Chemotherapy in Head and Neck Squamous Cell Cancer

Systemic therapy for head and neck squamous cell carcinoma: Historical perspectives and recent breakthroughs

“…Soon after World War II, Sidney Farber at Children's Hospital in Boston demonstrated the utility of folic acid derivatives in leukemia. These antimetabolites, a class of therapies inhibiting tumor growth through the metabolic inhibition of DNA synthesis, later served as the basis for the first HNSCC chemotherapies . In 1959, intra‐arterial methotrexate administration (regional chemotherapy) was described for several malignancies, suggesting this approach had greater impact than systemic injection.…”

“…Later, data showing that taxanes were potentially effective agents brought renewed interest to induction chemotherapy . In 2007, studies by the TAX‐323 and TAX‐324 groups were published simultaneously, comparing induction with docetaxel/5‐FU/cisplatin (TPF) versus cisplatin/5‐FU alone followed by radiotherapy alone (TAX‐323) or concurrent chemoradiation (TAX‐324) in unresectable patients and organ preservation candidates .…”

“…In 1996, the European Organization for Research and Treatment of Cancer (EORTC) evaluated the role of adjuvant chemoradiation in locally advanced HNSCC. Patients with high‐risk features (positive lymph nodes, positive margins, extracapsular spread [ECS], perineural/vascular invasion) received postoperative concurrent chemoradiation, improving 5‐year survival by 13% . Eight years later, the RTOG 9501 phase III trial demonstrated improved locoregional control with the addition of chemotherapy in high‐risk patients .…”

“…These antimetabolites, a class of therapies inhibiting tumor growth through the metabolic inhibition of DNA synthesis, later served as the basis for the first HNSCC chemotherapies. 2 In 1959, intra-arterial methotrexate administration (regional chemotherapy) was described for several malignancies, suggesting this approach had greater impact than systemic injection. In 1962, Espiner and colleagues used intraarterial methotrexate for 27 cases of advanced HNSCC 3 ; four patients experienced total regression, and partial responses were observed in others.…”

“…Later, data showing that taxanes were potentially effective agents brought renewed interest to induction chemotherapy. 2 In 2007, studies by the TAX-323 and TAX-324 groups were published simultaneously, comparing induction with docetaxel/5-FU/cisplatin (TPF) versus cisplatin/5-FU alone followed by radiotherapy alone (TAX-323) or concurrent chemoradiation (TAX-324) in unresectable patients and organ preservation candidates. 14,15 The addition of docetaxel improved disease-free survival and overall survival in both trials, and these data led to the FDA approval of docetaxel in induction regimens in unresectable, locoregionally advanced HNSCC in 2006.…”