968 resultados para Mammary carcinomas
Resumo:
Mouse mammary tumor virus (MMTV) expresses a superantigen (SAg) which plays a critical role in the viral life cycle. We have recently described the new infectious MMTV (SIM) encoding a Vbeta4-specific SAg in mice with a TCR-Vbeta(b) haplotype. We have now compared the SAg activity of this virus in BALB/c mice harboring the TCR-Vbeta(a), TCR-Vbeta(b) or TCR-Vbeta(c) haplotypes which differ by a central deletion in the TCR-Vbeta(a) and TCR-Vbeta(c) locus and by mutations in some of the remaining Vbeta elements. Injection of MMTV (SIM) led to a strong stimulation of Vbeta4+ CD4+ T cells in TCR-Vbeta(b) mice, but only to a weak stimulation of these cells in TCR-Vbeta(a) or TCR-Vbeta(c) mice. A large increase in the percentage of Vbeta10+ cells was observed among CD4+ T cells in mice with the Vbeta(a) or Vbeta(c), but not the Vbeta(b) TCR-Vbeta haplotype. Vbeta10+ cells dominated the response when Vbeta10(a/c) and Vbeta4 subsets were present together. This is the first report of a viral SAg interacting with murine Vbeta10+ cells. Six amino acid differences between Vbeta10(a/c) and Vbeta10(b) could account for the gain of reactivity of Vbeta10(a/c) to the MMTV(SIM) SAg. No mutations were found in the hypervariable region 4 (HV4) of the TCR. Mutations at positions 22 and 28 introduce into Vbeta10(a/c) the same amino acids which are found at these positions in the MMTV(SIM)-reactive Vbeta4. Tridimensional models indicated that these amino acids lie close to HV4 and are likely to be important for the interaction of the SAg with the TCR.
Resumo:
Mouse mammary tumor virus (MMTV) has been shown to preferentially infect B lymphocytes in vivo. We have used recombinant envelope-coated fluospheres and highly purified MMTV particles to study the distribution of the viral receptors on fresh mouse lymphocytes. A preferential dose-dependent binding to B lymphocytes was observed which could be competed with neutralizing antibodies. In contrast, T-lymphocyte binding remained at background levels. These results strongly suggest a higher density of viral receptor molecules on B lymphocytes than on T lymphocytes and correlate with the preferential initial infection of B lymphocytes observed in vivo.
Resumo:
Endogenous and infectious mouse mammary tumor viruses (MMTVs) encode in their 3' long terminal repeat a protein that exerts superantigen activity; that is, it is able to interact with T cells via the variable domain of the T cell receptor (TCR) beta chain. We show here that transmission of an infectious MMTV is prevented when superantigen-reactive cells are absent through either clonal deletion due to the expression of an endogenous MTV with identical superantigen specificity or exclusion due to expression of a transgenic TCR beta chain that does not interact with the viral superantigen. A strict requirement for superantigen-reactive T cells is also seen for a local immune response following MMTV infection. This immune response locally amplifies the number of MMTV-infected B cells, most likely owing to their clonal expansion. Collectively, our data indicate that a superantigen-induced immune response is critical for the MMTV life cycle.
Resumo:
Paul Ehrlich's inspired concept of 'magic bullets' for the cure of diseases has been revitalized by recent advances in immunology1. In particular, the development of cell fusion technology allowing the production of monoclonal antibodies (Mabs) with exquisite specificities2 triggered new hopes that we may now have the perfect carrier molecules with which to deliver cytotoxic drugs3 or toxins4 to the hidden cancer cells. This article reviews data on one aspect of the magic bullet concept, the use of radiolabelled antibodies as tracers for tumour localization. It will also discuss the very recent clinical use of 131I-labelled Mabs against carcinoembryonic antigen (CEA)5 to detect carcinoma either by conventional external photoscanning or by single photon emission computerized tomography (SPELT). This alliance of the most modern tools from immunology (Mabs) and nuclear medicine (SPELT) appears promising as a way to improve the sensitivity of 'immunoscintigraphy'. However, this approach is not yet ready, for widespread clinical use.
