oral cancer treatment C D A J O U R N A L , V O L 4 9 , Nº 3
Oral Cavity and Oropharyngeal Cancer: Treatment Robert S. Julian, DDS, MD; Brian M. Woo, DDS, MD; and Eric C. Rabey, DDS
abstract Background: The objective of this review is to outline the treatment of oral cavity and oropharyngeal cancers including surgery, radiation therapy and systemic therapy. Systemic therapy includes cytotoxic chemotherapy, immunotherapy and targeted therapy. Types of studies reviewed: Textbooks, review articles and large institution databases and guidelines were used in this review as appropriate. Case studies and smaller retrospective studies applied in specific and more controversial areas. Current phase III clinical trials and their reports were used in reviewing the most recent developments. Results: Surgery is the mainstay treatment for oral cavity cancer. Early-stage oropharyngeal cancer can be treated with either surgery and/or radiation therapy. Advanced-stage oropharyngeal cancers are best treated with radiation and possibly chemotherapy, and p16 positive tumors enjoy a much better prognosis. Recurrent disease and/or adverse pathologic features such as close or positive margins, perineural/ perivascular invasion and extracapsular lymph node spread may indicate the need for systemic therapy. Systemic therapy now includes the first-line use of the immunotherapy agent pembrolizumab (anti PD-1 mab) in addition to cytotoxic chemotherapy, typically cisplatin, and possibly targeted therapy, cetuximab, an epithelial growth factor receptor inhibitor. Practical implications: Dental health care providers should realize that surgical excision is the main treatment for oral cavity cancer and that HPV p16 positive oropharyngeal cancers respond favorably to radiation therapy. Targeted therapy now includes several immunotherapeutic agents, pembrolizumab and nivolumab, and the (EGFR) epithelial growth factor inhibitor, cetuximab. Rapid advances in targeted therapy are likely to improve clinical outcomes (survival and morbidity) for patients with oral cavity and oropharyngeal carcinoma. Key words: Oral cavity, oropharyngeal, carcinoma, surgery, immunotherapy, systemic therapy, radiation therapy, targeted therapy, cisplatin, pembrolizumab, nivolumab, cetuximab
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