Each year, more than 5.5 lakh patients are diagnosed with Head and Neck Cancers (HNC), representing 27.5% of all cancer cases in India. The disease burden in India is in sharp contrast to a mere 4% of cases reported in Western countries,^[1]making HNC a significant health challenge in our country. The high incidence of these cancers, including malignancies of the oral cavity, pharynx, larynx, nasal cavity, and salivary glands, is primarily due to risk factors such as tobacco chewing, smoking, and alcohol consumption, which are prevalent in various parts of the country.

In India, as of 2022, an estimated 253 million people aged 15 and above used tobacco products, positioning the country as the second-highest tobacco consumer globally and the highest in the WHO Southeast Asia Region (SEAR).^[2]Human Papillomavirus (HPV), particularly type 16, is another major cause of HNC, known to cause oropharyngeal cancers of the tonsils and base of the tongue.

Despite advances in medical science, survival rates for HNC patients in India remain relatively low due to late diagnosis and limited access to cutting-edge treatments. Late-stage diagnosis of these cancers is a critical concern, often stemming from a lack of awareness, inadequate screening programs, and limited healthcare infrastructure and accessibility, particularly in rural and remote areas. Social stigmas associated with tobacco and alcohol use exacerbate delayed diagnoses and treatments, as this condition is not discussed as much as other cancers.

The Innovations in Diagnosis: Beyond Tests and Scans
Timely diagnosis significantly enhances the survival rates of HNC patients, necessitating innovations in diagnostic tools and techniques for early-stage detection. These include:

Biomarker-based screening: Recent studies demonstrate that patient risk can now be assessed using non-invasive techniques, at earlier stages, and with greater accuracy through the integration of molecular biomarker panels in routine screenings. The adoption of molecular diagnostics allows for personalized treatment plans and improved outcomes. Techniques such as liquid biopsies, which analyze circulating tumor DNA (ctDNA) and other biomarkers in blood samples, enable earlier detection of cancer compared to traditional biopsies.^[3]

Advanced Imaging Techniques: Innovations in imaging technologies, such as PET, CT and MRI scans, can also provide detailed insights about the existence of tumors, their size, location, and spread. These technologies enable more accurate disease staging, critical for devising effective treatment plans.

Artificial Intelligence (AI) and Machine Learning (ML): AI and ML algorithms are being developed to analyze imaging data and pathology reports, aiding in the early and accurate diagnosis of HNC. These technologies can identify patterns and anomalies that might be missed by the human eye, thus facilitating early intervention.

The Innovations in Treatment: Beyond Chemotherapy and Radiation
Cancer treatment is personalized based on location, stage, cell type, overall health, and patient preference. Options range from single therapies to combinations. While traditional methods like chemotherapy and radiation have drawbacks such as severe side effects and reduced efficacy in advanced stages, recent innovations provide promising alternatives for managing HNC effectively. Some of these include:

Biosimilars: Biosimilars are nearly identical versions of original biologic products produced by pharmaceutical companies once the original product patent expires. Biosimilars of monoclonal antibodies like Cetuximab^[4],^[5]have shown promise for HNC treatment. Approved by the Drug Controller General of India (DCGI) for treating Squamous Cell Carcinoma of the Head and Neck (SCCHN), Cetuximab plays a crucial role in managing locoregional conditions. Biosimilars target specific proteins in cancer cells, inhibiting their growth and survival. More importantly, using biosimilars in India can help increase the affordability and accessibility of targeted therapies for a broader patient population.

Immunotherapies: Immunotherapy is a ground breaking approach that harnesses the body’s immune system to fight cancer. For HNC, immune checkpoint inhibitors block proteins that prevent the immune system from attacking cancer cells, enhancing the body’s defense mechanisms. Immunotherapy has shown promising results in improving overall survival rates and quality of life for HNC patients. This kind of treatment has the potential to treat HNC cases effectively. Several studies have shown that immunotherapies administered through biomaterials enhance their effectiveness.^[6]Moreover, novel immunotherapies harness the body’s immune response to fight disease and have potential to establish immunological memory to prevent recurrence. Controlled-release formulas localized to specific areas also minimize toxicity and enable the reduction of other treatment intensities.

Gene Therapy: Gene therapy is another promising treatment that can potentially treat HNC at the genetic level. This approach involves introducing genetic material into a patient’s body to fight or prevent disease. While still in the experimental stages, gene therapy holds promise for treating cancers caused by genetic mutations.

On World Head and Neck Cancer Day, let’s celebrate the advancements in diagnosis and treatment. However, we must continue collaborating with policymakers, healthcare providers, and the industry to ensure widespread access to these advancements, enabling India to make substantial progress in combating this cancer effectively and promoting overall public health.

This article was first published in the FE Healthcare on 26^th July 2024.

^[1]https://hncii.org/about-hncii#:~:text=About%20HNCII-,Introduction,and%20smoking%20beedies%20and%20cigarettes.

^[2]https://globalactiontoendsmoking.org/research/tobacco-around-the-world/india/

^[3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10772356/

^[4]https://geneteclifesciences.com/lupitux-cetuximab-injection/

^[5]https://www.lupin.com/lupin-announces-the-launch-of-cetuximab/

^[6]https://link.springer.com/article/10.1007/s40137-024-00386-z#:~:text=Innovations%20in%20Head%20and%20Neck,chemotherapies%20has%20driven%20recent%20advancements.