Immunotherapy’s Visible Promise Against Head and Neck Cancer

The drummer for the rock band Poison, Rikki Rockett, has made a name and a living for himself as a performing artist. However, his life where he performed before thousands of adoring fans and drummed on platinum albums, and his family life alike, was suddenly altered by what initially could have seemed like allergy or common cold symptoms. 

“In the summer of 2015, the family had sore throats, I had a sore throat, but everyone got over their sore throat and I (did not),” Rikki recalled in a 2019 interview for the Cancer Research Institute (CRI). “I had to have a biopsy, (and) everything changed from that moment on.” 

Unfortunately, Rikki had contracted human papillomavirus (HPV)-related oral squamous cell carcinoma, a form of head and neck cancer. Several types of cancer located in the nasal cavity, sinuses, mouth, salivary glands, voice box, and throat are collectively referred to as head and neck cancer. According to the ASCO Post, this cancer comprises nearly 4% of all cases in the U.S. 

Ezra Cohen, MD, associate physician of medicine at the University of California, San Diego, chief medical officer at Tempus AI, and former CRI CLIP Investigator, led a clinical trial that Rikki participated in after his diagnosis. Rikki’s initial prognosis was not hopeful: Dr. Cohen stated in 2019 that Rikki’s chance of survival had been less than 10%. 

The sign that Rikki needed more medical attention was a sore throat that would not subside. According to the Centers for Disease Control and Prevention (CDC), this is one of many detectable symptoms of head and neck cancer. They include, but are not limited to: 

• Sores and unusual bleeding or pain in the mouth 
• Trouble breathing or speaking 
• Difficulty consuming food 
• Persistent throat pain 
• Eye swelling and pain 
• Sinuses that are blocked and will not clear 

There are hurdles associated with treating head and neck cancer. According to Sidharth Puram, MD, PhD, associate professor of otolaryngology, head and neck surgery, division chief of head and neck surgery at the Washington University School of Medicine in St. Louis, and former CRI Tech Impact Award recipient, funding and treatment for this cancer is challenging. 

“Head and neck cancer research has been historically relegated to a disease of smokers and drinkers. In fact, some sources show that head and neck cancer is among the least funded cancer by incidence,” Dr. Puram says. “Challenges with treatment for head and neck are particularly onerous as cancers can affect the key aspects of human experience – taste, speech, voice, (the ability to) swallow, (the ability to hear), and many other aspects. As a result, our treatment (must consider) these delicate human functions while trying to eradicate (head and neck) cancer.” 

To Dr. Puram’s point about the sensitivity of human functions, potential complications with several avenues of treatment led Rikki towards learning about immunotherapy. In 2015, there were not as many available options for immunotherapy, and it was not as widely implemented or well-known as it is today. 

“I (did not) know a whole lot about oral cancer at all,” Rikki stated. “The options that I was given were chemo, (which would) buy me time, (or) surgery, which would render me speechless, literally, or this new thing called immunotherapy.” Rikki was treated with a combination immunotherapy treatment of pembrolizumab and epacadostat in a clinical trial. 

T.C., who is now Rikki’s wife, strongly advocated for immunotherapy after his diagnosis. 

“(Let us) try to train our immune system to fight this disease,” T.C. recalled in 2019. “It sounded groundbreaking.” 

Thankfully, there are several immunotherapy options and renewed hope specifically for HPV-related head and neck cancer patients. While treatment for head and neck cancer has its nuances, immunotherapy clinical trials can provide hope for patients, caregivers, and families. Joshua Brody, MD, director of the Lymphoma Immunotherapy Program at The Tisch Cancer Institute at Mount Sinai, faculty member of the Icahn Genomics Institute, and CRI Lloyd J. Old STAR, states that clinical trials are saving the lives of head and neck cancer patients. 

“Clinical trials are a chance to get ‘medicines of the future’ long before they are otherwise available,” Dr. Brody says. “The easiest proof of this is that we have many patients who enrolled in head and neck cancer immunotherapy trials a decade ago (e.g. the KEYNOTE-048 trial) who are alive today, and otherwise would not be.” 

Despite an initial dire outlook, Rikki’s health would take a swift turn for the better – much like the patients treated in clinical trials that Dr. Brody references. 

“What we were seeing (with his combination immunotherapy treatment) was a doubling of the response rate that one would expect with pembrolizumab alone,” Dr. Cohen recalled in 2019. “18 weeks into the clinical trial, Rikki’s cancer was completely gone.” 

After initially not knowing much about immunotherapy, Rikki became a proponent for clinical trials. 

“I hope that anybody who does a clinical trial has the same experience because I felt like I had the best care that I have ever had in my life,” Rikki said in 2019. “To look through that (cancer-free) scan, there is no feeling like that in the world.” 

Dr. Cohen shared Dr. Brody and Rikki’s warmth towards clinical trials and sees them as the path forward towards conquering head and neck cancer. 

“My belief is that we will look back on these days and we will recognize them as the beginning of the cure,” Dr. Cohen said in 2019. “The only way we are going to get there is through clinical trials.” 

Rikki stressed he was not alone as he fought against his cancer, and believed that he could not have persevered through his cancer treatment without T.C. After Rikki’s diagnosis, T.C. told Dr. Cohen that Rikki must dance at his daughter’s wedding. There was still a lot of life to live. 

“What do you want to do when I am too old to rock a stage?” T.C. recalled Rikki asking her one day after he was in remission. “You are never going to be too old to rock a stage,” she responded. 

As of 2023, Rikki remains cancer-free. While there are more treatments options for head and neck cancer patients, Dr. Puram emphasizes that there is a surefire way to prevent many incidences of head and neck cancer. 

“My message is simple: get yourself, your family, and your friends vaccinated (against HPV) to help avoid this disease,” Dr. Puram says “It will not eliminate all head and neck cancer, but it will prevent many (instances) and is worth getting. The FDA has recently approved this (vaccine) up to the age of 45.” 

Furthermore, the Centers for Disease Control and Prevention (CDC) does have some recommendations for additional ways individuals can best prevent or catch head and neck cancers: 

• Abstain from consuming tobacco products – including the smokeless variety 
• Limit alcohol consumption 
• Avoid harsh sunlight and tanning beds 
• Schedule regular dental exams, where a dentist can potentially detect oral cancer 

Head and neck cancer provides challenges for patients, caregivers, families, and oncologists. However, between patient-advocates like Rikki, caregivers like T.C., and scientists fighting the disease on the frontline like Drs. Brody, Puram, and Cohen, we are closer to creating a world immune to cancer.