Head and neck, meningioma research highlights of UC ASTRO abstracts

Alyssa Farley, MD. Photo/University of Cincinnati.

Following radiation treatment for head and neck cancer, some patients can experience osteoradionecrosis (ORN) when an area of exposed bone fails to heal after a three-month period.

"ORN of the mandible and maxilla (jaw bones) can be very debilitating, as it often causes severe pain, fistula formation, infection and susceptibility to fractures," said Alyssa Farley, MD, a third-year resident in the Department of Radiation Oncology in UC's College of Medicine. "The symptoms directly and indirectly from ORN lead to a significant decrease in quality of life for patients, including severe financial burdens."

Farley and her colleagues - including Vinita Takiar, MD, PhD, who is principal investigator on the project - looked at contemporary rates for ORN in oral cavity squamous cell carcinoma, a specific type of head and neck cancer.

In this subpopulation, the team found higher rates of ORN than previously reported. Rates of ORN increased as age at diagnosis decreased and when surgical removal of part or all of the mandible or maxilla was part of the treatment plan.

ORN management can range from conservative medications to intense surgical intervention, Farley said. Moving forward, the team plans to study preventative treatments in identified high-risk populations to decrease ORN rates.

Coauthors of the abstract include Takiar, Farley, Nigel Dick and Taylor Petery.

Morgan Bailey, MD. Photo provided.

Brain or spinal cord tumors called meningiomas can cause visual impairment, which is sometimes severe and permanent, that can be used as a surrogate for analyzing tumor growth.

In theory, the estrogen and progesterone receptors on these meningiomas could help the tumors grow when exposed to higher levels of these hormones. However, a lack of data prevented further understanding of how hormonal contraception affected tumor growth in premenopausal women with meningiomas being referred for radiation.

"We wanted to understand the connection and risk of taking hormonal contraception/supplementation to vision deficits related to meningiomas," said abstract first author Morgan Bailey, MD, a resident in the Department of Radiation Oncology in UC's College of Medicine.

The researchers found progesterone - specifically the drug formulation Provera - is a significant risk factor for meningioma-related vision loss in this patient population. They are now performing testing on all patient samples to see how many patients express the progesterone receptor.

"We have contacted women from our study taking these medications to inform them of the risk, many of whom have since stopped taking Provera," Bailey said. "Our findings highlight the importance of age-appropriate counseling, consistent pathologic assessment of estrogen receptor/progesterone receptor status for meningiomas and a greater awareness of the risk of meningioma-related vision loss amongst neurosurgeons and radiation oncologists."

Additional coauthors include senior author Kyle Wang, Chase Avery, Luke Pater, Tim Struve, Ralph Vatner, Andrew Frankart, Sarah Sittenfeld, Kevin Shiue, Lalanthica Yogendran, Rekha Chaudhary, Jonathan Forbes, Norberto Andaluz, Matthew Hagen, Ady Kendler, Rocco Rossi and John Breneman.

Julianna Korns, UC doctoral student. Photo provided.

Researchers analyzing patient and clinical trial data have found current frontline treatments for head and neck cancer are insufficient to improve survival outcomes on their own, presenting the need to develop combination therapies that attack cancer cells on multiple fronts.

Cancer Center researchers have focused on a specific gene called Plk1 that, when high, typically correlates with lower survival rates and is known to be overexpressed in many cancers, including head and neck cancers.

"The main research question we were asking was to investigate the role of Plk1 in head and neck cancer patients," said abstract first author Julianna Korns, a doctoral student working in Takiar and Trisha Wise-Draper's lab. "We wanted to determine if targeting Plk1 with a highly specific inhibitor, onvansertib, would enhance radiation therapy for head and neck cancer patients."

Korns explained head and neck cancers can be broken down by human papillomavirus (HPV) status. HPV-negative patients are typically more resistant to therapy than HPV-positive patients.

The team found combining onvansertib with radiation treatment reduced the cell viability and tumor growth of HPV-negative head and neck cancers but did not have the same effect on HPV-positive cancer cells.

"We are currently investigating the mechanistic differences between HPV-negative and HPV-positive head and neck cancers after treatment with onvansertib and radiation," Korns said. "Overall, we have promising data that points to combining Plk1 inhibition by using onvansertib and radiation in HPV-negative head and neck cancer patients that we hope will translate into clinical trials in this patient population."

Coauthors of the abstract include Takiar, Korns, Wise-Draper and Maria Lehn.

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