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Laryngeal cancer research

All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know that they are safe.

First of all, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe to test are they tested in people, in clinical trials. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.

There is research into chemotherapy, radiotherapy and biological therapies.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating laryngeal cancer section.

 

 

Why we need research

All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that

  • We can be sure they work
  • We can be sure they work better than the treatments that are available at the moment
  • They are known to be safe
 

The research process

First of all, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a potential treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either on the NHS or from private health services. Cancer Research UK supports a lot of UK laboratory research into cancer.

Tests of treatments on patients are called clinical trials. Cancer Research UK supports many UK and international clinical trials.

Our trials and research section has information about what trials are including information about the 4 phases of clinical trials. There is more about this in the trials and research section

If you are interested in taking part in a clinical trial, visit our database of clinical trials in the UK. Choose 'laryngeal cancer' from the dropdown menu box and click 'find'. If you find a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to refer you to the research team. The database also has information about closed trials and trial results.

The new approaches here are the subject of ongoing research. Until researchers complete their studies and find new effective treatments, these experimental treatments cannot be used as standard therapy for cancer of the larynx.

Here is a video on experiences of taking part in a clinical trial:

 

Preventing cancer

Research is going on into cancer prevention. Using medicines or other agents, such as diet, to help stop a cancer developing is called chemoprevention.

Drugs to prevent cancer

Scientists are always looking at different types of drugs to see if they can help to prevent cancer. One group of drugs in clinical trials for head and neck cancers is retinoids. Retinoids are chemicals similar to vitamin A. 

People who have had a head and neck cancer are at risk of developing a second type of head and neck cancer. One of the main aims of retinoid research is to see if these drugs can reduce this risk. One such drug being looked at is called isotretinoin (Accutane). Some early studies using retinoids showed promising results, but research since has been disappointing. One trial found that it may increase the risk slightly. We need more research before we know if retinoids may help to prevent a second head and neck cancer.

Diet to prevent cancer

A diet high in fresh fruit and vegetables seems to reduce cancer of the larynx risk. But we need much more detailed information about this. A large European study is looking into the links between diet and cancer. This study is called EPIC (the European Prospective Investigation of Cancer). The trial started in 1992 and will produce reports about diet and a variety of cancers over the next 10 to 20 years. It is starting with the more common types of cancers, including bowel cancer and breast cancer. You can read more about the EPIC study and its findings on the EPIC website. 

Some scientists and doctors believe that antioxidant vitamins and minerals may help prevent cancer when included in a healthy, balanced diet. Vitamin A, C and E are antioxidants. We don't know for sure whether eating these can help prevent cancer. This is a very difficult thing to prove.

Human papilloma virus (HPV)

A study is looking to see if HPV may cause abnormal cells or cancers of the head and neck.

 

Diagnosing laryngeal cancer earlier

Doctors are trying out different ways of diagnosing laryngeal cancer, to try to find it earlier. One test being used is auto fluorescence laryngoscopy. During laryngoscopy doctors shine a special type of laser light (a helium cadmium laser) at the larynx. Under the light, cancer tissues look different to normal tissues. Pictures of the larynx are taken by a special camera and analysed by a computer.

Another new type of test is confocal endomicroscopy. During laryngoscopy, a special lens magnifies the tissues of the larynx up to 1,000 times.

 

Combining treatments

Clinical trials are looking into the best way to combine surgery, radiotherapy and chemotherapy to treat cancer of the larynx. These trials are designed to find out

  • If giving radiotherapy or chemotherapy after surgery can lower the risk of the cancer coming back
  • If it is helpful to give radiotherapy or chemotherapy before surgery
  • How best to treat cancer that has spread to the lymph nodes

Results from trials combining chemotherapy and radiotherapy have shown that having chemoradiation for T3 and T4 larynx cancers may mean that you don't need surgery. One of the big advantages of not having to have surgery is that you may still be able to speak naturally afterwards. Speech and swallowing can sometimes be quite difficult after chemoradiation, so surgery may be recommended for you. Larger trials need to be done before we know for sure whether chemoradiation is better than surgery at keeping a person's voice. 

There is more information about chemoradiation treatment for T3 and T4 larynx tumours in the section about chemotherapy for laryngeal cancer.

 

Endoscopic surgery

Endoscopic surgery involves passing a tube (an endoscope) through the mouth and into the throat. The surgeon then uses surgical instruments or laser treatment to remove the cancer. This type of surgery might be used to remove early stage laryngeal cancers. Researchers want to find out how it compares to radiotherapy. A pilot trial called EaSTer is comparing these two treatments for early stage cancer of the glottis (part of the larynx). 

A multi centre study in Canada has shown that for early stage cancer of the glottis both laser treatment and radiotherapy work equally well. The voice quality after both types of treatment was similar.

 

Newer chemotherapy drugs or combinations

Doctors are constantly looking at new ways of using chemotherapy drugs that work for other cancers. They are studying different combinations of drugs, different doses, and giving treatments in a different order. This type of research aims to find better ways to treat cancer.

