Do nothing

In a July 18, 2019 post to “Andy’s Cancer Journey Blog”, Andy Krauska referred to a process whereby removal of a primary tumor may stimulate the growth of metastatic secondary tumors via “angiogenesis”. The following quote is from an article that also refers to this process. Andy has decided not to go for radiation or chemo yet, preferring “active surveillance” as his mode of treatment. I’ve asked my radiation oncologist for his thoughts about this.

One of the most mysterious aspects of angiogenesis is that a primary tumor will often secrete a substance that inhibits angiogenesis around secondary metastases. In this case, surgical removal of the primary tumor may stimulate growth of its metastatic secondary tumors. Several natural proteins that inhibit angiogenesis (e.g., angiogenin and endostatin) or antagonists of the VEGF receptor have excited much interest as therapeutic agents since they might be useful against many kinds of tumors. While new blood vessels are constantly forming during embryonic development, few form normally in adults; thus a specific inhibitor of angiogenesis might have few adverse side effects.

Molecular Cell Biology. 4th edition, New York: W. H. Freeman; 2000, Section 24.1 Tumor Cells and the Onset of Cancer

Immunotherapy Options

One more thing. I’ve only just clued into the fact that Cetuximab, a drug that has been tested in head-to-head trials against Cisplatin in RTOG 1016, De-ESCALaTE, and TROG 12.01, is a “targeted antibody” immunotherapy option. So far, RTOG 1016 and De-ESCALaTE have shown that, for people like me, Cetuximab is not as effective as Cisplatin. For people with compromised renal systems, hearing difficulties, or neuropathy, Cetuximab may be a better option. See here for a few more details.

There are [in the United States], currently three approved immunotherapy options for head and neck cancer.

Targeted Antibodies

Cetuximab (Erbitux®): a monoclonal antibody that targets the EGFR pathway; approved for subsets of patients with advanced head and neck cancer, including as a first-line therapy

Immunomodulators

Nivolumab (Opdivo®): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced head and neck cancer

Pembrolizumab (Keytruda®): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced head and neck cancer

Cancer Research Institute