Luke M Lewis1, Alice L Tang2, Trisha M Wise-Draper3, Kasiani C Myers4, Joel S Greenberger5, Vinita Takiar1,6. 1. Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA. 2. Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio, USA. 3. Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio, USA. 4. Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 5. Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 6. Cincinnati VA Medical Center, Cincinnati, Ohio, USA.
Abstract
BACKGROUND: Patients with the heritable disease, Fanconi anemia (FA), have a 500-fold risk of developing head and neck squamous cell carcinomas (HNSCC). However, the use of conventional cytotoxic agents including radiation therapy and cisplatin-based chemotherapy is contraindicated in patients with FA due to underlying DNA repair defects. METHODS/ RESULTS: We present a young FA patient with recurrent HNSCC and high-risk pathologic features treated with a therapeutic trial of chemoradiation. This novel strategy employs a gentle radiation dose and volume escalation with concurrent pembrolizumab. The patient completed the entire course of therapy with no treatment delays or interruptions. CONCLUSIONS: The FA patient population has a clear need for adjuvant treatment regimens given their predilection for HNSCC. A therapeutic trial may allow FA and other radiosensitive patients to trial radiation with the option to terminate treatment before any severe side effects occur and for some to complete a full course of treatment.
BACKGROUND:Patients with the heritable disease, Fanconi anemia (FA), have a 500-fold risk of developing head and neck squamous cell carcinomas (HNSCC). However, the use of conventional cytotoxic agents including radiation therapy and cisplatin-based chemotherapy is contraindicated in patients with FA due to underlying DNA repair defects. METHODS/ RESULTS: We present a young FA patient with recurrent HNSCC and high-risk pathologic features treated with a therapeutic trial of chemoradiation. This novel strategy employs a gentle radiation dose and volume escalation with concurrent pembrolizumab. The patient completed the entire course of therapy with no treatment delays or interruptions. CONCLUSIONS: The FA patient population has a clear need for adjuvant treatment regimens given their predilection for HNSCC. A therapeutic trial may allow FA and other radiosensitive patients to trial radiation with the option to terminate treatment before any severe side effects occur and for some to complete a full course of treatment.
Authors: Rex H Lee; Hyunseok Kang; Sue S Yom; Agata Smogorzewska; Daniel E Johnson; Jennifer R Grandis Journal: Clin Cancer Res Date: 2021-10-01 Impact factor: 12.531