Recurrent head and neck cancer: current treatment and future prospects.
Recurrent and metastatic squamous cell carcinoma of the head and neck still carries a poor prognosis. Response rates with combination chemotherapy regimens are generally higher than those observed with single-agent chemotherapy. However, this did not translate into an overall survival benefit, not in even a single randomized trial. As none of the combination chemotherapy regimens demonstrated an overall survival benefit when compared with single-agent methotrexate, cisplatin or 5-fluorouracil, the use of combination chemotherapy outside clinical trials is usually restricted to younger patients with a good performance status and with symptomatic disease who require prompt symptom relief. After decades without real progress, a recent randomized trial showed that adding cetuximab, the first clinically available EGF receptor-directed monoclonal antibody, to a standard chemotherapy regimen (platinum/5-fluorouracil), led to an important survival benefit. In addition, the response rate nearly doubled with this approach, which has great promise for the treatment of symptomatic disease. There is now a plethora of targeted therapies in various stages of preclinical and clinical development. The next challenge will be to sort out which of them have a clinically meaningful activity and find out how to incorporate them into existing treatment regimens.
Specenier
Pol M
PM
Department of Medical Oncology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium. pol.specenier@uza.be
Vermorken
Jan B
JB
D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy*; D000068818:Cetuximab; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005472:Fluorouracil / Q000008:administration & dosage; D005544:Forecasting; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D016879:Salvage Therapy
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068818:Cetuximab; D002945:Cisplatin; D005472:Fluorouracil; D008727:Methotrexate