Head & Neck Cancers, EGFR, T790M (c.2369C>T)

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Expand Collapse Head & Neck Cancers  - General Description This year about 52,000 people in the U.S. will be told by a doctor that they have cancer of the head and neck. Approximately 70% of these new patients will be men. However, about 265,000 Americans remain alive today after having been diagnosed with head & neck cancer.

Head and neck cancers develop inside the mouth (in the oral cavity), nose (nasal cavity), or the tube (pharynx) that runs from the back of the nose to the top of the windpipe (trachea) and the top of the tube that goes to the stomach (esophagus). Cancers that begins in the lips, salivary glands, throat or voice box (larynx) are also classified as head and neck cancer. However, cancers of the esophagus, eye, brain, and thyroid gland usually aren't regarded as head and neck cancers, and neither are cancers of the skin, muscles, or bones of the head and neck. Head and neck cancers usually begin in squamous cells and therefore are called squamous cell carcinomas. The FDA has approved the targeted therapy cetuximab (Erbitux) for treatment of patients with squamous cell carcinoma of the head and neck.

Head and neck cancer (and other tumors) can spread (metastasize) from the place where it started (the primary tumor) in 3 ways. First, it can invade the normal tissue surrounding it. Second, cancer cells can enter the lymph system and travel through lymph vessels to distant parts of the body. Third, the cancer cells can get into the bloodstream and go to other places in the body. In these distant places, the cancer cells cause secondary tumors to grow. To find out whether the cancer has entered the lymph system, a surgeon removes all or part of a node near the primary tumor and a pathologist looks at it through a microscope to see if cancer cells are present. Several kinds of imaging can also be performed to determine if the cancer has spread. These include MRI and CT scans.

Despite significant improvements in the treatment of head & neck cancers, novel therapies and treatment strategies are needed.

Source: National Cancer Institute, 2012
An estimated 644,000 new cases of head and neck cancer are diagnosed each year worldwide, posing the sixth leading cause of cancer death. The American Cancer Society projected 39,400 new head and neck cancer diagnoses and 7,900 cancer deaths in the U.S. in 2009. In Europe, the projected incidence for 2008 was 132,300 and the mortality was 62,800. The estimated annual incidence of head and neck cancers is 2-4-fold higher among men than women.

More than 95% of head and neck cancers are of squamous cell histology (SCCHN) and originate in the mucosal lining of the upper aerodigestive tract. Anatomic sites include the lip/oral cavity, nasopharynx, oropharynx, hypopharynx and larynx. Common risk factors include tobacco use (smoking and/or chewing) and alcohol consumption, with a suggested synergistic effect. Less common risk factors include chewing of betel nuts (a common practice in some parts of Asia) and occupational exposures. Infection with the oncogenic human papillomavirus (HPV) has been identified as a distinct and rising risk factor, particularly among patients with squamous cell carcinoma of the oropharynx, specifically tonsils and the base of tongue. The incidence of SCCHN has increased steadily during the last several decades, whereas the incidence of tobacco-associated SCCHN has decreased, to the point where the incidence of HPV-associated and non-HPV-associated cancers is nearly equivalent. HPV status has been shown to strongly predict outcomes in patients with locally or regionally advanced oropharynx squamous cell carcinoma, but the prognostic impact of HPV in recurrent/metastatic SCCHN is currently less well understood.

Molecular hallmarks of SCCHN that have been identified as key drivers over the past decade include gene mutations in TP53, CDKN2A, PIK3CA, PTEN and HRAS. Recent investigations using high-throughput gene sequencing also found mutations in other cell differentiation-related genes, such as NOTCH1, NOTCH2, NOTCH3 and TP63, suggesting that deregulation of the terminal differentiation program is critical for squamous cancer development.

The epidermal growth factor receptor (EGFR) and its downstream molecular pathways are of particular importance in SCCHN. EGFR is overexpressed in up to 90% of all SCCHN. High expression levels of EGFR and transforming growth factor (TGF, a ligand of EGFR), as well as EGFR gene amplification, has been associated with increased resistance to treatment and poorer clinical outcome, including decreased disease-free and overall survival.

