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Nasal and paranasal sinus cancer research

This page is about research into the treatments for nasal and paranasal sinus cancer. You can find the following information

 

A quick guide to what's on this page

Nasal and paranasal sinus 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.

For nasal and paranasal sinus cancer, researchers are looking into

 

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

 

 

Why research is important

All potential new treatments have to be fully researched before they can be used 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 already available
  • They are known to be safe

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 treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS. Cancer Research UK supports a lot of UK laboratory research into cancer.

 

Finding a trial

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 clinical trials, including the 4 phases of clinical trials. In that section you can also visit our searchable database of clinical trials for nasal and sinus cancer. You may also find trials for head and neck cancer of interest to you.

If there is 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. Our database also has information about closed trials and trial results.

Everything covered on this page is the subject of ongoing research. Until studies are completed and new effective treatments are found, these experimental treatments cannot be used as standard therapy for head and neck cancers.

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

View a transcript of the video (Opens in a new window)

 

Causes of head and neck cancer

The PREGO study is looking at changes in genes that may cause head and neck cancers to develop. Most head and neck cancers take many years to develop and often go through different stages, such as from abnormal tissue to carcinoma in situ (very early cancer) and eventually invasive cancer. The researchers are collecting samples of cells from each of the different stages to look at the genes.

Another small study is looking at the causes of head and neck cancer. This study is looking to see if a virus called the human papilloma virus causes abnormal cells (pre cancers) and cancers of the head and neck. HPV is a common virus that affects many people and doesn't usually cause major problems. But we know from research that certain types of HPV may cause some head and neck cancers. The researchers in this study are looking at tissue samples to see if they find HPV and the molecules this virus makes.

There is information about these trials for nasal and sinus cancer on our clinical trials database. Remember to tick the boxes to see trials that have closed and those that have produced results.

 

Radiotherapy

Doctors are looking at finding better ways of giving radiotherapy to treat nasal and sinus cancers. You sometimes have radiotherapy after surgery for head and neck cancers to try to stop the cancer coming back. The CH03 trial is comparing radiotherapy 3 times a day with once daily treatment (standard or conventional radiotherapy). The researchers want to see which is better at stopping the cancer coming back and to compare the side effects. This trial has closed and we are waiting for the results.

 

Chemotherapy

Researchers have found that combining chemotherapy with radiation for people with stage 3 and stage 4 nasal and sinus cancers works better than radiotherapy on its own. Researchers are now looking into different types of chemotherapy that might work better and give fewer side effects.

 

Biological therapy

Biological therapies act on processes in cancer cells or change the way that cells signal to each other. They can stimulate the body to attack or control the growth of cancer cells. There is detailed information about biological therapies in our cancer treatment section. There are many different types of biological therapies including

Monoclonal antibodies

Monoclonal antibodies (MAB) can block growth factor receptors on cancer cells that signal to the cancer to grow. MABs being looked at for head and neck cancers include

Cetuximab is also known as Erbitux. It blocks a receptor called epidermal growth factor receptor (EGFR). Scientists hope that blocking these receptors will stop the signals that tell nasal and paranasal cancers to grow.

Cetuximab has been tested in trials for squamous cell cancers of the head and neck. One large study found that people with locally advanced head and neck cancer treated with cetuximab and radiotherapy lived longer than people who just had radiotherapy. Cetuximab is licensed in combination with radiotherapy to treat squamous cell head and neck cancers that have spread locally.

Research looking at giving cetuximab alongside other biological therapies or chemotherapy for head and neck cancer is continuing around the world.

Panitumumab is another type of MAB. It has been looked at in a large trial with chemotherapy for squamous cell head and neck cancer that had come back after treatment or had spread. The people taking part had panitumumab with cisplatin and fluorouracil chemotherapy or panitumumab on its own. The trial team found that adding panitumumab to chemotherapy stopped the cancer from growing for longer. But it did not increase the amount of time people lived.

