The 2021 edition of the ESMO Award will go to an Italian woman who has been involved for over 30 years in the study and treatment of head and neck cancers. AND Lisa Licitra, Director of the Complex Structure Medical Oncology 3 – Head-Neck Tumors of the IRCCS Foundation National Cancer Institute of Milan, associate professor in the Department of Oncology and Hemato-Oncology of the University of Milan and scientific director of the Cnao foundation, the National Center of Oncological hadrotherapy for the treatment of tumors. The prize, “for his outstanding contribution to advancing the understanding and treatment of head and neck cancers, and for his commitment to motivate and mentor medical oncologists around the world“, As the motivation states, it will be delivered on September 17, the second day of the Congress of the European Society for Medical Oncology (ESMO), when Licitra will hold the conference entitled”A medical oncologist facing a disease”.
Head and neck tumors: under the eyes of all, ignored by too many
by Mara Magistroni
A disease, head and neck cancer, which Licitra found herself facing from the mid-1980s, when with a scholarship she joined, as a young oncologist, a group of surgeons and radiotherapists. “It was an ante litteram interdisciplinary group – explains the expert – which here in Isistuto had formed naturally, out of necessity, around a rare and deadly disease, against which at a certain point it was necessary to add skills. Cervico-facial oncology was born in the hands of surgeons and radiotherapists, after involving experts in chemotherapy and systemic care. Above all to manage cisplatin, which still today represents the main treatment in the treatment of cervico-facial tumors. The award that was awarded to me has a motivation to which I am very attached and that is to have made my discipline known to other disciplines. Surgery and radiotherapy held the knowledge of head and neck cancers, the medical oncologist did not have it, and very often unfortunately still does not have it. This is a somewhat peculiar disease ”.
In what sense is it a particular disease?
Because it is a local disease, and recurrence and metastases are also very often local, only a minority of patients develop distant lesions. Normally the medical oncologist does not see the lesions: the disease I deal with can be seen and heard instead. It involves many senses, it is highly disabling, those who suffer from it find it hard to breathe, to speak, to swallow. And there is the question of physical appearance, which is very often compromised. Here, in one out of two cases, a head and neck tumor is all this stuff. Of course, over the years surgery has learned to reconstruct tissues, radiotherapy to limit radiation and to preserve organ functions as much as possible.
There is a lot of talk about precision oncology. What are the prospects in this regard for this rare tumor?
It is true that it is a rare disease (10 thousand cases a year in 2020 in Italy, ed) however head and neck cancers are the most frequent among the families of rare cancers. The problem is that these tumors are merged into many different subgroups, which have different natural histories, treatments and biology. So it is logical to try to unhinge this simplification, since we are moving towards precision oncology. We must aim to select patients as much as possible, to divide the large family of head and neck tumors into the various subgroups on the basis of the clinic and the biology of the disease. Head and neck tumors have a particular biology that in itself lends itself little to precision oncology as it is understood and how it works today.
“That day I felt the taste of coffee again”
by TIZIANA MORICONI
Precision oncology today is based on the identification of mutations against which drugs are targeted. Now, there are mutations in cervico-facial tumors, but they are not useful in designing innovative drugs because they are mutations in tumor suppressor genes, that is, genes with an inhibitory activity that does not work. Today it is very difficult to develop drugs that target inhibitors that don’t work. We are facing a disease for which few drugs have proved useful: the only drug that affects a specific approved target is cetuximab, but in other cancers, such as that of the lung or breast, this type of drug there are dozens of them. The two main drugs against the disease that I deal with are cisplatin and cetuximab. There is the new entry of immunotherapy: in Italy we have nivolumab and pembrolizumab. We do not have exceptional data, of course, as for melanoma or lung cancer, but we have them: in patients with recurring or metastatic disease with these drugs we have observed an increase in survival. Now it is a question of understanding how to insert immunotherapy into the natural history of the disease.
So what is the strategy to follow to find new therapeutic solutions for head and neck cancer?
Use a lot of data and select the patients as much as possible, collecting them in small groups so as to better target the objectives of the studies. If I maintain a heterogeneity within the trials, I risk seeing very little. To give an example: it is clear that there is a small group of patients who benefit from immunotherapy, but we need to understand who they are. So, I repeat, we need to have smaller and smaller groups of homogeneous patients. We need to exploit a lot of data, all the data that the clinical history and the biology of the tumor produce, put them together and try to divide the cases on the basis of this information.
But to put together a lot of data and analyze them you need a lot of people, a lot of professionalism and a lot of collaboration. Are we talking about multidisciplinarity?
For those dealing with cervical-facial tumors, multidisciplinarity is a religion. Let’s start with big data: if I want to put together millions of data I need clinicians but also engineers, bioinformaticians, statisticians, artificial intelligence experts. On the more clinical front, it is clear that patients with head and neck cancer need integrated approaches, which can only be decided by a group of people: the surgeon, the radiologist, the pathologist, the biologist, the nurse, the assistant. social, the psychologist, the rehabilitator, the speech therapist, the dentist, the stomatologist. In short, multidisciplinarity is necessary both inside and outside the department. Big data, multidisciplinarity, collaboration and integration are the future of all medicine, not just those dealing with head and neck cancers. We just need more today.
She was awarded the ESMO Award 2021 for her scientific achievements but also for her commitment to tutor and motivate other doctors. How important is it for you to support and stimulate young oncologists?
Having young people around, dedicated people, people who have a light in their eyes is exciting for me. My joke is: so guys it took me 30 years to understand this thing, but my duty is to make you understand in a few minutes. You do the rest, go ahead!