Therapeutic options and treatment decisions at first diagnosis are dependent on disease stage. For early-stage and locally advanced disease (the majority of new
cases), therapy is tailored to the primary site of disease, feasibility of organ preservation and prognosis and functional outcomes following therapy. Despite aggressive treatment, only 35% to 55% of patients who present with locally advanced SCCHN remain alive and free of disease 3 years after standard curative treatment. Between 30-40% of patients develop loco-regional recurrences, with distant metastases occurring in 20-30% of cases. The majority of recurrences appear within 2 years of initial treatment. An additional 10-20% of patients have evidence of distant metastases at the time of first diagnosis.

For patients with recurrent/metastatic SCCHN who are considered incurable with surgery or radiotherapy, first-line palliative treatment options include platinum agents, taxanes, methotrexate, 5-fluorouracil and cetuximab. Even with combination regimens, objective radiographic responses are achieved in fewer than 40% of patients in most large studies. Patients with disease progression on platinum-based therapy have limited treatment options and a poor prognosis. In these patients, overall response to second-line cytotoxic therapy has been 3%. Poor survival at this stage is related to the development of metastases and poor local disease control.

Source: National Cancer Institute, 2012
This year about 52,000 people in the U.S. will be told by a doctor that they have cancer of the head and neck. Approximately 70% of these new patients will be men. However, about 265,000 Americans remain alive today after having been diagnosed with head & neck cancer.

Head and neck cancers develop inside the mouth (in the oral cavity), nose (nasal cavity), or the tube (pharynx) that runs from the back of the nose to the top of the windpipe (trachea) and the top of the tube that goes to the stomach (esophagus). Cancers that begins in the lips, salivary glands, throat or voice box (larynx) are also classified as head and neck cancer. However, cancers of the esophagus, eye, brain, and thyroid gland usually aren't regarded as head and neck cancers, and neither are cancers of the skin, muscles, or bones of the head and neck. Head and neck cancers usually begin in squamous cells and therefore are called squamous cell carcinomas. The FDA has approved the targeted therapy cetuximab (Erbitux) for treatment of patients with squamous cell carcinoma of the head and neck.

Head and neck cancer (and other tumors) can spread (metastasize) from the place where it started (the primary tumor) in 3 ways. First, it can invade the normal tissue surrounding it. Second, cancer cells can enter the lymph system and travel through lymph vessels to distant parts of the body. Third, the cancer cells can get into the bloodstream and go to other places in the body. In these distant places, the cancer cells cause secondary tumors to grow. To find out whether the cancer has entered the lymph system, a surgeon removes all or part of a node near the primary tumor and a pathologist looks at it through a microscope to see if cancer cells are present. Several kinds of imaging can also be performed to determine if the cancer has spread. These include MRI and CT scans.

Despite significant improvements in the treatment of head & neck cancers, novel therapies and treatment strategies are needed.

Source: National Cancer Institute, 2012
An estimated 644,000 new cases of head and neck cancer are diagnosed each year worldwide, posing the sixth leading cause of cancer death. The American Cancer Society projected 39,400 new head and neck cancer diagnoses and 7,900 cancer deaths in the U.S. in 2009. In Europe, the projected incidence for 2008 was 132,300 and the mortality was 62,800. The estimated annual incidence of head and neck cancers is 2-4-fold higher among men than women.

More than 95% of head and neck cancers are of squamous cell histology (SCCHN) and originate in the mucosal lining of the upper aerodigestive tract. Anatomic sites include the lip/oral cavity, nasopharynx, oropharynx, hypopharynx and larynx. Common risk factors include tobacco use (smoking and/or chewing) and alcohol consumption, with a suggested synergistic effect. Less common risk factors include chewing of betel nuts (a common practice in some parts of Asia) and occupational exposures. Infection with the oncogenic human papillomavirus (HPV) has been identified as a distinct and rising risk factor, particularly among patients with squamous cell carcinoma of the oropharynx, specifically tonsils and the base of tongue. The incidence of SCCHN has increased steadily during the last several decades, whereas the incidence of tobacco-associated SCCHN has decreased, to the point where the incidence of HPV-associated and non-HPV-associated cancers is nearly equivalent. HPV status has been shown to strongly predict outcomes in patients with locally or regionally advanced oropharynx squamous cell carcinoma, but the prognostic impact of HPV in recurrent/metastatic SCCHN is currently less well understood.

Molecular hallmarks of SCCHN that have been identified as key drivers over the past decade include gene mutations in TP53, CDKN2A, PIK3CA, PTEN and HRAS. Recent investigations using high-throughput gene sequencing also found mutations in other cell differentiation-related genes, such as NOTCH1, NOTCH2, NOTCH3 and TP63, suggesting that deregulation of the terminal differentiation program is critical for squamous cancer development.

