include white patches in the throat or mouth, unexplained weight loss, swelling in the throat or neck, and bleeding in the nose or mouth.³ The most common way of treating throat cancer is by radiation therapy, which is used for cancer that has not spread to other body parts (metastatic). 

In addition, chemotherapy can also be combined with radiation therapy or surgery for more advanced cases.⁴ However, these approaches severely impact the throat’s function: chemotherapy and radiation can cause changes in the mouth and the salivary gland, which produces saliva, and leads to infections, tooth decay and mouth sores.⁵ 

Additionally, despite the combination therapies for head and neck cancer, the outcome remains poor. Therefore, there have been suggestions for immunotherapy, which involves using the body’s immune system to control cancer cell growth.⁶ Although immunotherapy only works on 15-20% of patients, it has been approved and used for recurrent and metastatic head and neck cancers. 

Recent clinical trials show promising results when providing immunotherapy as the first step for cancer treatment before continuing with chemotherapy or radiotherapy.⁷ This approach targets the patient's immune system by attacking the tumour cells. Therefore, there is the expectation that this will increase the chances of obtaining a better therapeutic effect than other methods.  In addition, patients tolerate immunotherapy better than chemotherapy due to the severe side effects associated with chemotherapy. Therefore, immunotherapy is a more appealing option for throat cancer patients.

In a study, 36 patients with head and neck cancer were treated with immunotherapy and followed up with surgery 2 to 3 weeks afterwards. The results of the study show that the relapse rate (cancer recurrence) after 1 year was 16.7%, which was lower than previous historical data. However, there have been safety concerns regarding toxicities and the body attacking its cells. In contrast, this particular study showed that immunotherapy has been safe and does not cause any surgical delays during clinical trials.⁷

In conclusion, immunotherapy has demonstrated positive results regarding the treatment of head and neck cancer. However, further clinical studies would be required to identify high-risk patients who would benefit most from this treatment, as immunotherapy treatment can be expensive.