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In Reply

Emory Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA

We agree with Dr Bossi et al with regard to their comments about the potential utility of chemoprevention strategies in head and neck cancer, more specifically, with folate. In this regard, we would like to remind them, and other readers, that our editorial on chemoprevention approaches to head and neck cancer was, in addition to the commentary on the article establishing the prognostic significance of podoplanin¹ in head and neck cancer, intended to delineate potential approaches to such chemoprevention approaches in general.² Editorials, unlike comprehensive reviews, are constructed to provoke thought and place data in their proper perspective. They are not intended as a comprehensive summary of all such data.

We have clearly noted that folate deficiency, due to either low intake or polymorphisms in enzyme metabolizing the genes, have been linked to a higher risk of developing head and neck cancer. Epidemiologic studies have stressed the importance of a folate-rich diet that can prevent cancer. We also agree that supplemental folate inhibits the proliferation of colon cancer cell lines with a concurrent reduction of epidermal growth factor receptor (EGFR) tyrosine kinase and its ligands EGF or transforming growth factor-. We further support the opinion that folate supplementation in EGFR-dependent tumors, such as head and neck cancer, deserves further investigation. In fact, our own studies³ regarding the expression rate of folic acid receptor in squamous cell carcinoma of the head and neck shows that at least 50% of the examined tumors (103 tumor samples) expressed folic acid receptor. As a result, folate is certainly a promising natural compound to incorporate in future chemoprevention studies particularly for head and neck cancer and other tumor types.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Although all authors completed the disclosure declaration, the following author(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a "U" are those for which no compensation was received; those relationships marked with a "C" were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.

Employment or Leadership Position: None Consultant or Advisory Role: Dong M. Shin, Eli Lilly (C) Stock Ownership: None Honoraria: Fadlo R. Khuri, Sanofi-aventis, Novartis, Genentech; Dong M. Shin, Bristol-Meyers Squibb Co, Sanofi-aventis Research Funding: Fadlo R. Khuri, Sanofi-aventis, Novartis, Genentech; Dong M. Shin, Domantis Ltd Expert Testimony: None Other Remuneration: None

REFERENCES

1. Kawaguchi H, El-Naggar AK, Papadimitrakopoulou V, et al: Podoplanin: A novel marker for oral cancer risk in patients with oral premalignancy. J Clin Oncol 26:354-360, 2008[Abstract/Free Full Text]

2. Khuri FR, Shin DM: Head and neck cancer chemoprevention gets a shot in the arm. J Clin Oncol 26:345-347, 2008[Free Full Text]

3. Saba NF, Wang X, Tighiouart M, et al: Examining expression of folate receptors in squamous cell carcinoma of the head and neck (SCCHN) as a target for novel nanotherapeutic drug. Proc Am Assoc Cancer Res 48:2007 (abstr LB-174)

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Related Correspondence

• Folate in Head and Neck Squamous Cell Cancer Chemoprevention: Purposely Left Out?
  Paolo Bossi, Laura D. Locati, Lisa Licitra, and Elda Tagliabue
  JCO 2008 26: 3463 [Full Text]

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