Resumo:
Cytotoxic T cells represent a powerful strategy for antitumor treatment. Depending on the route of injection, an important role for CD4 T cell-mediated help was observed in the induction of this response. For this reason, we investigated whether induction of a CTL response to the HLA-A2-restricted immunodominant peptide melanoma antigen Melan-A was improved by using rVVs expressing the CTL-defined epitope alone or in combination with an SAg. In the latter case, the few infected dendritic cells simultaneously presented an SAg and an antigen, i.e., peptide. Here, we show that the anti-Melan-A response was efficiently induced but not significantly improved by coexpression of the SAg.
Resumo:
Many mucosal pathogens invade the host by initially infecting the organized mucosa-associated lymphoid tissue (o-MALT) such as Peyer's patches or nasal cavity-associated lymphoid tissue (NALT) before spreading systemically. There is no clear demonstration that serum antibodies can prevent infections in o-MALT. We have tested this possibility by using the mouse mammary tumor virus (MMTV) as a model system. In peripheral lymph nodes or in Peyer's patches or NALT, MMTV initially infects B lymphocytes, which as a consequence express a superantigen (SAg) activity. The SAg molecule induces the local activation of a subset of T cells within 6 days after MMTV infection. We report that similar levels of anti-SAg antibody (immunoglobulin G) in serum were potent inhibitors of the SAg-induced T-cell response both in peripheral lymph nodes and in Peyer's patches or NALT. This result clearly demonstrates that systemic antibodies can gain access to Peyer's patches or NALT.
Resumo:
To assess the use of radiotherapy (RT) or concurrent chemoradiotherapy (CRT) following taxane-based induction chemotherapy (T-ICT) in locally advanced head and neck squamous cell carcinoma (LAHNSCC) and to evaluate the tolerability of CRT after T-ICT. From 01/2006 to 08/2012, 173 LAHNSCC patients treated as a curative intent by T-ICT, followed by definitive RT/CRT were included in this analysis. There was an 86% objective response (OR) after ICT among 154 evaluable patients. Forty-four patients received less than three cycles (25%) and 20 received only one cycle of T-ICT. The 3-year actuarial overall survival (OS) was 49% and there was no OS difference according to the type of ICT (regimen or number of cycle) or the addition of concurrent CT (cisplatin, carboplatin, or cetuximab) to RT. In multivariate analysis (MVA), clinically involved lymph node (cN+), age more than 60 years, the absence of OR after ICT, and performance status of at least 1 predicted for a decreased OS, with hazard ratios (HR) of 2.8, 2.2, 2.1, and 2, respectively. The 3-year actuarial locoregional control (LRC) and distant control (DC) rates were 52 and 73%, respectively. In MVA, the absence of OR after ICT (HR: 3.2), cN+ (HR: 3), and age more than 60 years (HR: 1.7) were prognostic for a lower LRC whereas cN+ (HR: 4.2) and carboplatin-based T-ICT (HR: 2.9) were prognostic for a lower DC. The number of cycles (≤ 2) received during ICT was borderline significant for DC in the MVA (P=0.08). Among patients receiving less than or equal to three cycles of ICT, higher outcomes were observed in patients who received cisplatin-based T-ICT (vs. carboplatin-based T-ICT) or subsequent CRT (vs. RT). T-ICT in our experience, followed by RT or CRT, raises several questions on the role and type of induction, and the efficacy of CRT over RT. The role of RT or CRT following induction, although feasible in these advanced patients, awaits answers from randomized trials.
Resumo:
Only few infectious mouse mammary tumor viruses (MMTV) have been characterized which induce a potent superantigen response in vivo. Here we describe the characterization of an MMTV which was isolated from milk of the highly mammary tumor-prone SHN mouse strain. Exposure of newborn mice to milk-borne MMTV (SHN) results in a very slow deletion of V beta 7, 8.1, 8.2 and 8.3 expressing peripheral T cells. Subcutaneous injection of adult mice with this virus induces a rapid and strong stimulation of all four affected V beta-subsets in vivo. Besides the strong T cell effect we observed an early proliferation and activation of the local B cell pool leading to the initial secretion of IgM followed by preferential secretion of IgG2a by day 6. Sequence comparison of the polymorphic C terminus with known open reading frames revealed high homology to the endogenous provirus Mtv-RCS. This is the first report of a virus having a complete overlap in V beta-specificity with a bacterial superantigen stimulating as many as 35% of the whole CD4+ T cell repertoire including V beta 8.2.
