Nasal and paranasal sinus cancer research

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.

Tests of treatments on patients are called clinical trials. There is information about clinical trials, including the 4 phases of clinical trials in the trials and research section of CancerHelp UK. In that section you can also visit our searchable database of clinical trials. Choose 'head and neck cancer' from the dropdown menu box and click 'search'. 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. The 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.

Doctors are looking at finding better ways of giving radiotherapy to treat nasal and sinus cancers. One of these is intensity modulated radiotherapy (IMRT). This is radiotherapy where the radiotherapy beam and the dose within the beam are shaped to match the tumour’s shape and thickness.

IMRT gives less radiotherapy to normal tissues compared to standard radiotherapy. Research results show that long term side effects such as dry mouth can be milder or less common with IMRT. This type of treatment is new, but should now be available in every cancer network in England.

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.

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 trial is using a combination of 3 drugs called docetaxel, cisplatin and fluorouracil. This combination of drugs is also known as TPF. 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.

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. There are many different types of biological therapies including

• Monoclonal antibodies
• Tyrosine kinase inhibitors
• Possible new targets for biological therapies
• Gene therapy

Monoclonal antibodies

Monoclonal antibodies (MAB) can block growth factor receptors on cancer cells that signal to the cancer to grow. MABs used to treat nasal and sinus cancers include

• Cetuximab
• Zalutumumab

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 cancer of the head and neck. The research 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 now licensed in combination with radiotherapy to treat squamous cell head and neck cancers that have spread locally. There is more information about cetuximab in the biological therapy for nasal and sinus cancer section of CancerHelp UK.

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

Zalutumumab is another monoclonal antibody that blocks epidermal growth factor receptors (EGFR) on cancer cells. A phase 3 trial looked at zalutumumab for people with head and neck cancer that had come back after chemotherapy. It compared zalutumumab and best supportive care with supportive care on its own. Best supportive care means you have treatment to control symptoms. The trial showed that the cancer stopped growing for longer in people who had zalutumumab.

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. Iressa is a type of tyrosine kinase inhibitor. It is also called ZD 1839 or gefitinib. 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.

Possible new targets for biological therapies

Other growth factor receptors that have been found in nasopharyngeal cancers 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.

Gene therapy

Researchers have used a new type of biological therapy called OncoVEX GM-CSF alongside standard treatment for head and neck cancer that had spread to the lymph nodes. In a small trial, 17 people had treatment with radiotherapy and cisplatin chemotherapy as well as OncoVEX GM-CSF directly into the 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 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 using this treatment.

Trials into gene therapy are still in very early stages. We will need larger trials before we know whether these treatments are any better at treating head and neck cancers than the treatments used now.

Rarely, radiotherapy to the head and neck area can damage the jawbone. This damage is called osteoradionecrosis (ORN). 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. You may be able to join this trial if your cancer has been successfully treated with radiotherapy and you are going to have jaw or dental surgery. Doctors think that having surgery can trigger the problem. There is more information about this trial on our clinical trials database.

Doctors have been trying a new way of scanning patients with head and neck cancer during treatment to see if they can get a better idea of how well the treatment is working. The scan is a combined PET-CT scan.  PET-CT scans may give doctors more precise information than either PET scans or CT scans on their own. This study is no longer recruiting patients and we are waiting for the results.

Another trial is comparing surgery to remove lymph nodes in squamous cell cancers of the head and neck with a watch and wait policy using PET-CT scanning. There is more information about these trials on our clinical trials database.

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
• Acupuncture for pain after neck surgery
• Acupuncture and moxibustion to relieve lymphoedema

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.

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 has been looking at whether 2 complementary therapies can help to relieve the symptoms of lymphoedema. The therapies being researched are acupuncture and moxibustion. Acupuncture uses fine sterile needles which are put just under the skin at particular points (acupuncture points) on the body.

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 has now finished and we are waiting for the results.

A small UK trial 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 people taking part in this study are having a sample of tissue taken because they may have a cancer of the head and neck. The researchers want to look at these tissue samples to see if they find HPV and the molecules this virus makes.

To visit our database of UK clinical trials, click on 'head and neck cancer clinical trials' further up on the left hand side of this page. This will show up trials that are currently recruiting, those that have closed and trials that have produced results.