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6th ICHNO
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6
th
ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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well as to discuss their perspectives in the future.
SP-036 Immunity and immune toxicity: clinical
management of immune checkpoint inhibition
U. Keilholz
1
1
Charité Comprehensive Cancer Center, Department of
Medical Oncology, Berlin, Germany
Abstract text
Immunotherapy with immune checkpoint inhibitors is
rapidly developing as the fifth treatment modality in
concert with surgery, radiotherapy, chemotherapy, and
targeted therapy. Relevant clinical activity and especially
pong-tem responses have been observed in a variety of
histologies, mainly in cancers with high mutational load.
However, novel toxicities have also been observed, some
of them requiring tight clinical and pharmacological
management. In general, these toxicities are immune-
mediated and resemble a minor form of graft-versus-host
disease after allogeneic stem cell transplantation.
Following tightly the established management guidelines,
toxicities can be detected early on and usually be confined
to low grade with minor impact on patient’s quality of life.
The most important general principle is derived from the
observation that more severe autoimmune toxicities
require immunosuppressive medications, and that
treatment of autoimmunity does not negatively impact on
immune-mediated control of the neoplastic disease.
Actually, many patients in whom severe autoimmune
toxicities were observed and adequately managed belong
to the group of patients with prolonged complete
resolution of metastases. Organ systems most often
affected by autoimmune toxicities include skin, liver,
colon, lungs, kidneys and endocrine glands. While early
recognition of toxicities to liver, kidney and endocrine
glands can be achieved by monitoring liver enzymes,
creatinine, TSH and cortisol, early recognition of colitis
and pneumonitis require close clinical attention. In
patients with diarrhea colonoscopy is indicated in case of
pain or bloody stool. In patients with unexplained cough
or shortness of breath, slight end-inspitatory rales may be
the only clinical sign pointing towards extensive
pneumonitis with profound infiltates on CT scan.
Immediate
and
prolonged
intervention
with
glucocorticoids, and sometimes immunosuppressive drugs
is necessary to control these transient autoimmune
reactions, only the endocrine toxicities may be
permanent.
SP-037 Immunotherapy beyond anti PD1 inhibitors
P. Coulie
1
1
Université catholique de Louvain and de Duve Institute,
Cellular Genetics, Brussels, Belgium
Abstract text
Immunostimulatory antibodies blocking the PD-1 co-
inhibitory pathway have potent antitumor activity in a
sizeable proportion of patients with various types of
cancer. We will discuss the likely mechanism of action of
these treatments, the proposed predictive biomarkers and
the potential reasons for treatment failure. The latter
include low tumor antigenicity, which in advanced cancer
might result from previous immunoselections by antitumor
T cells, poor immunogenicity of the tumor i.e. the absence
of potent spontaneous antitumor T cell responses, and
various mechanisms of local immunosuppression. Several
of these mechanisms of tumor resistance to cancer
immunotherapy with PD-1-blocking antibodies can be
circumvented by drugs that are or will be tested soon in
combination therapies.
Keynote lecture
SP-038 Clinical implementation of adaptive
radiotherapy: challenges ahead
O. Hamming-Vrieze
1
1
Netherlands Cancer Institute Antoni van Leeuwenhoek
Hospital, Radiation Oncology, Amsterdam, The
Netherlands
Abstract text
Intensity modulated radiotherapy is the standard of care
in organ preserving treatment of head and neck cancer.
Highly conformal dose distributions are optimized based
on the anatomy of the pre-treatment planning CT.
However, during treatment, accurate delivery of the
planned dose can be influenced by anatomical changes
which occur, especially by non-rigid anatomical changes
for which set up protocols cannot correct. Anatomical
changes during treatment may be related to change in
tumor volume, weight, edema, muscle mass or fat
distribution. Several studies have described changes of
gross tumor volume (GTV) and organs at risk (OAR) in size,
shape and position during a course of radiotherapy. In the
presence of these anatomical changes, the actual
delivered dose may differ significantly from the planned
dose. Anatomical changes during treatment can be
accounted for with adaptive radiotherapy (ART) where the
radiation plan is adjusted during the course of treatment.
In recent years, considerable efforts have been made to
develop ART to compensate for under-dosage of the target
volumes or over-dosage of OAR. Ideally, the treatment
plan is adapted on a daily basis. At the moment however,
the effort of re-imaging, re-contouring and re-planning
does not outweigh the advantage and ART is not routinely
used for all patients. Selection of the appropriate patients
for ART remains a challenge, as well as the timing of re-
scanning. Moreover, re-definition of target volumes raises
the question whether the clinical target volume (CTV) can
safely be adjusted to spare OAR. For instance, field size
reduction following visible tumor regression assumes that
microscopic disease in the CTV behaves congruent with
changes in the visible GTV. These challenges for the
clinical implementation of ART in head and neck cancer
patients will be discussed in this presentation.
Symposium: Adenoid cystic carcinoma
SP-039 Adenoid cystic carcinoma: considerations in
surgical approach and factors modifying expected
outcome following treatment
V. Vander Poorten
1
, J. Meulemans
2
, P. Delaere
3
1
University Hospitals Leuven - KU Leuven,
Otorhinolaryngology- Head and Neck Surgery and
Department of Oncology- section Head and Neck
Oncology, Leuven, Belgium
2
University Hospitals Leuven- KU Leuven,
Otorhinolaryngology- Head and Neck Surgery and
Department of Oncology- section Head and Neck
Oncology, Leuven, Belgium
3
University Hospitals Leuven- KU Leuven,
Otorhinolaryngology- Head and Neck Surgery and
Department of Oncology- section Head and Neck
Oncology, Leuven, Belgium
Primary surgery
In AdCCs that are deemed resectable, the gold standard is
free-margin resection with postoperative radiotherapy
(RT). Clear margins are hard to achieve, given the