S10. The emerging role of biomarker profiling and functional imaging for guidance of head and neck cancer management

Abstract

The current focus is to identify methods and patients to tailor or de-escalate treatment intensity to reduce toxicity with minimal, no loss or improvement in control rates. Biomarkers and functional imaging with positron emission tomography (PET) are emerging as potential tools to achieve this goal. A number of biomarkers associated with outcomes in head and neck cancer (HNC) have been identified, but their role in modifying treatment are yet to be fully defined. Currently, the presence of HPV-positive oropharyngeal squamous cell carcinoma is the strongest biomarker, predicting for favourable outcomes. Treatment de-escalation is attractive in this group. Trials to address this question are being considered with epidermal growth factor receptor antibodies, as possible candidates for less intense treatments. Functional imaging with fluorodeoxyglucose (FDG) PET has emerged as a valuable oncologic tool. Re-staging with FDG PET has a high negative predictive value for the detection of residual nodal disease in HNC following RT and can now be used to guide the subsequent management of the neck. In addition to anatomic delineation, PET has the ability to qualitatively describe tumors. Radio-isotopes such as FAZA, F-Miso and FLT in combination with PET, has the potential to biologically characterise tumors, pre-, during and post-therapy and tailor treatment accordingly. Biomarkers and functional imaging to characterise tumors at a molecular level are being explored to modify treatment and improve the therapeutic ratio.