Some chemotherapy drugs being tested in clinical trials for cancer of the larynx include

The links take you to pages with information about each drug and its side effects.

The TITAN trial is looking at giving chemotherapy before surgery and radiotherapy to see whether it lowers the chance of the cancer coming back after treatment. The trial is for people who have squamous cell cancer of the head and neck that has spread beyond the place where it first started. Chemotherapy before other treatments is called induction chemotherapy. 

The TITAN trial is using a combination of 3 drugs called docetaxel, cisplatin and fluorouracil. This combination of drugs is also known as TPF chemotherapy. We know from research that TPF can shrink head and neck cancers. But we don’t know if having this type of chemotherapy before surgery makes a difference to the long term outcome.

 

Different ways of giving chemotherapy

Researchers are also studying different ways of giving chemotherapy. For example, a trial has been looking into injecting chemotherapy directly into the arteries that supply the cancer. Researchers are also looking at giving this treatment in combination with radiotherapy.

There is also intralesional chemotherapy. This means injecting chemotherapy drugs directly into the tumour. In the past this method was not very successful because the drugs tended to leak and damage tissue around the tumour. The drugs could also spread to other parts of the body and cause damage. Researchers have been working on improving the way the drug is prepared so that it stays just in the tumour area. This is early research and we won’t know how effective it is until we have results from large studies.

 

New ways of giving radiotherapy

Doctors are looking at finding better ways of giving radiotherapy to treat head and neck cancers. These include

You can find information about these trials on our clinical trials database. Choose 'larynx' from the dropdown menu of cancer types.

Intensity Modulated Radiotherapy (IMRT)

IMRT shapes the radiotherapy beam to fit the shape of the tumour very accurately and the dose in the radiotherapy area can be varied. Because less normal tissue is in the radiotherapy beam, you may have fewer or less severe side effects. 

Research shows that IMRT reduces the risk of a dry mouth by giving only a low dose of radiotherapy to the salivary glands. IMRT should now be available in every cancer network in England.

The ART DECO study is comparing standard doses of intensity modulated radiotherapy with higher doses for cancer of the voice box (cancer of the larynx) or the hypopharynx. The hypopharynx is the part of the food pipe that surrounds the larynx.

Radiosensitising drugs

Doctors know that radiotherapy works best on cells that have a good supply of oxygen. Cancer cells do not always have high levels of oxygen, especially the cells in the centre of a tumour. Research aims to find different ways of increasing the oxygen levels of cancer cells so that radiotherapy can kill more of them. Nimorazole is a drug that mimics the effect of oxygen in tumour cells. The Danish Head and Neck Cancer Study showed that it significantly improved the effect of radiotherapy for supraglottic cancer of the larynx. More research is needed but in 2011 the European Medicines Agency (EMA) granted nimorazole orphan status. This means it may be available for the treatment of squamous cell carcinoma of the head and neck for patients having radiotherapy.

The aims of the phase 3 NIMRAD trial are to find out whether giving nimorazole with radiotherapy is better than radiotherapy alone for some head and neck cancers. And to learn more about the side effects of nimorazole.

Radiosensitising is the theory behind combining chemotherapy and radiotherapy. Some chemotherapy drugs, such as cisplatin and fluorouracil, are known to make cancer cells more sensitive to radiation. Combining the treatments increases the side effects though, so doctors need to be completely sure that patients get more benefit from this combined treatment.

 

Reducing side effects

One of the main side effects of radiotherapy to the head and neck area is a dry mouth. Doctors call this xerostomia. This happens because the radiotherapy affects the glands that make saliva (spit). You may make less saliva than usual, or none at all. This can make chewing, swallowing and talking difficult.

There is a need for new treatments because current treatments are limited. If you are making some saliva, drugs to stimulate your salivary glands may help. These include the drugs pilocarpine and bethanechol. But these drugs cause unbearable side effects, such as blurred vision, sickness, and sweating, in 15 out of every 100 people (15%) who use them.

Recent research suggests that a drug called amifostine can reduce the number of people who have a dry mouth after chemotherapy and radiotherapy. This drug is a type of chemoprotectant, meaning a drug that helps to protect against side effects. 

A few minutes before each radiotherapy treatment, amifostine is injected into a vein in your arm. It aims to limit the amount of damage the radiation causes to the salivary glands. Side effects of amifostine include low blood pressure, dizziness, flushing, chills, and feeling or being sick. This drug is still experimental and not used as standard treatment. Amifostine is not licensed in the UK.

The LEONIDAS-2 study is looking at a medical device to stimulate the gums to increase the amount of saliva in the mouth. The researchers hope this will reduce the symptoms of dry mouth and improve quality of life. This study has closed and we are waiting for the results.