Resumo:
ÁBSTRACT : Mammary gland is composed of two main epithelial cell types, myoepithelial and luminal. The mechanisms involved in determination and maintenance of them remain poorly understood. Notch signaling is known to regulate cell fate determination in other tissues like skin and nervous system. It was also shown that it can act as tumor suppressor or oncogene depending on the tissue type. The mouse models overexpressing active Notch receptors indicated that Notch signaling is oncogenic in the mammary gland. This observation was followed by some descriptive and functional studies in human breast cancer and it was reported that Notch signaling activity or expression of its components are increased in some of the breast tumor samples compared to normal tissue. However, the physiological role of the Notch signaling and its downstream mechanisms in mammary gland is poorly defined. p63, a member of p53 family, has been implicated in the cell fate determination of keratinocytes. Knockout mouse models revealed that p63 is required for the formation of the mammary anlagen in embryo and its ΔN isoform is expressed exclusively in the myoepithelial layer of the adult breast. In order to understand its function in normal breast epithelial cells, I activated Notch signaling by expression of Notch1 intracellular domain (NICD) in normal primary human breast epithelial cells (HBECs). In this context, NICD reduced growth of HBECs and led to downmodulation of extracellular matrix-receptor interaction network (ECM) components as well as ΔNp63. Expression of ΔNp63 together with NICD partially rescued Notch induced growth reduction, which was correlated with an increase in ECM components. Moreover, silencing ΔNp63 in myoepithelial HBECs reduced growth similar to Notch activation and it led to downregulation of myoepithelial and upregulation of luminal markers. Complementing this observation, forced expression of ONp63 in luminal HBECs induced myoepithelial phenotype and decreased luminal markers. In vivo, by the analysis of a Notch reporter mouse strain, I showed that Notch is activated during puberty specifically at the sites of ductal morphogenesis, terminal end buds. FAGS analysis revealed that it can be detected in two different populations based on CD24 expression (low (lo) or high (high)): at lower levels in CD24lo, which includes stem/progenitor and myoepithelial cells and higher levels in CD24hi, which contains luminal cells. In parallel with in vitro results, the CD24lo mouse mammary epithelial cells displaying Notch activity have lower levels of p63 expression. Furthermore, deletion of RBPjk, the main mediator of Notch signaling, or the overexpression of ΔNp63 inhibited luminal cell lineage in vivo. Another important point revealed by Notch reporter mouse strain is the simultaneous activation of Notch with estrogen signaling during pubertal development. The expression of FOXA1, the mediator of estrogen receptor (ER) transcriptional activity, is correlated with Notch activation in vivo that it is lower in CD24lo than in CD24hi cells. Moreover, FOXA1 is regulated by NICD in vitro supporting the presence of a link between Notch and ER signaling. Taken together, I report that Notch signaling is involved in luminal cell fate determination and its effects are partially mediated through inhibition of ONp63. Besides, ΔNp63 is required for the maintenance and sufficient for the induction of myoepithelial phenotype in HBECs in vitro and is not compatible with luminal lineage in vivo. Based on these results, I propose a model for epithelial cell hierarchy in mammary gland, whereby there are two different types of luminal progenitors, early and late, displaying different levels of Notch activity. Notch signaling contributes to the determination of luminal cell lineage in these two progenitor steps: In "Early Luminal Progenitor" stage, it inhibits myoepithelial fate by decreasing p63 expression, and in "Late Luminal Progenitor" stage, Notch signaling is involved in induction of luminal lineage by acting on ER-FOXA1 axis. It has to be investigated further whether Notch signaling might behave as an oncogene or tumor suppressor depending on which cell type in the epithelial hierarchy it is modulated and which one is more likely to occur in different human breast cancer types. RÉSUMÉ : La glande mammaire est composée de deux types principaux de cellules: les cellules luminales, qui bordent le lumen et les cellules myoépithéliales, qui se trouvent entre la lame basale et les cellules luminales. Les mécanismes intervenant dans leur différenciation et leur maintenance demeurent encore mal compris. La protéine transmembranaire Notch est connue pour déterminer le destin des cellules dans plusieurs types de tissus comme la peau ou le système nerveux. Selon le type de tissu dans lequel se trouve Notch, il agira soit comme un suppresseur de tumeur