People with cancer of the nasopharynx, an area behind the nose, may benefit from a new combination therapy, according to an international study led by Memorial Sloan-Kettering radiation oncologist Nancy Y. Lee.
Reported in The Lancet Oncology, the findings suggest that adding the drug bevacizumab (Avastin®) to currently used therapy might prevent the spread of nasopharyngeal tumors to other parts of the body, prolonging the lives of patients.
An antibody drug, bevacizumab is currently used to treat other types of cancers, including colorectal, lung, and kidney cancers. The drug targets a protein called VEGF and is believed to act on the blood vessels that nourish tumors, curbing a tumor’s ability to grow and spread.
In recent years, significant improvements have been made in the treatment of nasopharyngeal cancer and other types of head and neck tumors in patients whose tumors are confined to their tissue of origin. This progress is due to the advent of intensity-modulated radiotherapy and other medical advances, Dr. Lee notes. “In nasopharyngeal cancer, we are now able to control localized disease in more than 90 percent of patients,” she says.
However, in approximately one-third of patients, the cancer eventually comes back — typically after four to five years — with new tumors growing at distant sites. For such metastatic disease, no effective treatment exists, Dr. Lee explains.
“A crucial focus of research is to find therapies that could help us make a difference for patients who are diagnosed with advanced stages of disease by preventing tumor spread,” she says.
In the multicenter phase II study, conducted in North America and Hong Kong, 46 patients who had been diagnosed with advanced stages of nasopharyngeal cancer and had not previously been treated for their disease received bevacizumab along with standard radiation therapy and chemotherapy.
Investigators found that adding bevacizumab was safe and led to improved outcomes. More than 90 percent of patients in the study were alive and showed no sign of cancer spread two years after their treatment had begun. Typically, the expected two-year survival rate for patients receiving standard therapy alone is between 70 and 80 percent.
“This improvement is really remarkable,” Dr. Lee affirms, while adding that more research is needed to confirm the findings.
While nasopharyngeal cancer is relatively rare in the United States, it is more widespread in other parts of the world, including Asia and North Africa. In collaboration with investigators in several countries in Eastern Asia, Dr. Lee is now leading preparations for a phase III trial supported by the National Cancer Institute that will evaluate the usefulness of the new treatment in a larger group of patients and over a longer period of time.
“Ultimately, we are hoping that the new treatment strategy might prove useful for treatment of several advanced tumors of the head and neck — not only in nasopharyngeal carcinoma,” Dr. Lee notes.