The epidermal growth factor receptor (EGFR) and its downstream molecular pathways are of particular importance in SCCHN. EGFR is overexpressed in up to 90% of all SCCHN. High expression levels of EGFR and transforming growth factor (TGF, a ligand of EGFR), as well as EGFR gene amplification, has been associated with increased resistance to treatment and poorer clinical outcome, including decreased disease-free and overall survival.

Therapeutic options and treatment decisions at first diagnosis are dependent on disease stage. For early-stage and locally advanced disease (the majority of new
cases), therapy is tailored to the primary site of disease, feasibility of organ preservation and prognosis and functional outcomes following therapy. Despite aggressive treatment, only 35% to 55% of patients who present with locally advanced SCCHN remain alive and free of disease 3 years after standard curative treatment. Between 30-40% of patients develop loco-regional recurrences, with distant metastases occurring in 20-30% of cases. The majority of recurrences appear within 2 years of initial treatment. An additional 10-20% of patients have evidence of distant metastases at the time of first diagnosis.

For patients with recurrent/metastatic SCCHN who are considered incurable with surgery or radiotherapy, first-line palliative treatment options include platinum agents, taxanes, methotrexate, 5-fluorouracil and cetuximab. Even with combination regimens, objective radiographic responses are achieved in fewer than 40% of patients in most large studies. Patients with disease progression on platinum-based therapy have limited treatment options and a poor prognosis. In these patients, overall response to second-line cytotoxic therapy has been 3%. Poor survival at this stage is related to the development of metastases and poor local disease control.

Source: National Cancer Institute, 2012
Expand Collapse EGFR  - General Description
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The EGFR gene encodes for a cell-surface protein known as the epidermal growth factor receptor, which is found in many normal epithelial tissues such as the skin and hair follicles. When members of the epidermal growth factor family attach to EGFR, they activate several different cell signaling pathways that control various cell functions, including cell growth.

Mutations in EGFR can lead to unregulated activation of the protein. These types of activating mutations are often found in NSCLC (non-small cell lung cancer), glioblastoma and head and neck squamous cell carcinoma. Sometimes, excess EGFR protein is produced due to the presence of too many copies of the EGFR gene, leading to excessive cell division and growth in the presence of epidermal growth factor. Among the human cancers in which EGFR overabundance is present are cancers of the head and neck (squamous cell), colon, rectum, lung (NSCLC), central nervous system (glioblastoma), pancreas and breast (HER2-positive metastatic). Blocking EGFR in tumors may keep cancer cells from growing. The FDA has approved several therapies that target EGFR in one or more cancers.

Tumor mutation profiling performed clinically at the MGH Cancer Center has indicated that EGFR mutations occur primarily in lung cancer (~15%), but also in a minor subset of gastric (2%), brain (1%) and pancreatic (1%) cancers.

Source: Genetics Home Reference
The epidermal growth factor receptor (EGFR) gene encodes for a cell-surface protein that belongs to the ERBB family of receptor tyrosine kinases. Four members of the ERBB family have been identified: EGFR (ERBB1, HER1), ERBB2 (HER2), ERBB3 (HER3) and ERBB4 (HER4). Binding of a ligand induces ERBB receptor homo-/hetero-dimerization and triggers a signaling cascade that drives many cellular responses. These include the activation of PI3K-AKT/mTOR and MAP kinase/ERK pathways, which promote cell survival and proliferation. EGFR mutations have been most frequently associated with non-small cell lung cancer, but have also been described in other malignancies including gliomas, head and neck, prostate and ovarian tumors.

Tumor mutation profiling performed clinically at the MGH Cancer Center has indicated that EGFR mutations occur primarily in lung cancer (~15%), but also in a minor subset of gastric (2%), brain (1%) and pancreatic (1%) cancers.

Source: Genetics Home Reference
PubMed ID's
15864276, 15118073, 15118125, 15329413, 18772890, 15837736, 16720329, 21057220
Expand Collapse T790M (c.2369C>T)  in EGFR
The EGFR T790M mutation arises from the nucleotide change c.2369C>T in exon 20, resulting in an amino acid substitution of the threonine (T) at position 790 by a methionine (M).
The EGFR T790M mutation arises from the nucleotide change c.2369C>T in exon 20, resulting in an amino acid substitution of the threonine (T) at position 790 by a methionine (M).