soit comme un oncogène. A l'aide de modèles de souris surexprimant les récepteurs actifs de Notch, il a été démontré que la voie de signalisation de Notch est oncogénique au niveau de la glande mammaire. Des études descriptives et fonctionnelles dans le cadre du cancer du sein ont permis de mettre en évidence une augmentation de l'activité de Notch ou de l'expression de ces composants dans certains tissus cancéreux. Toutefois, le rôle physiologique de Notch et des mécanismes qu'il active restent méconnus. P63, une protéine membre de la famille p53, est impliquée dans la différenciation des kératinocytes. Le modèle issu de l'étude des souris p63 knockout a révélé que cette protéine est requise pour la formation des primordia mammaires chez l'embryon et que son isoforme ΔNp63 est exclusivement exprimée dans la couche myoépithéliale de la glande mammaire adulte. Dans le but de comprendre les fonctions physiologiques de Notch, je l'ai activé en exprimant le domaine intracellulaire de Notch 1 (NICD) dans des cellules épithéliales primaires de glande mammaire humaine (HBECs). Le NICD a alors réduit la croissance des HBECs et conduit à la régulation négative non seulement de p63 mais également des composants du réseau d'interaction des récepteurs de la matrice extracellulaire (ECM). En exprimant conjointement ΔNp63 et NICD, il est apparu que la réduction de croissance induite par Notch était partiellement compensée, et qu'il y avait également une augmentation des composants ECM. De plus, lorsque ΔNp63 a été inactivé dans les cellules HBECs myoépithéliales, une réduction de croissance cellulaire identique à celle provoquée par l'activation de Notch a pu être mise en évidence, de même qu'une régulation négative des marqueurs myoépithéliaux ainsi qu'une augmentation des marqueurs luminaux. Afin de compléter ces informations, l'expression de ΔNp63 a été forcée dans les HBECs luminales, ce qui a induit un phénotype myoépithélial et une diminution des marqueurs lumineux. In vivo, par l'analyse de souris ayant un gène rapporteur de l'activité de Notch, j'ai démontré que Notch est activé pendant la puberté au niveau des sites de la morphogenèse canalaire, à savoir les bourgeons terminaux. Les analyses par FACS (Fluorescence-activated cell sorting) basées sur l'expression de l'antigène CD24 ont révélé qu'il peut tre détecté dans deux populations différentes : une population qui l'exprime faiblement, qui regroupe les cellules souches/progéniteurs et les cellules myoépithéliales, et une population qui l'exprime fortement qui est composé des cellules luminales. Parallèlement aux résultats in vitro, j'ai mis en évidence un faible niveau d'expression de p63 dans les cellules épithéliales de la glande mammaire de souris, exprimant faiblement l'antigène CD24 et présentant une activité de Notch. De plus, la délétion de RBPjr~, médiateur principal de la signalisation de Notch, ainsi que la surexpression de ΔNp63 in vivo ont inhibé la lignée des cellules luminales. Un autre point important révélé par les souris rapporteur de l'activité de Notch a été l'activation simultanée de Notch et de la signalisation de l'oestrogène pendant le développement pubertaire. L'expression de FOXA1, médiateur de l'activité transcriptionnelle des récepteurs aux oestrogènes (ER), est en corrélation avec l'activation de Notch in vivo, plus basse dans les cellules avec une faible expression de l'antigène CD24 que dans celles avec une forte expression. De plus, FOXA1 est régulé par NICD in vitro confirmant la présence d'un lien entre Notch et la signalisation des ER. En résumé, la signalisation de Notch est impliquée dans la détermination du destin cellulaire des cellules luminales et ses effets sont partiellement modifiés par l'inhibition de ΔNp63. ΔNp63 est requis pour la maintenance et est suffisant pour l'induction du phénotype myoépithéliale dans les HBECs in vitro et ne peut donc pas se trouver dans les cellules luminales in vivo. Basé sur ces résultats, je propose un modèle de hiérarchisation des cellules épithéliales de la glande mammaire, dans lequel sont présents deux types de progéniteurs des cellules luminales exprimant des niveaux différents d'activité de Notch, les progéniteurs lumineux précoces et tardifs. La signalisation de Notch contribue à la différenciation de la lignée cellulaire luminale au niveau de ces deux progéniteurs : dans la forme précoce, il inhibe la différenciation des cellules myoépithéliales en réduisant l'expression de p63 et dans la forme tardive, Notch est impliqué dans l'induction de la lignée luminale en agissant sur l'axe ER-FOXA1. Il serait nécessaire d'investiguer plus loin si le fait que Notch agisse comme oncogène ou suppresseur de tumeur dépend du stade de différenciation de la cellule dans laquelle il est modulé et laquelle de ces deux fonctions il est le plus probable de rencontrer dans les différents types de cancer du sein.
