Successful use of a therapeutic trial of graduated volume and dose escalation for postoperative head and neck radiotherapy in a Fanconi anemia patient

Luke M Lewis; Alice L Tang; Trisha M Wise-Draper; Kasiani C Myers; Joel S Greenberger; Vinita Takiar

doi:10.1002/hed.26395

Successful use of a therapeutic trial of graduated volume and dose escalation for postoperative head and neck radiotherapy in a Fanconi anemia patient

Head Neck. 2020 Oct;42(10):E16-E22. doi: 10.1002/hed.26395. Epub 2020 Aug 8.

Authors

Luke M Lewis¹, Alice L Tang², Trisha M Wise-Draper³, Kasiani C Myers⁴, Joel S Greenberger⁵, Vinita Takiar^{1

6}

Affiliations

¹ Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA.
² Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio, USA.
³ Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio, USA.
⁴ Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁵ Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
⁶ Cincinnati VA Medical Center, Cincinnati, Ohio, USA.

PMID: 32770810
DOI: 10.1002/hed.26395

Abstract

Background: Patients with the heritable disease, Fanconi anemia (FA), have a 500-fold risk of developing head and neck squamous cell carcinomas (HNSCC). However, the use of conventional cytotoxic agents including radiation therapy and cisplatin-based chemotherapy is contraindicated in patients with FA due to underlying DNA repair defects.

Methods/results: We present a young FA patient with recurrent HNSCC and high-risk pathologic features treated with a therapeutic trial of chemoradiation. This novel strategy employs a gentle radiation dose and volume escalation with concurrent pembrolizumab. The patient completed the entire course of therapy with no treatment delays or interruptions.

Conclusions: The FA patient population has a clear need for adjuvant treatment regimens given their predilection for HNSCC. A therapeutic trial may allow FA and other radiosensitive patients to trial radiation with the option to terminate treatment before any severe side effects occur and for some to complete a full course of treatment.

Keywords: Fanconi anemia; pembrolizumab; radiation therapy; squamous cell carcinoma; therapeutic trial.

Publication types

Case Reports
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Carcinoma, Squamous Cell* / therapy
Fanconi Anemia* / complications
Fanconi Anemia* / therapy
Head and Neck Neoplasms* / therapy
Humans
Neoplasm Recurrence, Local
Squamous Cell Carcinoma of Head and Neck / therapy

Grants and funding

IK2 BX004360/BX/BLRD VA/United States