325generally consume higher levels of folate than normal cells to fuel their growth,
some cancer cell types, including ovarian, have high concentrations of the folate
receptor on their surface. Vintafolide is designed to selectively target the folate
receptor to deliver the anti-cancer agent to the cancerous tissue. Tumors that have
high concentrations of the folate receptor are identifi ed by etarfolatide, a non-
invasive imaging diagnostic agent. Intravenous folic acid is used with 99m
Tc- etarfolatide^ for the enhancement of image quality.
EMA has approved vintafolide (Merck & Co/Endocyte’s Vynfi nit ® ) and com-
panion imaging agents, etarfolatide (Folcepri ® ) as well as intravenous folic acid
(Neocepri ® ), in patients with platinum-resistant ovarian cancer. FDA has also
granted orphan drug status to vintafolide and etarfolatide. Further evaluation is
ongoing in the global PROCEED phase III clinical trial in folate receptor-positive,
PROC.
Personalized Management of Head and Neck Cancer
Molecular targeted therapy in head and neck squamous cell carcinoma (HNSCC)
continues to make strides, and holds much promise. Cetuximab remains the sole
FDA-approved molecular targeted therapy available for HNSCC, though several
new biologic agents targeting the EGFR and other pathways are currently in the
regulatory approval pipeline. While targeted therapies have the potential to be per-
sonalized, their current use in HNSCC is not personalized. This is illustrated for
EGFR-targeted drugs, where EGFR as a molecular target has yet to be individual-
ized for HNSCC. Future research needs to identify factors that correlate with
response (or lack of one) and the underlying genotype-phenotype relationship that
dictates this response. Comprehensive exploration of genetic and epigenetic land-
scapes in HNSCC is opening new frontiers to further enlighten and mechanistically
inform newer as well as existing molecular targets, and to set a course for eventually
translating these discoveries into therapies for patients. A snapshot of the evolution
of molecular subtyping in HNSCC and its current clinical applicability, as well as
new emergent paradigms with implications for controlling this disease in the future
has been presented in an opinion article (Worsham et al. 2012 ).
Relevance of Biomarkers of HPV-Related Head and Neck Cancer
Some reports have associated a subset of HNSCC with high-risk human papilloma-
viruses (HPVs), particularly HPV16, the same subset of HPVs responsible for the
majority of cervical and anogenital cancers. A positive test for HPV DNA alone was
not signifi cantly linked to head and neck squamous cell carcinoma (HNSCC) out-
comes. On the other hand, when found in combination with E6 and E7 expression,
a positive HPV16 test did coincide with improved oropharyngeal cancer outcomes.
Likewise, elevated levels of p16 in a tumor were not especially informative on their
Personalized Management of Cancers of Various Organs