Innovations in Head and Neck Cancer Treatment

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in otolaryngology-head and neck surgery.

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on Twitter @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology - Head and Neck Surgery by following @CleClinicHNI on Twitter, that's CleClinicHNI. And new this year, find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.

Today I'm excited to speak to my friend and colleague, Dr. Eric Lamarre, Section Head of Head and Neck Cancer Surgery in our Head & Neck Institute. Dr. Lamarre, welcome to Head and Neck Innovations.

Eric Lamarre: Thank you, Dr. Bryson.

Paul Bryson: Let's start by having you share some background on yourself for our listeners, where you're from, where you trained, how you came to Cleveland Clinic.

Eric Lamarre: Yeah, thank you. I'm originally from Canada, but, I grew up in Vermont just outside of Killington, Vermont, and went to medical school at Penn State in Hershey, Pennsylvania, and then from there got introduced to the Cleveland Clinic, was fortunate to match here as a resident, and then did some additional training in head and neck cancer and reconstructive surgery in Seattle, Washington. And then came back with my wife, who's also a physician here to practice at the Cleveland Clinic, and we've been here for over a decade and just loved every moment of it. It's been a great organization and really allows us to treat kind of the most complex of head and neck cancer patients.

Paul Bryson: You know, to that end, during your time here, there's been a lot of growth. Do you want to share with the listener just some of some of that growth, like how many surgeons we have now, some of the collaborations that you've established with the Taussig Cancer Center? You know, you have the sort of the institutional knowledge and awareness of seeing this over your time, not only, as a trainee, but now as a staff member.

Eric Lamarre: Yeah, I mean, as a section I think we've added a surgeon scientist. We've just recruited another surgeon, and so that will increase our numbers to about six surgeons. In addition to that, we've really kind of harnessed the multidisciplinary collaborative nature with Taussig Cancer Institute and medical oncology, radiation oncology and really kind of continued our collaborations as we've done for years with neurosurgeons, skull base center, as well as the thoracic surgery department. And I think that's what makes this organization great, is the ability to leverage a lot of these collaborations clinically to tackle problems that many centers won't tackle.

Paul Bryson: Yeah. Well, congratulations on that. It's, you know, working with you over these years, it's really awesome to see just how much growth and, and how easily people interact. Like there's a real sort of palpable comradery and respect and focus on patient care and getting access for these patients and, you know, working together as a team. So, you know, congrats. Thank you on that not you know, this week, we had many of our head and neck surgeons attending the American Head & Neck Society’s 11th International Conference on Head and Neck Cancer. I was really excited to see the email list of projects going around. You know, it's sort of a testament to the team that you are building and that you're a part of. Can you share with the listener some of these new research projects that were presented that you're excited about?

Eric Lamarre: Yeah, absolutely. I think there was a great effort amongst all those in the section as well as the Taussig Cancer Institute to present at this meeting. But some of the points that I'll bring up are Natalie Silver has some great work, and she presented some of her work with respect to microbiomes and oral cavity cancer, and so we're excited and she just received a grant on that topic, and so we're excited to see the evolution of that. Dr. (Joseph) Scharpf continued with his research into thyroid cancer and presented a great talk on identification of advanced thyroid cancer population, molecular markers and genetic testing. And Dr. (Brandon) Prendes did some great work on oral lichen plaintiffs and oral cavity cancer, something that we see quite a bit of. And Dr. (Jamie) Ku presented a great multi-institutional trial looking at low and intermediate grade salivary gland carcinomas and trying to avoid adjuvant radiation on those.

And then I presented in a collaborative fashion some outcomes that we've had on metastatic thyroid cancer and in using tyrosine kinase inhibitors and looking at our experiences in management of minor salivary gland cancers over 20 years. And finally looking at our collaborations with our pathologist in terms of evaluating resection specimen versus tumor bed sampling margin assessment. And so, highlighting our collaborations with our head and neck pathologist as well. But we're excited about all these aspects and continue to grow our clinical retrospective research and that front, also our clinical trials.

Paul Bryson: Yeah, I mean you know, as an observer one thing that I'm struck with is that all the specific silos within head and neck oncology are sort of touched upon by this. And you talk about salivary gland malignancies, thyroid malignancies, oral cavity malignancies. As you sort of grow the program, has that been sort of a focus of the group to this sort of broad-based approach to all these, sort of subspecialties within head and neck cancer?

