Head and neck cancers are sixth most common malignancy worldwide. Oral cavity cancers are one of the commonest cancers in India and remain a leading cause for cancer-related mortality in the country. Two-thirds of head and neck cancers are locally advanced at diagnosis and have high chances of recurrence despite best efforts. Patients with recurrent and metastatic head and neck cancer have limited survival rate even with available treatment options. Nearly half of the newly-diagnosed patients do not survive beyond five years.

Understanding disease biology is critical for therapy. Efforts to discover the cancer pathway for a specific patient and personalising treatment options are ongoing. A multi-disciplinary approach is being taken with newer surgical and radiation techniques, chemotherapy, targeted therapy and immunotherapy. Targeted treatment with Cetuximab, an EGFR inhibitor that targets the cell-surface EGFR receptors, delivered in combination with chemotherapy has been shown to improve survival among patients. Micro array analysis for gene expression profiling and next generation sequencing for tumor mutation profiling has helped discover cancer genome pathways that may be utilised for novel therapeutic development to prevent cancer growth.

The Cancer Genome Atlas helped identify several genomic targets that are active in head and neck cancers. Subsequent work by others on longitudinal samples has helped identify newer targets like PIK3CA and PTEN mutations and FGFR mutations and amplifications leading to efforts for novel drug development. 

Arrival of immunotherapy has opened a new era of treatment in head and neck cancer and has shown to enhance survival with improved quality of life. One of the biggest challenges of immunotherapy in head and neck cancer has been the immunosuppressive nature of the disease. The biggest advantage is the durability of response and improved quality of life for the responders. Research is ongoing to overcome the inherent immunosuppressive nature of head and neck cancers and enhance the efficacy of the immune checkpoint inhibitors. A recently presented study showed further benefit from addition of chemotherapy to immunotherapy in head and neck cancer patients. Other approaches like combining immunotherapy with radiation (with or without chemotherapy) are being investigated bringing new light in the world of head and neck oncology with hope of lasting responses, enhanced survival and limited morbidity.

Anatomically, the head and neck area is divided into numerous sub sites. However, the treatment strategies, especially at the systemic level, are still the same. Cancer genomic tests have also demonstrated a genetically diverse signature of this heterogeneous malignancy. It is imperative that we understand the disease biology and integrate molecular diagnostics to help design improved therapeutic approaches and enhance survival.