Resumo:
Squamous cell carcinoma of the head and neck (SCCHN) is a common disease that develops in the upper aerodigestive epithelium. The most important risk factors are tobacco and alcohol consumption. There is also increasing evidence that human papillomavirus plays an important role in the cause of SCCHN. The complex anatomy, the vital functions of the upper aerodigestive tract and the close proximity to vital structures, explain that the goal of treatment is not only to improve survival outcomes, but also to preserve organ function. Radiotherapy and surgery are the standard modalities of treatment, reflecting the locoregional predominance of SCCHN. Chemotherapy plays an important role in the treatment of patients with locoregionally advanced disease, in conjunction with radiotherapy and surgery. Indeed, standard therapy for resectable locoregionally advanced (stage III or IV) SCCHN cancers consists either of surgery and adjuvant chemoradiotherapy or definitive concomitant chemoradiotherapy, depending upon disease site, stage and resectability of the tumour, or institutional experience. Concomitant chemoradiotherapy has been shown in several randomised trials to improve disease-free and overall survival in the postoperative setting for resected disease with poor prognostic factors. Furthermore, multiple randomised studies and meta-analyses have shown that definitive chemoradiotherapy, as well anti-epidermal growth factor receptor treatment in one randomised study, improved disease-free and overall survival when compared with radiotherapy alone. This overview reviews the most relevant published studies on the multidisciplinary management of SCCHN and discusses future strategies to reduce locoregional failures.
Resumo:
The superantigen (SAg) expressed by mouse mammary tumor virus (MMTV) has been shown to play an essential role in the course of the viral life cycle. In the present study, we describe a V beta 4-specific SAg encoded by a new exogenous MMTV carried by the SIM mouse strain. This is the first report of a viral or bacterial SAg reacting with mouse V beta 4+ T cells. Injection of MMTV(SIM) into adult BALB/c mice leads to a rapid and strong stimulation of V beta 4+ CD4+ T cells, followed by a slow deletion of these cells. Neonatal exposure to the virus also leads to a progressive deletion of V beta 4+ T cells. In contrast to other strong MMTV SAg, this new SAg requires the presence of major histocompatibility complex class II I-E molecules to be presented efficiently to T cells. Sequence analysis revealed a new predicted amino acid sequence in the C-terminal polymorphic region of this SAg. Furthermore, sequence comparisons to the most closely related SAg with different V beta specificities hint at the specific residues involved in the interaction with the T cell receptor.
Resumo:
BACKGROUND/AIMS: Neonatal thymectomy induces autoimmune gastritis in BALB/c (minor lymphocyte-stimulating antigen [Mls]-1b) mice, whereas DBA/2 (Mls-1a) mice are resistant. Resistance has been linked to the Mls-1a locus, which encodes a retroviral superantigen, and to superantigen reactive T cells that express V beta 6+ T-cell receptors. V beta 6+ T cells are known to be deleted in mice expressing Mls-1a superantigens. METHODS: Neonatal thymectomized BALB/c and Mls-1a congenic BALB.D2.Mls-1a mice were analyzed to examine directly the role of Mls-1a self-superantigens and V beta 6+ T cells in autoimmune gastritis. RESULTS: Autoimmune gastritis was detected in thymectomized BALB.D2.Mls-1a mice with high incidence. Autoantibodies to the gastric H+,K(+)-adenosine triphosphatase were present independent of the Mls phenotype in sera of gastritic mice. Severe gastritis had already appeared 1 month after thymectomy in BALB.D2.Mls-1a mice. V beta 6+ T cells were deleted in the stomach lymph nodes of 1-month-old gastritic BALB.D2.Mls-1a mice but could be detected by immunocytochemistry in the stomach lesions. CONCLUSIONS: Endogenous Mls-1a self-superantigens and Mls-1a reactive V beta 6+ T cells are not involved in resistance to autoimmune gastritis in BALB.D2 mice.