Several studies suggest that having acupuncture appears to reduce the severity of dry mouth caused by radiotherapy in people with head and neck cancers. These trials are still in very early stages. Much larger trials are needed before we will know exactly how good acupuncture is in helping to control a dry mouth in people who have had radiotherapy for head and neck cancer.

 

Biological therapies 

Biological therapies are treatments that act on processes in cancer cells. They can work in different ways such as changing the way cells signal to each other or by stimulating the body to attack or control the growth of cancer cells. Research into biological therapies for laryngeal cancer include

Cancer growth blockers

There are different types of cancer growth blocker. One type is called PI3K inhibitors. In some cancers, PI3K is permanently switched on. This means that the cancer cells grow uncontrollably. Researchers are developing new treatments that block PI3K, and stop cancer cells growing. 

Buparlisib is a type of PI3K inhibitor. A trial is looking at buparlisib with paclitaxel chemotherapy for head and neck cancer that has come back or spread to another part of the body. The aim of the trial is to see if paclitaxel and buparlisib works better than paclitaxel and a dummy drug (placebo).

Immunotherapy

Immunotherapy is a type of biological therapy. Immunotherapy works by encouraging the body's natural defence system – the immune system – to attack cancer cells. There are 2 main biological therapies used to treat cancer. Interferon alpha (IFN) and aldesleukin (also sometimes called interleukin 2 or IL-2). Researchers are looking at ways of using your own immune system to fight cancer.

Gene therapy

Research is being done to understand better how changes in certain genes make cells in the larynx or hypopharynx become cancerous. By studying these changes, scientists aim to eventually develop gene therapies, which replace damaged genes in cancer cells with normal genes.

In a small UK trial, 17 people with head and neck cancer used the gene therapy OncoVEX GM-CSF alongside standard treatment for head and neck cancer. OncoVEX treatment uses a type of the cold sore virus that has been genetically changed. It makes a natural substance called GM-CSF that attacks cancer cells. The researchers wanted to see how well OncoVEX worked alongside radiotherapy and chemotherapy. 

In the trial the combined treatments were used for head and neck cancers that had spread to the lymph nodes in the neck. The trial aimed to find the best OncoVEX dose to give and more about the side effects. The researchers found that the OncoVEX shrank the cancer or helped to stop it coming back in some people. This is a small study but the cancer responded to the treatment in 14 people. So the researchers plan bigger trials of this treatment.

 

Reolysin in advanced cancer

Doctors are looking into using Reolysin to help treat advanced head and neck cancer. Reolysin is made using a type of virus called reovirus. Reovirus rarely causes any symptoms, but it can kill cancer cells.

A small trial looked at giving Reolysin at the same time as paclitaxel and carboplatin (PC chemotherapy) in people with advanced cancer. The researchers found that the cancer stayed the same or got smaller in more than half the people with head and neck cancer who had Reolysin and PC chemotherapy. The most serious side effects were a drop in the number of blood cells and low blood pressure.

The REO 18 trial is looking at Reolysin with paclitaxel and carboplatin chemotherapy for people with squamous cell head and neck cancers that have spread to other parts of the body or have got worse despite having other treatment. The aim of the trial is to see if having Reolysin at the same time as carboplatin and paclitaxel helps these people more than having the chemotherapy alone.

You can find more information about these trials on our clinical trials database.

 

Light treatment

A phase 2 study is looking at a type of light treatment with chemotherapy for cancer of the head and neck. Researchers are looking at a new treatment called PC A11 for people with squamous cell head and neck cancer that has come back after treatment. With PC A11 treatment, you have a drug called Amphinex which makes body tissue sensitive to light. You also have a chemotherapy drug called bleomycin. After having these drugs, the doctor directs a laser light onto the surface of the cancer, or through fibres that are put directly into the cancer. The light activates the Amphinex, which in turn helps the bleomycin to get into the cancer cells and kill them. The researchers hope that when you have bleomycin in this way you will only need one dose.

Photodynamic therapy (PDT) is another type of light treatment. Doctors hope that PDT may be useful for treating patients with advanced head and neck cancer who are not able to have any more standard treatment. It will not be able to cure advanced cancer, but it may help to shrink or slow the growth of the cancer, and relieve symptoms. This is called palliative treatment.

 

Head and neck cancer services

Services for people with head and neck cancers which includes cancer of the larynx are now offered at fewer larger centres. The Head and Neck 5000 study aims to ask 5000 people how well these services work for them

 

Research into living with laryngeal cancer

When people have their voice box removed (laryngectomy) the surgeon makes a passage through the wall between the food pipe and wind pipe. After the surgery they can fit a device to help you speak again. These devices are called voice prostheses and there are several different types. 

A voice prosthesis can make it difficult to swallow. There are different types of prosthesis and some may be easier to use than others. A study is trying to find out which speaking devices (voice prostheses) people prefer for speaking and swallowing after surgery. 

The aim of this study is to look at the impact of different voice prostheses on swallowing and voice quality.

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Updated: 11 September 2013