Critical Issues in Head and Neck Oncology: Key Concepts from the Seventh THNO Meeting

This publication is a selection of lectures presented at the Seventh Meeting of Trends in Head and Neck Oncology (‘THNO-7’), which took place in Athens, Greece, in November 2019, and was organised by the same co-ordinating team (editors) as that of the fifth and sixth meeting (previously published by Springer). It was supported by Pharma, with endorsement from the European Head and Neck Society and the European Organisation for Research and Treatment of Cancer. Thesemeetings aim to present themost up-to-date information on head and neck cancer, by recognised experts, guaranteeing that shortly afterwards the proceedings will be published. On this occasion, this happenedwithin eightmonths, but this reviewerwas unaware of its publication. The themes of this volume, in six sections, are: biomarkers in head and neck squamous cell carcinoma (6 chapters); primary disease (15 chapters); recurrent and/or metastatic disease (4 chapters); rare head and neck cancers (1 chapter); nasopharyngeal cancer (3 chapters); and a keynote lecture on innovation and advances in precision medicine in head and neck cancer. Each chapter is enhanced with coloured figures and diagrams, and is liberally supported by published references (dated up to 2020). As a surgical oncologist reviewer, there was an abundance of information on the non-surgical management of primary and recurrent or metastatic squamous cell carcinoma. This included the current role of biomarkers in early disease diagnosis, biomarkers for hypoxic human papillomavirus status and proliferation, imaging perspective, and biomarkers for immune modulatory treatment. There were chapters on the state and role of chemotherapy and immunotherapy, and their position in the treatment schedule, including induction therapy, high dose/low dose chemo-radiotherapy, and the role of neoadjuvant targeted therapy and immunotherapy, as well as a chapter on new and promising targeted therapies, in firstand second-line treatment settings. Considered appropriate was a chapter on ‘Optimal Supportive Measures during Primary Treatment’. A separate section on nasopharyngeal cancer covered epidemiology aspects, new developments in current management, and new drugs for recurrent or metastatic disease. The chapters that I found enlightening were those on the assessment of surgical margins, the surgical approach to older adult patients, salvage surgery, and one entitled ‘Re-irradiation for Local Relapses or Second Primaries: When and How?’ There was a short chapter on rare head and neck cancers – defined as less than 6 per 100 000 inhabitants (incidence) per year – this would include for the European population most of the head and neck subsites! The final chapter on ‘Innovation and Advances in Precision Medicine’ gave an insight into current and possible improvements in the therapeutic options for recurrent or metastatic head and neck cancer. Targeting treatment at the tumour’s molecular pathogenesis results in the tailoring of a specific treatment for a specific patient, with improved outcomes. The challenges so far encountered include the diversity of genetic aberrations, the heterogeneous mutational spectrum and the lack of actionability of the majority of genomic-based alterations observed. The identification of biomarkers and their inclusion into clinical trials may help identify selected patients who are more likely to respond to specific therapies. The continued recognition of the complexity and molecular diversity of head and neck squamous cell carcinoma has resulted in the development and expansion of the ‘omics’ technologies – epigenomics, transcriptomics, proteomics, metabolomics and shotgun metagenomics. Although each single level First published online: 9 January 2023 https://doi.org/10.1017/S0022215122002651, (2023), 137, 471–472.

this happened within eight months, but this reviewer was unaware of its publication.
The themes of this volume, in six sections, are: biomarkers in head and neck squamous cell carcinoma (6 chapters); primary disease (15 chapters); recurrent and/or metastatic disease (4 chapters); rare head and neck cancers (1 chapter); nasopharyngeal cancer (3 chapters); and a keynote lecture on innovation and advances in precision medicine in head and neck cancer. Each chapter is enhanced with coloured figures and diagrams, and is liberally supported by published references (dated up to 2020).
As a surgical oncologist reviewer, there was an abundance of information on the non-surgical management of primary and recurrent or metastatic squamous cell carcinoma. This included the current role of biomarkers in early disease diagnosis, biomarkers for hypoxic human papillomavirus status and proliferation, imaging perspective, and biomarkers for immune modulatory treatment. There were chapters on the state and role of chemotherapy and immunotherapy, and their position in the treatment schedule, including induction therapy, high dose/low dose chemo-radiotherapy, and the role of neoadjuvant targeted therapy and immunotherapy, as well as a chapter on new and promising targeted therapies, in first-and second-line treatment settings. Considered appropriate was a chapter on 'Optimal Supportive Measures during Primary Treatment'. A separate section on nasopharyngeal cancer covered epidemiology aspects, new developments in current management, and new drugs for recurrent or metastatic disease.
The chapters that I found enlightening were those on the assessment of surgical margins, the surgical approach to older adult patients, salvage surgery, and one entitled 'Re-irradiation for Local Relapses or Second Primaries: When and How?' There was a short chapter on rare head and neck cancersdefined as less than 6 per 100 000 inhabitants (incidence) per yearthis would include for the European population most of the head and neck subsites! The final chapter on 'Innovation and Advances in Precision Medicine' gave an insight into current and possible improvements in the therapeutic options for recurrent or metastatic head and neck cancer. Targeting treatment at the tumour's molecular pathogenesis results in the tailoring of a specific treatment for a specific patient, with improved outcomes. The challenges so far encountered include the diversity of genetic aberrations, the heterogeneous mutational spectrum and the lack of actionability of the majority of genomic-based alterations observed. The identification of biomarkers and their inclusion into clinical trials may help identify selected patients who are more likely to respond to specific therapies. The continued recognition of the complexity and molecular diversity of head and neck squamous cell carcinoma has resulted in the development and expansion of the 'omics' technologiesepigenomics, transcriptomics, proteomics, metabolomics and shotgun metagenomics. Although each single level omics approach has shed some light on epigenetic alterations, their activity has been limited; the combining of these findings into 'multi-omics' approaches may enhance additional predictive and prognostic value. This research avenue requires dedication and sustained scientific collaboration to realise and achieve this goal of precision medicine for the treatment of patients with head and neck squamous carcinoma.
This publication is recommended to all clinicians involved in the management of patients with head and neck cancer, as a 'source of knowledge' on the modern and future treatment options of this disease. This volume can be downloaded from Springer Nature or from the web for free on the Oapen (online library and publication platform) website at: https://library.oapen.org/handle/20.500.12657/49504. This reviewer purchased his paper edition (as he had already purchased the other volumes). The e-book's open access is more than satisfactory for short study periods, rather than to be considered a textbook. A suggestion and comment to the publishers is that all of the chapters, for consistency, should use the American Psychological Association reference style, to include the Digital Objective Identifier (DOI) or the Uniform Resource Locator (URL; reference location on the internet).

Patrick J Bradley
Nottingham, UK