Cancer growth blockers

There are different types of cancer growth blockers. One type is called tyrosine kinase inhibitors. Tyrosine kinase is a substance within cells that triggers them to grow and divide. Blocking tyrosine kinase stops the cells growing and making more cells. Gefitinib (Iressa) is a type of tyrosine kinase inhibitor. Doctors hope that if Iressa stops tyrosine kinase working, it will stop the growth of cancer cells. Iressa is not licensed for head and neck cancers at the moment in the UK. But clinical trials are going on. These trials include nasal and sinus cancers that have come back after treatment. The research so far has not shown Iressa to work any better than chemotherapy.

PI3K inhibitors are another type of cancer growth blocker. 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. One type of PI3K inhibitor is called buparlisib. 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).

Possible new targets for biological therapies

Other growth factor receptors that have been found and could be targets for new growth factor blocker drugs are

  • C-KIT (CD117)
  • C-erb-2 (HER2)
  • Vascular endothelial growth factor (VEGF)

But we need more research before we will know if these will lead to new treatments for this type of head and neck cancer.

 

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.

 

Oxygen treatment to prevent bone damage

Rarely, radiotherapy to the head and neck area can damage the jawbone. This damage is called osteoradionecrosis (ORN). If the damage is bad enough to cause symptoms, you may have surgery to remove the damaged part of the jawbone. 

ORN develops because the blood supply to the area is reduced. Doctors think that a high pressure oxygen therapy called hyperbaric oxygen (HBO) can help to stop this happening. The idea is that HBO works by increasing the blood supply to the jaw. The HOPON trial is looking to see if high pressure oxygen prevents jaw damage after radiotherapy for head and neck cancer.

The DAHANCA 21 trial is comparing HBO before and after surgery to remove the damaged part of the jaw bone with surgery alone. The main aim is to see if high pressure oxygen therapy can help with healing the jaw bone after surgery.

 

Reducing side effects of treatment

Treatment for nasal and sinus cancer can sometimes cause side effects that are difficult to cope with. There is information below about research into

Helping to relieve a dry mouth

Radiotherapy to the head and neck area can cause a dry mouth. This is very uncomfortable and can make chewing, swallowing and even talking difficult. If you are making some saliva, a drug to stimulate your salivary glands may help. These include the drugs pilocarpine and bethanechol. But in about 1 in every 6 patients (15%) these drugs can cause side effects such as blurred vision, sickness and sweating.

Recent research suggests that a drug called amifostine can help with a dry mouth. This drug is a chemoprotectant, meaning it helps to protect against the harmful side effects of chemotherapy and radiotherapy. Amifostine is still only being tested at the moment and is not used as standard treatment. Our section about mouth problems with cancer has information about this and other treatments for a dry mouth.

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.

Some studies suggest that having acupuncture can help with a dry mouth caused by radiotherapy in people with head and neck cancers. But we need more research before we will know exactly how much it can help.

Acupuncture for pain following neck surgery

Some people who have a neck dissection operation to remove lymph nodes in their neck also have their accessory nerve removed. This nerve controls shoulder movement, and the surgery can leave your shoulder and neck stiff and painful. These side effects are usually treated with physiotherapy and non steroidal anti inflammatory pain killers (NSAIDs). Early research in the USA suggests that acupuncture may also help to relieve the pain caused by having a neck dissection.

Acupuncture and moxibustion to relieve lymphoedema

Lymphoedema is swelling caused by a build up of lymph fluid in the body. It can be a side effect of surgery or radiotherapy treatment if the lymph nodes that usually drain the fluid are removed or damaged. Lymphoedema can cause discomfort, pain and difficulty moving. There is no cure for lymphoedema, but treatments can relieve symptoms.

A small trial looked at acupuncture and moxibustion for lymphoedema. These are types of complementary therapies. Acupuncture uses fine sterile needles which are put just under the skin at particular points (acupuncture points) on the body. In this trial, they did not put the acupuncture needles in the area affected by lymphoedema. Moxibustion uses a dried herb called mugwort which is rolled into a stick. The moxibustion practitioner holds the glowing end of the lit stick over acupuncture points to warm them.

The trial team found that acupuncture and moxibustion was safe and the people taking part reported some improvement in their symptoms. The team suggest that more research is needed to see how much it could help improve symptoms.

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Updated: 29 July 2014