Resumo:
Wnt and Notch signaling have long been established as strongly oncogenic in the mouse mammary gland. Aberrant expression of several Wnts and other components of this pathway in human breast carcinomas has been reported, but evidence for a causative role in the human disease has been missing. Here we report that increased Wnt signaling, as achieved by ectopic expression of Wnt-1, triggers the DNA damage response (DDR) and an ensuing cascade of events resulting in tumorigenic conversion of primary human mammary epithelial cells. Wnt-1-transformed cells have high telomerase activity and compromised p53 and Rb function, grow as spheres in suspension, and in mice form tumors that closely resemble medullary carcinomas of the breast. Notch signaling is up-regulated through a mechanism involving increased expression of the Notch ligands Dll1, Dll3, and Dll4 and is required for expression of the tumorigenic phenotype. Increased Notch signaling in primary human mammary epithelial cells is sufficient to reproduce some aspects of Wnt-induced transformation. The relevance of these findings for human breast cancer is supported by the fact that expression of Wnt-1 and Wnt-4 and of established Wnt target genes, such as Axin-2 and Lef-1, as well as the Notch ligands, such as Dll3 and Dll4, is up-regulated in human breast carcinomas.
Resumo:
Murine T cell reactivity with products of the minor lymphocyte stimulatory (Mls) locus correlates with the expression of particular variable (V) domains of the T cell receptor (TCR) beta chain. It was recently demonstrated that Mls antigens are encoded by an open reading frame (ORF) in the 3' long terminal repeat of either endogenous or exogenous mouse mammary tumor virus (MMTV). Immature thymocytes expressing reactive TCR-V beta domains are clonally deleted upon exposure to endogenous Mtv's. Mature T cells proliferate vigorously in response to Mls-1a (Mtv-7) in vivo, but induction of specific anergy and deletion after exposure to Mtv-7-expressing cells in the periphery has also been described. We show here that B cells and CD8+ (but not CD4+) T cells from Mtv-7+ mice efficiently induce peripheral deletion of reactive T cells upon transfer to Mtv-7- recipients, whereas only B cells stimulate specific T cell proliferation in vivo. In contrast to endogenous Mtv-7, transfer of B, CD4+, or CD8+ lymphocyte subsets from mice maternally infected with MMTV(SW), an infectious homologue of Mtv-7, results in specific T cell deletion in the absence of a detectable proliferative response. Finally, we show by secondary transfers of infected cells that exogenous MMTV(SW) is transmitted multidirectionally between lymphocyte subsets and ultimately to the mammary gland. Collectively our data demonstrate heterogeneity in the expression and/or presentation of endogenous and exogenous MMTV ORF by lymphocyte subsets and emphasize the low threshold required for induction of peripheral T cell deletion by these gene products.
Resumo:
Despite advances in surgery, radio- and chemotherapy, therapeutic approaches for patients with head and neck squamous carcinoma (HNSCC) need to be improved. Immunotherapies eliciting tumor specific immune responses might constitute novel treatment options. We therefore investigated the expression and immunogenicity of two tumor-associated antigens (TAA) the receptor for hyaluronic acid mediated motility (RHAMM) and carboanhydrase IX (G250/CAIX) in HNSCC patients. Twenty-two HNSCC samples were examined for the expression of RHAMM and G250 by Western blotting and immunohistochemistry, 14/22 samples were tested for HLA-A2 expression by flow cytometry. For 8/22 samples single tumor-cell suspensions were generated, and mixed lymphocyte peptide cultures (MLPC) were performed to evaluate the frequencies of cytotoxic T cells specifically recognizing RHAMM and G250 using Tetramer staining/multi-color flow cytometry and enzyme linked immunosorbent spot (ELISPOT) assays. RHAMM and G250 were expressed in 73 and 80% of the HNSCC samples at the protein level. A co-expression of both TAAs could be detected in 60% of the patients. In 4/8 HLA-A2+ patients, 0.06-0.13% of CD8+ effector T cells recognized Tetramers for RHAMM or G250 and secreted IFNgamma and granzyme B in ELISPOT assays. RHAMM and G250 are expressed at high frequency and high protein level in HNSCCs and are recognized by cytotoxic CD8+ effector T cells. Therefore both TAAs constitute interesting targets for T cell based immunotherapies for HNSCC.