Systemic Therapy in Head and Neck Cancer: Changing Paradigm

Abstract

Head and neck cancers comprise a heterogenous group of cancers that require a multidisciplinary approach. Last few decades have seen an increasing role of chemotherapy with intent of treatment shifting from palliation to cure. We performed a thorough search online and offline for all relevant articles of chemotherapy in head and neck cancer. Cancers of nasopharynx and salivary glands were excluded.

Recent Progress in Therapeutic Treatments and Screening Strategies for the Prevention and Treatment of HPV-Associated Head and Neck Cancer

“…Head and neck cancer is classified into the following categories: early-stage or stage I/II, locally advanced or stage III/IV, and recurrent or metastatic phase [ 67 ]. Early stages of head and neck cancer are usually treated with a single-modality treatment, such as radiotherapy or surgical resection [ 4 , 12 , 13 , 15 , 68 ]. A combination of multiple therapies for superior oncologic results are required for the management of advanced stages III/IV [ 4 , 61 , 67 ]; for example, surgery with adjuvant radiation or chemoradiation with chemotherapy being added for high risk pathologic features found from the surgical specimen [ 2 , 14 , 35 , 69 , 70 ], or radiotherapy with concomitant chemotherapy [ 14 , 64 , 71 , 72 , 73 ].…”

“…A combination of multiple therapies for superior oncologic results are required for the management of advanced stages III/IV [ 4 , 61 , 67 ]; for example, surgery with adjuvant radiation or chemoradiation with chemotherapy being added for high risk pathologic features found from the surgical specimen [ 2 , 14 , 35 , 69 , 70 ], or radiotherapy with concomitant chemotherapy [ 14 , 64 , 71 , 72 , 73 ]. Therefore, patients with advanced stages of head and neck cancer are treated through a multidisciplinary and multimodal treatment approach [ 50 , 67 , 68 , 74 ].…”

“…We have come a long way in understanding the molecular biology of head and neck cancer over the past few decades [ 68 ]. Interestingly, the EGFR has been shown to be frequently elevated in over 90% of HNSCC patients [ 2 , 4 , 67 , 71 , 88 , 150 ].…”

Emerging drugs for head and neck cancer

“…CT is an integral part from palliative care to an important component of curative treatment for LA-HNSCC and is often administered concurrently with RT (known as concurrent chemoradiotherapy [CRT]) or before RT (known as induction CT) [7]. The platinum compounds cisplatin and carboplatin are regarded as standard agents in combination with RT or with other agents.…”

“…Docetaxel is a second-generation taxane that displays potent and broad antineoplastic properties, however, with a similar RR of 20 – 42% as single agent in recurrent/metastasis (R/M) HNSCC [6]. Other agents, including methotrexate, 5-FU and bleomycin are associated with overall responses ranging from 20 to 40% [7]. The combination of cisplatin and 5-FU (PF regimen) is widely used [8].…”