2023CSCO头颈部肿瘤专场—新增鼻腔鼻窦肿瘤并调整靶向治疗推荐等级

On April 21-22, 2023, the CSCO Guidelines Conference was held in Guangzhou. This conference has newly released the "Chinese Society of Clinical Oncology (CSCO) Head and Neck Cancer Diagnosis and Treatment Guidelines 2023 Edition". The following are the updated highlights of the head and neck tumor session at the conference! Check it out quickly!

What are head and neck tumors?

Head and neck tumors are relatively common malignant tumors in my country, accounting for approximately 20%-30% of all malignant tumors in the body. Head and neck tumors generally refer to all malignant tumors from the base of the skull to the clavicle and in front of the cervical spine, but do not include malignant tumors within the skull, cervical spine, and eyes. The more common ones include nasopharyngeal cancer, laryngeal cancer, thyroid cancer, lip cancer, etc. The clinical symptoms of patients with head and neck tumors vary depending on the location of the tumor. Some patients may present with difficulty breathing, pain in swallowing, local swelling, coughing and hemoptysis, etc.

(Picture from Baidu Encyclopedia, deleted if infringement)

Two updated highlights of the head and neck cancer special session at the 2023 CSCO Conference

1. New nasal cavity and sinus tumors

One of the highlights of the new CSCO guideline update in 2023 is the addition of a new chapter on nasal cavity and sinus tumors. Although the incidence of nasal cavity and sinus tumors is not high, its diagnosis and treatment path, treatment results and prognosis have its own characteristics. Authoritative foreign guidelines such as the American "AJCC Cancer Staging Manual" and NCCN (National Comprehensive Cancer Network) all have independent staging. In the new CSCO Head and Neck Cancer Diagnosis and Treatment Guidelines, we also added new recommendations for staging, diagnosis, and treatment of sinonasal tumors in the topic. However, because there is no authoritative guideline on sinonasal tumors in the world, most of the studies conducted on them are retrospective, with very few samples, so there is not enough evidence-based medical evidence. However, this very important chapter was finally completed with the joint efforts of all editorial board members.

2. Adjustment of recommended levels of targeted therapy

The newly added tislelizumab + gemcitabine + cisplatin (category 1A)c, toripalizumab (category 2A)f, and camrelizumab (category 2A)f were upgraded to level I recommendations, while the level III recommendations were newly added pembrolizumab + cetuximab (category 2A) b, nivolumab + cetuximab (category 2A] b, as shown in the figure below.

As we all know, head and neck tumors have the highest expression of EGFR (epidermal growth factor receptor) among all tumors. EGFR-targeted drugs, such as cetuximab, have been approved in China and the United States for recurrent and metastatic head and neck tumors, and have been gradually included in the national basic medical insurance catalog. Therefore, the 2023 CSCO new version of the diagnosis and treatment guidelines for head and neck tumors has raised its recommendation level.

In recent years, because some patients are difficult to tolerate chemotherapy, the immune combination model has a good synergistic effect as a treatment method. Due to the lack of conclusive evidence-based medical basis, it can only be used as a third-level recommendation for the treatment of recurrent and metastatic head and neck squamous cell carcinoma. In addition, although immunotherapy has become the standard treatment in the first and second lines, it still faces efficacy bottlenecks on a larger scale.

3. Conclusion

The above is the editor’s interpretation of the updated highlights of the head and neck cancer special session at the 2023 CSCO conference. I hope it can be helpful to doctors who specialize in head and neck cancer. Here, we look forward to seeing more exploration of clinical combination treatments in the future, bringing new hope to patients who are deeply troubled by head and neck tumors!