Unlike what has been demonstrated for lung cancer, clinical trial studies have reported that the presence of EGFR activating mutations in cancers of the head and neck cannot adequately predict response to EGFR inhibitors (such as erlotinib).

Unlike what has been demonstrated for lung cancer, clinical trial studies have reported that the presence of EGFR activating mutations in cancers of the head and neck cannot adequately predict response to EGFR inhibitors (such as erlotinib).

PubMed ID's
22668015, 21274259, 19258037, 23578570, 22261807, 16299242, 16857803, 17121883, 18559552, 20840671, 17538160, 16943533, 14581353
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Your Matched Clinical Trials

Trial Matches: (D) - Disease, (G) - Gene, (M) - Mutation
Trial Status: Showing Results: 1-10 of 20 Per Page:
12Next »
Protocol # Title Location Status Match
NCT01953926 An Open-label, Phase 2 Study of Neratinib in Patients With Solid Tumors With Somatic Human Epidermal Growth Factor Receptor (EGFR, HER2, HER3) Mutations or EGFR Gene Amplification An Open-label, Phase 2 Study of Neratinib in Patients With Solid Tumors With Somatic Human Epidermal Growth Factor Receptor (EGFR, HER2, HER3) Mutations or EGFR Gene Amplification MGH Open DGM
NCT02335918 A Dose Escalation and Cohort Expansion Study of Anti-CD27 (Varlilumab) and Anti-PD-1 (Nivolumab) in Advanced Refractory Solid Tumors A Dose Escalation and Cohort Expansion Study of Anti-CD27 (Varlilumab) and Anti-PD-1 (Nivolumab) in Advanced Refractory Solid Tumors MGH Open D
NCT02099058 A Phase 1/1b Study With ABBV-399, an Antibody Drug Conjugate, in Subjects With Advanced Solid Cancer Tumors A Phase 1/1b Study With ABBV-399, an Antibody Drug Conjugate, in Subjects With Advanced Solid Cancer Tumors MGH Open D
NCT01714739 A Study of an Anti-KIR Antibody in Combination With an Anti-PD1 Antibody in Patients With Advanced Solid Tumors A Study of an Anti-KIR Antibody in Combination With an Anti-PD1 Antibody in Patients With Advanced Solid Tumors MGH Open D
NCT02467361 A Study of BBI608 Administered in Combination With Immune Checkpoint Inhibitors in Adult Patients With Advanced Cancers A Study of BBI608 Administered in Combination With Immune Checkpoint Inhibitors in Adult Patients With Advanced Cancers MGH Open D
NCT00585195 A Study Of Oral PF-02341066, A c-Met/Hepatocyte Growth Factor Tyrosine Kinase Inhibitor, In Patients With Advanced Cancer A Study Of Oral PF-02341066, A c-Met/Hepatocyte Growth Factor Tyrosine Kinase Inhibitor, In Patients With Advanced Cancer MGH Open D
NCT02834247 A Study of TAK-659 in Combination With Nivolumab in Participants With Advanced Solid Tumors A Study of TAK-659 in Combination With Nivolumab in Participants With Advanced Solid Tumors MGH Open D
NCT02488759 A Study to Investigate the Safety and Efficacy of Nivolumab and Nivolumab Plus Ipilimumab in Virus-associated Tumors A Study to Investigate the Safety and Efficacy of Nivolumab and Nivolumab Plus Ipilimumab in Virus-associated Tumors MGH Open D
NCT02551185 ACY 241 in Combination With Paclitaxel in Patients With Advanced Solid Tumors ACY 241 in Combination With Paclitaxel in Patients With Advanced Solid Tumors MGH Open D
NCT02568267 Basket Study of Entrectinib (RXDX-101) for the Treatment of Patients With Solid Tumors Harboring NTRK 1/2/3 (Trk A/B/C), ROS1, or ALK Gene Rearrangements (Fusions) Basket Study of Entrectinib (RXDX-101) for the Treatment of Patients With Solid Tumors Harboring NTRK 1/2/3 (Trk A/B/C), ROS1, or ALK Gene Rearrangements (Fusions) MGH Open D
Trial Status: Showing Results: 1-10 of 20 Per Page:
12Next »
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