What We Care For
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.
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