Translational research in head and neck oncology

Abstract

Translational research continues to shape the clinical practice of head and neck oncology. Ongoing discoveries in basic mechanisms of cancer biology and technological advances in diagnostic imaging and radiation delivery seek to improve treatment outcomes, maximizing therapeutic benefit and minimizing toxicity. Its ultimate goal is to offer an ever-expanding menu of options available for the care of individual patients. Focusing on this goal has become more challenging, with socioeconomic and political pressures casting shadows across the health care landscape. As external financial concerns encroach on the translational process, it is imperative to recognize that the research itself is best positioned to remedy them-matching more efficacious treatments with reduced toxicity burdens in appropriately selected patient populations. What should also not be lost in translation is the unpredictable and serendipitous nature of research. Decades of research with rational strategies based on tumor hypoxia in head and neck tumors have yet to penetrate widespread clinical practice. Meanwhile, two current mainstays of therapy, cisplatin and cetuximab, were developed with fortuitous levels of chance. However, even these two workhorses face new scrutiny with more recent publications. And perhaps, the long-heralded realm of cancer immunology may finally find its way to the table. To borrow a phrase from the fashion world, one day you’re in, and the next day, you’re out. Since the last edition of this textbook, the practice of head and neck cancer has seen two significant translational trends-(1) the power of viruses to potentially dictate management and (2) the realization that doing more to patients does not necessarily translate into better outcomes for them. This chapter will explore the meaning of translational research, identify potential pitfalls on the horizon, and highlight common themes and new avenues of research using specific examples from both the head and neck and general oncology literature.