ReviewCurrent concepts for the management of head and neck cancer: Chemotherapy
Introduction
The role of chemotherapy is slowly moving towards a more prominent position within the different treatment paradigms in patients with squamous cell carcinoma of the head and neck (SCCHN). This is particularly true for the locoregionally advanced (LA) disease condition in which chemotherapy may be given either concurrently with irradiation (as definitive treatment or postoperatively) or before (induction) or after (adjuvant) locoregional treatment as a single modality. However, also at last in the recurrent/metastatic setting results are changing with the introduction and integration of molecular targeting therapies.1, 2
Section snippets
Locoregionally advanced squamous cell carcinoma of the head and neck
Two-thirds of the SCCHN are in a LA stage at time of diagnosis. Treatment paradigms in that setting include various forms of curative combined modality therapies, including concurrent chemoradiation (or biochemoradiation), induction chemotherapy followed by irradiation and sequential therapy (induction chemotherapy followed by concurrent chemoradiation). The role of bio(chemo)radiation will be discussed in the separate chapter on targeted therapies in this issue.
Recurrent disease
While the vast majority of the patients presenting with stage I and II SCCHN will remain disease free after surgery and/or radiotherapy, the majority of patients presenting in a more advanced disease stage will eventually relapse either locoregionally and/or at distant sites. A few patients with a locoregional recurrence can be salvaged by surgery or reirradiation. However, most patients with recurrent or metastatic disease only qualify for palliative treatment. Treatment options in these
Combination of chemotherapy with targeted therapies
Targeted therapies are discussed in a separate chapter in this issue. The most promising data on targeted therapies in SCCHN have been observed with the anti-EGFR monoclonal antibodies. The combined use of chemotherapy and anti-EGFR antibodies is strongly supported by preclinical data,82 and recently, by randomized phase III studies in the recurrent/metastatic disease setting.83, 84, 85, 86 In the EXTREME study,84, 85, 86 442 patients were randomized to receive either chemotherapy alone
Conclusions
We conclude that cisplatin-based chemoradiation is still the standard approach for the treatment of LA–SCCHN. TPF has emerged as the new standard regimen when induction chemotherapy is appropriate. Areas of active investigation in LA–SCCHN are the sequential administration of induction chemotherapy followed by chemoradiation and the integration of targeted therapies. None of the combination chemotherapy regimens demonstrated an overall survival benefit when compared to single agent
Conflict of interest statement
None declared.
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