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Head and Neck Cancer Research Lab

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Field Based Meeting on Oropharynx Cancer in Veterans

In May of 2019, Dr. Sandulache co-hosted the Field Based Meeting titled “Innovations in risk-stratification and treatment of Veterans with oropharynx cancer” as a joint event between the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine. The meeting was co-sponsored by the Biomedical Laboratory Research and Development Service of the Department of Veterans Affairs and the National Institute of Dental and Craniofacial Research.

Meeting Executive Summary

Over 60 thought leaders from hospitals and academic cancer centers across the country and within the Veterans Health Administration convened at the Baylor College of Medicine for a highly interactive “Field-Based Meeting” (FBM) focused on oropharyngeal squamous cell carcinoma (OPSCC). Participants agreed that OPSCC in the US, the Veteran population poses unique challenges, due to higher relative incidence and poorer treatment outcomes than those observed in the civilian population. Human papillomavirus (HPV)-related OPSCC has more favorable outcome relative to tobacco-associated head and neck cancer, making survivorship a significant issue in this population. However, due to high rates of tobacco use in the Veteran population, there is a large cohort of “dual exposed” OPSCC patients who have HPV-related disease in the setting of a significant history of tobacco use. While these patients clearly have worse outcomes than non-tobacco users with HPV-related OPSCC, many details about prognosis and optimum treatment strategy in this group of patients are not known. The high level of medical comorbidities in the Veteran population, and poor social support for many Veterans pose additional challenges to treatment of OPSCC in this population. Furthermore, there are few cross-VA consortia to coordinate multi-center clinical trials for Veterans with OPSCC, and care delivery sites for OPSCC in the VA system are very heterogeneous and vary widely in terms of services available (e.g. radiation oncology) and infrastructure to support research and clinical trials.

The participants rapidly identified a critical gap in clinical knowledge, namely a thorough understanding of HPV-related OPSCC epidemiology within the Veteran population. They identified utilization of both the Million Veteran Program and cross-institutional collaborations, as critical elements in the first steps to leveraging existing Veterans Health Administration (VHA) database resources towards better understanding disease incidence and prevalence in the modern era. The participants identified unmet needs with respect to basic and translational OPSCC research including: 1) appropriate preclinical models, and 2) an improved understanding of the genomic and epigenetic landscape of HPV-related OPSCC in smokers. In large part, this is because of a lack of studies focused on patient specimens derived from the Veteran population generally, and HPV-positive OPSCC smokers more specifically.

There was consensus that Veterans with HPV-positive OPSCC have reduced access to clinical trials, and that the HPV-positive OPSCC smoker subset is specifically underrepresented across existing and planned clinical trials. Furthermore, the participants identified survivorship as a critical unmet clinical need in both the Veteran and non-Veteran populations. To address the HPV-positive OPSCC cohort, the participants have proposed formation of an active, multi-disciplinary working group to vet and coordinate multi-institutional clinical trials within the VHA to target OPSCC in particular and head and neck cancer more broadly. With respect to the latter patient cohort, the participants identified the VHA as a uniquely positioned health care delivery system to conduct the first, multi-institutional prospective OPSCC survivorship registry study designed to understand the oncologic, functional and quality of life outcomes associated with HPV-positive OPSCC smokers.”

Learn more.

Releases

Therapeutic De-escalation in HPV-Positive Head and Neck Cancer - Sept. 3, 2020
Cisplatin-based chemoradiation for locally advanced HPV-positive head and neck cancer has substantial long-term toxicity. To combat this, there’s been a significant effort to de-escalate treatment. Clinicians must approach de-escalation cautiously when applying immature datasets to at-risk populations.

Dr. Sandulache awarded AHNS Community Service Award - April 30, 2020
Drs. Vlad Sandulache received the American Head and Neck Society Community Service award for his screening program for veterans with HNSCC & HCV.

Immunotherapy summit brings together patients, experts - Jan. 11, 2018
The NCI-designated Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine is hosting a free educational program for cancer patients and their caregivers seeking to learn more about cancer immunotherapy and clinical trials.

Know your risk for developing head and neck cancer -  July 27, 2016
Dr. Vlad Sandulache discusses different factors that could increase your chances and what symptoms to watch for.

Baylor College of Medicine receives grant to study experimental immunotherapy in HPV-related throat cancer - Sept. 2015
Baylor researchers receive $1.1 million grant from the U.S. Food and Drug Administration to advance clinical studies of an experimental immunotherapy for HPV related throat cancer.

Baylor’s Dan L Duncan Cancer Center receives highest National Cancer Institute designation – Comprehensive status - July 30, 2015
The National Cancer Institute has awarded the Dan L Duncan Cancer Center at Baylor College of Medicine the prestigious designation of a Comprehensive Cancer Center.

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Head and Neck Cancer Research Lab

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Contact: Research Administration Associate, Mariana Villanueva, M.S.
Phone: (713) 798-4529
Email: mariana.villanueva@bcm.edu

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Clinical Trials

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Clinical trials are conducted to test whether a new drug, prevention strategy, or screening test is safe and effective in people.

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