Eric Lamarre: Yeah, absolutely. I think particularly in the realm of clinical trials, we're trying to recruit clinical trials to address all facets of head and neck oncology. And all of that is done in a very multidisciplinary manner. So, whether it's skull base, oral cavity with sentinel lymph node biopsies, or as you mentioned, salivary gland malignancies trying to touch and round out a lot of what's up and coming with respect to advancement of the management of head and neck cancer patients within each facet of head and neck cancer.

Paul Bryson: And then another thing that I wanted to highlight too is sort of the you know; we have a lot of residents that we bring through. We have a fellowship program that you lead. The medical student aspect of this has also been, you know, as an observer, very impressive. Can you comment on, you know, sort of the role that some of these medical students have played, you know, in the projects and sort of the momentum that you seem to be building with the medical student research program?

Eric Lamarre: Yeah, it's been great to over the past three to four years, I've mentored a couple of medical students and it's great when they go off to new residencies or residencies fortunate to join us here to see the development of their careers. And so, it's an exciting prospect. But yes, I think integrating medical students within this is a wonderful opportunity and I think it really helps to grow their careers in a very positive light.

Paul Bryson: Well, you know, as you look ahead, what else is on the horizon as far as additional research that you and the team are working on? You know, any exciting follow-ups to some of these projects? I know you mentioned clinical trials and some funding through Dr. Silver. Any, anything else that you want to highlight for the listener?

Eric Lamarre: Yeah, I think we continue to try to grow our clinical trial portfolio, so partnering with industry to look at basically immune oncolytic therapies for difficult to treat had neck cancers. So, both partnering with industry and also participating with national, cooperative groups to answer questions related to either adjuvant treatments or even surgically based treatments. And as I mentioned before, facets of head and neck cancer, just to provide patients with an up-to-date treatments with respect to their head and neck cancers. Also, to advance the science, because I think that's our main mission is to advance cures, so improve overall survival, and disease-free survival in conjunction with, make it as functionally palatable as we can. So, we continue to work hard on all those fronts in a multidisciplinary manner, working with our medical oncologists and radiation oncologists to provide our patients with the best treatment options available.

Paul Bryson: Well, you know, I appreciate you sharing that. And you know for the listeners that that might be thinking about referring somebody to Cleveland Clinic, what can they expect when it comes to plan of care? Like what, who will the patient meet with? What sort of patient experience, you know, for folks that might want to refer a patient or for perhaps patients that are listening that want to come here for another opinion or for their care?

Eric Lamarre: I think that as a section in cancer we really emphasize a multidisciplinary approach. And so, from the moment a patient is referred to our center or Taussig Cancer Institute, we triage the patient to see what the best specialist would be to evaluate that patient and ensure that we have all the up-to-date imaging and pathology. And so, when a patient is seen we've already pre-screened that patient and they're seen the same day by multiple providers, if that's what's necessary. And at that time, we come up with kind of a consensus opinion for the patient. And so, it's a really expedited way to provide an opinion in a multidisciplinary fashion. In addition to that, we work closely with our speech and language pathologists to assess swallowing if there's any impact that treatment may have on swallowing, they work on techniques to improve that. Additionally, we work with a nutritionist as well and any other resources the patients may need to better equip them for management of the cancer and treatments and the effects of treatment. So really stress kind of the multidisciplinary nature of it and in our team-based approach with respect to that.

Paul Bryson: Well, you know, as we wrap up, any final take home messages for our listener or, I feel like you hit a lot of highlights. There's a lot of positive things going on in the group, but anything to bring home today?

Eric Lamarre: Yeah, I think, I mean, it's for providers and patients as well too, that whenever you're diagnosed with a head and neck cancer, I think there's always a sense of urgency to try to get treatment completed as soon as possible, which is important. But I would also emphasize the need to, and I stress this among my own patients, to seek other opinions as well too, if it's in expeditious fashion, just to make a, a decision that you're comfortable with as well as a team that you're comfortable, in providing the care for you. Because as I emphasize in all my patients, typically the first treatment for a head and neck cancer is, is really the most important treatment. And I think it's imperative that you're comfortable with the team and the decisions that, uh, you collectively arrive at.

Paul Bryson: Well, Dr. Lamarre, it was great to have you today.

Eric Lamarre: Thank you, Paul. I appreciate it.

Paul Bryson: For more information on Head and Neck Cancer diagnosis and treatment at Cleveland Clinic, please visit ClevelandClinic.org/headandneckcancer. That's ClevelandClinic.org/headandneckcancer. And to speak with a specialist or submit a referral, please call our cancer answer line at 866.223.8100. That's 866.223.8100. Thanks for joining us today on Head and Neck Innovations.

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