[Palliative chemotherapy of head and neck cancer: present status and future development].
BACKGROUND
Patients with head and neck tumors are treated with palliative chemotherapy in case of the detection of distant metastases or local recurrence without the option of surgical therapy or radiation. Alongside 5-fluorouracil (5-FU) in combination with cisplatin or carboplatin, taxanes, gemcitabine and vinorelbine as well as monoclonal antibodies or small molecule tyrosine kinase inhibitors have been used.


METHODS
This review analyses the published literature of the past 15 years, including selected abstracts with view to response rate, overall survival and adverse effects.


RESULTS
5-FU plus cisplatin or carboplatin can still be considered as standard treatment, achieving response rates of 20-30 %. The addition of taxanes increases the objective response rate but adds remarkable toxicity to the treatment protocol. Phase III studies demonstrate higher response rates but fail to demonstrate a significant increase of the overall survival after polychemotherapy as compared to monotherapy protocols. Thus, patients with a reduced performance can be treated with monotherapy. In case of disease progression after cisplatin-containing chemotherapy further treatment should only be offered to selected patients. For this situation, platin-free chemotherapy protocols containing taxanes, gemcitabine or vinorelbine seem promising. Recent studies with monoclonal antibodies or small molecule tyrosine kinase inhibitors report on a response rate of 10-20 %.


CONCLUSIONS
The use of new drugs increases the response rate and amends the side effects of the chemotherapy. However, phase III studies documenting an improved overall survival are lacking. Targeted therapies broaden the therapeutic armament, and possibly, EGFR inhibition will help to overcome chemotherapy resistance in the future.
Abteilung für Hämatologie und Onkoloie, Universitätsklinikum Regensburg. burkhard.hennemann@klinik.uni-regensburg.de
B
B
Hennemann
D000818:Animals; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D018450:Disease Progression; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D005544:Forecasting; D000077156:Gefitinib; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D010166:Palliative Care; D018579:Patient Selection; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011799:Quinazolines / Q000008:administration & dosage / Q000627:therapeutic use; D051381:Rats; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077235:Vinorelbine; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D043823:Taxoids; D003841:Deoxycytidine; D014747:Vinblastine; D066246:ErbB Receptors; D011505:Protein-Tyrosine Kinases; D002945:Cisplatin; D000077235:Vinorelbine; D000077156:Gefitinib; D000093542:Gemcitabine