Head & Neck Cancer

Philosophy

The role of the medical oncologist in the multidisciplinary care of the head and neck cancer patient is overall treatment planning and the use of anti-cancer medicines.

The majority of patients are treated with a goal of cure. In these cases, systemic therapies (medications that travel throughout the body) such as chemotherapy, targeted therapy, and immunotherapy may be used to shrink cancer prior to surgery or radiation, at the same time as radiation or following surgery or radiation. When cure is not possible, we believe that the purpose of care is to maximize quality of life and duration of life. To this end, we work with patients to individualize treatment plans that minimize side effects and maximize efficacy. Whenever possible, we attempt to use cutting-edge molecular diagnostics, clinical trials, immunotherapy, and targeted therapy to avoid the use of chemotherapy.

We are proud to offer cutting-edge trials aimed at increasing the rate of cure, decreasing side effects, and offering hope where standard therapies cannot. We heavily vet our clinical trials for scientific promise (likelihood of working), minimization of potential side effects, ethics, and patient convenience. We offer trials using novel immunotherapies, cellular therapy (such as tumor infiltrating lymphocytes (TILs), and CAR-T), targeted therapies, and novel agents (phase I).

Specialties

Squamous Head and Neck Cancer

Oral cavity, tonsils, base of tongue, hypopharynx, larynx: We specialize in both HPV negative and HPV positive cancers.  For both types of cancer, our goal is to cure cancer with the lowest possible long term side effects. The most commonly used standard agent in combination with radiation therapy is cisplatin. When we give cisplatin, we favor a weekly schedule that breaks up the dose over a large dose every three weeks. This allows us to adjust nimbly based on tolerance and side effects. When cisplatin is not possible, we use laboratory testing to ensure low risk of allergic reactions with cetuximab.

When these cancers have spread and/or are no long curable, we use anti-cancer therapies to shrink them, with the goals of extending duration of life and preserving quality of life. We helped pioneer the use of immunotherapy for squamous head and neck cancer and continue to favor its use for appropriately selected patients. When chemotherapy is required, we choose agents and schedules that minimize side effects and we provide aggressive supportive care to improve overall patient well-being.

Thyroid Cancer

Anaplastic thyroid cancer: We have a multidisciplinary treatment team that is dedicated to the treatment of this deadly cancer. We have adopted practices to conduct molecular testing for all new diagnoses, which allows us tailor our treatment selection. We consider the use of targeted therapy for all patients who have a mutation in the BRAF. We are opening new clinical trials that will help patients with anaplastic disease and have a vested interest to become national experts in the treatment of this cancer.

Differentiated thyroid cancer: We work closely with endocrinologists and nuclear medicine to provide curative-intent radioactive iodine therapy as the preferred option.  When cancer is radioactive iodine refractory, we typically utilize TSH suppression with levothyroxine and consider growth rates—many cancers are slow growing and quality of life can be maximized with careful observation.

We routinely conduct advanced molecular testing to seek a targeted therapy option based on the molecular genetics of the individual tumor, for when treatment is needed. When no actionable target is found, and treatment is required, we use targeted therapies to block the blood supply to the tumor. While there are always exceptions for unusual cases, we almost never use chemotherapy for differentiated thyroid cancer.

Medullary thyroid cancer: We helped pioneer the use of RET targeted therapeutics for these cancers and continue to favor their use when RET mutation is present. When absent, we employ advanced molecular diagnostics to seek other targeted therapy options. When not present, we work closely with the neuro-endocrine group to consider optimal therapeutics.

Rare Tumors

Sinonasal (NUT carcinoma, squamous cell carcinoma, sinonasal undifferentiated carcinoma (SNUC), sinonasal adenocarcinoma (SNAC): we have a growing expertise in these rare cancers of the sinus cavities and nasal track. We are developing studies to give anti-cancer therapies prior to surgery to maximize the chance of cure with surgery and/or radiation therapy.

Salivary tumors (adenoid cystic carcinoma, carcinoma ex pleomorphic adenoma, adenocarcinoma): Curative therapy of these malignancies is mostly surgical. When medicines are required, it is typically for cancers that have spread outside of the head and neck and/or are no longer curable.  In these cases, we seek to maximize both quality of life and duration of life. Our first question is always whether treatment is truly required, or whether observation might be a better option. When treatment is required, we used advanced immunohistochemical testing and molecular testing to identify targeted, non-chemotherapeutic options.

Skin Cancers of the Head and Neck

Basal cell carcinoma: The initial systemic treatment, when required, is targeted therapy with hedgehog inhibitors. Immunotherapy is now an option for subsequent therapy.

Squamous skin cancer: We primarily utilize immunotherapy agents to treat squamous skin cancers, when systemic therapy is required either prior to surgery or in patients with metastatic disease. We offer clinical trials for patients with these cancer in hopes of developing improved anti-cancer treatments

Our Team

Head and neck cancer requires tight integration of numerous specialists to optimize care. Our team meets every Friday to discuss patients at the UNC Head and Neck Tumor Conference. This conference is attended by clinicians from all related specialties, with a shared passion to reduce suffering from head and neck cancer,  including ENT surgeons, radiation oncology, head and neck medical oncology, radiology, head and neck pathology, nurse navigators, and clinical trial coordinators.

We believe strongly that this collaborative approach, with everyone reviewing and discussing imaging, pathology and other data together improves care. We have also physically structured our clinics so that we all see patients in the same space.  We believe that this improves care by facilitating interdisciplinary discussions.

Nurse Navigators

Nurse navigators are the heart of our program.  Nurse navigators provide a single point of contact for patients and their families, allowing us to bring to bear the powerful resources of a large and advanced program, with the ease of a smaller hospital.  Nurse navigators provide supportive care, patient counseling and care coordination.

Clinical Pharmacists

We have a dedicated head/neck oncology clinical pharmacist. Our pharmacists are experts in treatment selection, side effects, and monitoring. They assist with patient access to medications, counseling on how to take new treatments, and strategies to decrease side effects related to cancer therapy.

Nutrition

Rapid healing is not possible without adequate nutrition, so we are passionate about optimizing it.

Social Work

We greatly value all patients, regardless of ability to pay.  We are proud to work at UNC because UNC accepts almost any insurance, as well as patients with no insurance (charity care).  We recognize that despite charity care, many patients still have significant barriers to optimal care and work closely with social work to help however we can.

Medical Oncology Providers